forgot to add partial template

common/templates/course_modes/_contribution.html

+          <dl>
+            <dt>
+              Select your contribution for this course:
+            </dt>
+            <dd>
+              <ul class="pay-options">
+                % for price in suggested_prices:
+                <li>
+                  <input type="radio" name="contribution" value="${price|h}" selected="${'selected' if price == chosen_price else ''}"><label for="contribution-${price|h}">$${price} ${currency}</label>
+                </li>
+                % endfor
+
+                <li class="other1">
+                  <input type="radio" id="contribution-other" name="contribution" value=""/>
+                  <label for=" contribution-other"><span class="sr">Other</span></label>
+                </li>
+                <li class="other2">
+                  <label for="contribution-other-amt"><span class="sr">Other Amount</span> </label>$<input type="text" size="5" name="contribution-other-amt" id="contribution-other-amt" />
+                </li>
+              </ul>
+            </dd>
+          </dl>
+