{"id":1108,"date":"2019-01-06T22:48:33","date_gmt":"2019-01-07T03:48:33","guid":{"rendered":"https:\/\/cci4asl.com\/home\/?page_id=1108"},"modified":"2023-12-22T14:37:24","modified_gmt":"2023-12-22T19:37:24","slug":"interpreter-registration","status":"publish","type":"page","link":"https:\/\/cci4asl.com\/home\/interpreter-registration\/","title":{"rendered":"Interpreter Registration"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"1108\" class=\"elementor elementor-1108\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fdd1d19 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fdd1d19\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b2d8af0\" data-id=\"b2d8af0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e533215 elementor-widget elementor-widget-shortcode\" data-id=\"e533215\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-2865\"><form id=\"wpforms-form-2865\" class=\"wpforms-validate wpforms-form\" data-formid=\"2865\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/home\/wp-json\/wp\/v2\/pages\/1108?wpforms_form_id=2865\" data-token=\"2c4f4272376cbac2e3ac8b30c1040152\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator circles\" data-indicator=\"circles\" data-indicator-color=\"#9c2b21\" data-scroll=\"1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#9c2b21\">1<\/span><span class=\"wpforms-page-indicator-page-title\">Contact Information<span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\"><span class=\"wpforms-page-indicator-page-number\">2<\/span><span class=\"wpforms-page-indicator-page-title\">Establish Rates<span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\"><span class=\"wpforms-page-indicator-page-number\">3<\/span><span class=\"wpforms-page-indicator-page-title\">Documentation<span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\"><span class=\"wpforms-page-indicator-page-number\">4<\/span><span class=\"wpforms-page-indicator-page-title\">Preferences and Conflicts of Interests<span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-2865-field_13-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"13\"><\/div><div id=\"wpforms-2865-field_206-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"206\"><div id=\"wpforms-2865-field_206\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Welcome to CCI's Interpreter registration<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_273-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"273\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_273\">What do you need to do today?<\/label><ul id=\"wpforms-2865-field_273\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_1\" name=\"wpforms[fields][273]\" value=\"First time registration\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_1\">First time registration<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_2\" name=\"wpforms[fields][273]\" value=\"Update all or multiple aspects of previous registration\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_2\">Update all or multiple aspects of previous registration<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_3\" name=\"wpforms[fields][273]\" value=\"Update rates only\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_3\">Update rates only<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_4\" name=\"wpforms[fields][273]\" value=\"Update records only (certification, resume, insurance, etc)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_4\">Update records only (certification, resume, insurance, etc)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_5\" name=\"wpforms[fields][273]\" value=\"Update preferences\/conflicts of interest only\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_5\">Update preferences\/conflicts of interest only<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_273_7\" name=\"wpforms[fields][273]\" value=\"Update contact information only\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_273_7\">Update contact information only<\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_208-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"208\"><\/div><div id=\"wpforms-2865-field_207-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"207\" style=\"display:none;\"><div id=\"wpforms-2865-field_207\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 22px;\">Great! Let's get started.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_209-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"209\"><\/div><div id=\"wpforms-2865-field_134-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"134\" style=\"display:none;\"><div id=\"wpforms-2865-field_134\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Contact Information<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_138-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"138\"><\/div><div id=\"wpforms-2865-field_31-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"31\"><\/div><div id=\"wpforms-2865-field_1-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"1\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_1\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2865-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-2865-field_2-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"2\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_2\">Name of Business<\/label><input type=\"text\" id=\"wpforms-2865-field_2\" class=\"wpforms-field-large\" name=\"wpforms[fields][2]\" ><div class=\"wpforms-field-description\">if applicable<\/div><\/div><div id=\"wpforms-2865-field_3-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"3\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_3\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2865-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-2865-field_4-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"4\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_4\">Mobile Phone<\/label><input type=\"tel\" id=\"wpforms-2865-field_4\" class=\"wpforms-field-large wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" ><\/div><div id=\"wpforms-2865-field_7-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_7\">Address<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2865-field_7\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][7][address1]\" ><label for=\"wpforms-2865-field_7\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-2865-field_7-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][7][address2]\" ><label for=\"wpforms-2865-field_7-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2865-field_7-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][7][city]\" ><label for=\"wpforms-2865-field_7-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2865-field_7-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][7][state]\" ><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2865-field_7-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2865-field_7-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][7][postal]\" ><label for=\"wpforms-2865-field_7-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-2865-field_32-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_32\">Preferred contact method to offer assignments<\/label><ul id=\"wpforms-2865-field_32\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_32_1\" name=\"wpforms[fields][32]\" value=\"Text message\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_32_1\">Text message<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_32_2\" name=\"wpforms[fields][32]\" value=\"Call mobile\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_32_2\">Call mobile<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_32_3\" name=\"wpforms[fields][32]\" value=\"Email\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_32_3\">Email<\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_35-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"35\"><\/div><div id=\"wpforms-2865-field_12-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"12\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"2865\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-2865-field_60-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"60\" style=\"display:none;\"><div id=\"wpforms-2865-field_60\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Establish Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_215-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"215\" style=\"display:none;\"><div id=\"wpforms-2865-field_215\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 20px;\">You indicated that you do not need to update your rates at this time. Please click \"next\" to continue.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_139-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"139\"><\/div><div id=\"wpforms-2865-field_127-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"127\" style=\"display:none;\"><div id=\"wpforms-2865-field_127\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\">Select the region(s) below where you would like establish rates.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_140-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"140\"><\/div><div id=\"wpforms-2865-field_9-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"9\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_9\">(selecting &quot;Florida&quot; indicates one rate statewide)<\/label><ul id=\"wpforms-2865-field_9\" class=\"wpforms-image-choices wpforms-image-choices-none\"><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/Florida-e1593807053402.png\" alt=\"All of Florida\" title=\"All of Florida\"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_6\" name=\"wpforms[fields][9][]\" value=\"All of Florida\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">All of Florida<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/Northwest-Florida--e1593655367522.png\" alt=\"Northwest Florida\" title=\"Northwest Florida\"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_5\" name=\"wpforms[fields][9][]\" value=\"Northwest Florida\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Northwest Florida<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/Northeast-Fla--e1593655415158.png\" alt=\"Northeast Florida\" title=\"Northeast Florida\"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Northeast Florida\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Northeast Florida<\/span><\/label><\/li><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/Central-FL-v2-e1593807006362.png\" alt=\"West-Central Florida \" title=\"West-Central Florida \"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_1\" name=\"wpforms[fields][9][]\" value=\"West-Central Florida \" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">West-Central Florida <\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/Central-FL-1-e1593806973359.png\" alt=\"East-Central Florida \" title=\"East-Central Florida \"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_3\" name=\"wpforms[fields][9][]\" value=\"East-Central Florida \" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">East-Central Florida <\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2020\/07\/South-FLa--e1593806941481.png\" alt=\"South Florida\" title=\"South Florida\"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_4\" name=\"wpforms[fields][9][]\" value=\"South Florida\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">South Florida<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_9_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><img decoding=\"async\" src=\"https:\/\/cci4asl.com\/home\/wp-content\/uploads\/2022\/06\/Operator3.png\" alt=\"Remote\" title=\"Remote\"><\/span><br><input type=\"checkbox\" id=\"wpforms-2865-field_9_7\" name=\"wpforms[fields][9][]\" value=\"Remote\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Remote<\/span><\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_54-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"54\"><\/div><div id=\"wpforms-2865-field_261-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"261\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_261\">Language(s) in which you are fluent and qualified to interpret between <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2865-field_261\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][261]\" required><div class=\"wpforms-field-description\">Spoken language interpreters that are fluent in more than two languages and have varying rates for each language will need to return to the interpreter registration page and choose \"Updates Rates Only\" for each additional language.<\/div><\/div><div id=\"wpforms-2865-field_126-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"126\"><\/div><div id=\"wpforms-2865-field_124-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><div id=\"wpforms-2865-field_124\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\">What time does your \"day\" time rates begin and end?<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table>\r\n<\/div><\/div><div id=\"wpforms-2865-field_38-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-fourth wpforms-firstwpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_38\">Start at<\/label><input type=\"text\" id=\"wpforms-2865-field_38-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-large\" data-time-format=\"g:i A\" data-step=\"60\" data-rule-time12h=\"true\" name=\"wpforms[fields][38][time]\" ><\/div><div id=\"wpforms-2865-field_39-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-fourthwpforms-one-fourth wpforms-first wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"39\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_39\">End at<\/label><input type=\"text\" id=\"wpforms-2865-field_39-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-large\" data-time-format=\"g:i A\" data-step=\"60\" data-rule-time12h=\"true\" name=\"wpforms[fields][39][time]\" ><\/div><div id=\"wpforms-2865-field_266-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-firstwpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"266\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_266\">Minimum billable time<\/label><input type=\"text\" id=\"wpforms-2865-field_266\" class=\"wpforms-field-large\" name=\"wpforms[fields][266]\" ><\/div><div id=\"wpforms-2865-field_270-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourthwpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"270\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_270\">Billable increments<\/label><input type=\"text\" id=\"wpforms-2865-field_270\" class=\"wpforms-field-large\" name=\"wpforms[fields][270]\" ><\/div><div id=\"wpforms-2865-field_268-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds wpforms-firstwpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"268\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_268\">Cancelation terms<\/label><input type=\"text\" id=\"wpforms-2865-field_268\" class=\"wpforms-field-large\" name=\"wpforms[fields][268]\" ><\/div><div id=\"wpforms-2865-field_125-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"125\"><\/div><div id=\"wpforms-2865-field_56-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"56\" style=\"display:none;\"><div id=\"wpforms-2865-field_56\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_149-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"149\" style=\"display:none;\"><div id=\"wpforms-2865-field_149\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_46-container\" class=\"wpforms-field wpforms-field-divider wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"46\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_141-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"141\"><\/div><div id=\"wpforms-2865-field_41-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"41\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_41\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_41\" class=\"wpforms-field-large\" name=\"wpforms[fields][41]\" ><\/div><div id=\"wpforms-2865-field_42-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"42\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_42\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_42\" class=\"wpforms-field-large\" name=\"wpforms[fields][42]\" ><\/div><div id=\"wpforms-2865-field_48-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"48\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_48\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_48\" class=\"wpforms-field-large\" name=\"wpforms[fields][48]\" ><\/div><div id=\"wpforms-2865-field_44-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_44\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_44\" class=\"wpforms-field-large\" name=\"wpforms[fields][44]\" ><\/div><div id=\"wpforms-2865-field_228-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"228\" style=\"display:none;\"><div id=\"wpforms-2865-field_228\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_229-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"229\"><\/div><div id=\"wpforms-2865-field_47-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"47\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_47\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_47\" class=\"wpforms-field-large\" name=\"wpforms[fields][47]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_43-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_43\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_43\" class=\"wpforms-field-large\" name=\"wpforms[fields][43]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_50-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"50\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_50\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_50\" class=\"wpforms-field-large\" name=\"wpforms[fields][50]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_49-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"49\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_49\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_49\" class=\"wpforms-field-large\" name=\"wpforms[fields][49]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_51-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"51\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_51\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_51\" class=\"wpforms-field-large\" name=\"wpforms[fields][51]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_52-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_52\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_52\" class=\"wpforms-field-large\" name=\"wpforms[fields][52]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_242-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"242\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_242\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_242\" class=\"wpforms-field-large\" name=\"wpforms[fields][242]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_222-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"222\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_222\">Areas available to interpret<\/label><input type=\"text\" id=\"wpforms-2865-field_222\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"222\" data-text-limit=\"20\" name=\"wpforms[fields][222]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_64-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"64\"><\/div><div id=\"wpforms-2865-field_75-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"75\" style=\"display:none;\"><div id=\"wpforms-2865-field_75\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Northwest Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_150-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"150\" style=\"display:none;\"><div id=\"wpforms-2865-field_150\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_142-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"142\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_65-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"65\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_65\">Weekday (day) <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_65\" class=\"wpforms-field-large\" name=\"wpforms[fields][65]\" ><\/div><div id=\"wpforms-2865-field_68-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"68\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_68\">Weekday (night) <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_68\" class=\"wpforms-field-large\" name=\"wpforms[fields][68]\" ><\/div><div id=\"wpforms-2865-field_71-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"71\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_71\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_71\" class=\"wpforms-field-large\" name=\"wpforms[fields][71]\" ><\/div><div id=\"wpforms-2865-field_73-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_73\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_73\" class=\"wpforms-field-large\" name=\"wpforms[fields][73]\" ><\/div><div id=\"wpforms-2865-field_230-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"230\" style=\"display:none;\"><div id=\"wpforms-2865-field_230\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_231-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"231\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_66-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"66\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_66\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_66\" class=\"wpforms-field-large\" name=\"wpforms[fields][66]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_69-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"69\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_69\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_69\" class=\"wpforms-field-large\" name=\"wpforms[fields][69]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_74-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"74\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_74\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_74\" class=\"wpforms-field-large\" name=\"wpforms[fields][74]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_72-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"72\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_72\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_72\" class=\"wpforms-field-large\" name=\"wpforms[fields][72]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_67-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"67\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_67\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_67\" class=\"wpforms-field-large\" name=\"wpforms[fields][67]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_70-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"70\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_70\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_70\" class=\"wpforms-field-large\" name=\"wpforms[fields][70]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_243-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"243\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_243\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_243\" class=\"wpforms-field-large\" name=\"wpforms[fields][243]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_223-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"223\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_223\">NW areas available to interpret <\/label><input type=\"text\" id=\"wpforms-2865-field_223\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"223\" data-text-limit=\"20\" name=\"wpforms[fields][223]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_85-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"85\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_98-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"98\" style=\"display:none;\"><div id=\"wpforms-2865-field_98\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Northeast Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_151-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"151\" style=\"display:none;\"><div id=\"wpforms-2865-field_151\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_143-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"143\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_76-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_76\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" ><\/div><div id=\"wpforms-2865-field_78-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"78\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_78\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" ><\/div><div id=\"wpforms-2865-field_81-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"81\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_81\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_81\" class=\"wpforms-field-large\" name=\"wpforms[fields][81]\" ><\/div><div id=\"wpforms-2865-field_83-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"83\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_83\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" ><\/div><div id=\"wpforms-2865-field_234-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"234\" style=\"display:none;\"><div id=\"wpforms-2865-field_234\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_232-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"232\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_77-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_77\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_77\" class=\"wpforms-field-large\" name=\"wpforms[fields][77]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_79-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"79\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_79\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_79\" class=\"wpforms-field-large\" name=\"wpforms[fields][79]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_84-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"84\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_84\">Legal <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_82-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"82\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_82\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_86-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"86\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_86\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_86\" class=\"wpforms-field-large\" name=\"wpforms[fields][86]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_80-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"80\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_80\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_80\" class=\"wpforms-field-large\" name=\"wpforms[fields][80]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_244-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"244\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_244\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_244\" class=\"wpforms-field-large\" name=\"wpforms[fields][244]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_224-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"224\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_224\">NE areas available to interpret<\/label><input type=\"text\" id=\"wpforms-2865-field_224\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"224\" data-text-limit=\"20\" name=\"wpforms[fields][224]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_87-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"87\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_99-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"99\" style=\"display:none;\"><div id=\"wpforms-2865-field_99\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">West Central Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_152-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"152\" style=\"display:none;\"><div id=\"wpforms-2865-field_152\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_144-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"144\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_97-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"97\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_97\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_97\" class=\"wpforms-field-large\" name=\"wpforms[fields][97]\" ><\/div><div id=\"wpforms-2865-field_94-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"94\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_94\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_94\" class=\"wpforms-field-large\" name=\"wpforms[fields][94]\" ><\/div><div id=\"wpforms-2865-field_91-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"91\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_91\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" ><\/div><div id=\"wpforms-2865-field_89-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"89\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_89\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" ><\/div><div id=\"wpforms-2865-field_235-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"235\" style=\"display:none;\"><div id=\"wpforms-2865-field_235\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_96-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"96\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_96\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_96\" class=\"wpforms-field-large\" name=\"wpforms[fields][96]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_93-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"93\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_93\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_93\" class=\"wpforms-field-large\" name=\"wpforms[fields][93]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_88-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"88\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_88\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_88\" class=\"wpforms-field-large\" name=\"wpforms[fields][88]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_90-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"90\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_90\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_95-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"95\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_95\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_95\" class=\"wpforms-field-large\" name=\"wpforms[fields][95]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_92-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"92\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_92\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_245-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"245\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_245\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_245\" class=\"wpforms-field-large\" name=\"wpforms[fields][245]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_226-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"226\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_226\">West-central areas available to interpret<\/label><input type=\"text\" id=\"wpforms-2865-field_226\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"226\" data-text-limit=\"20\" name=\"wpforms[fields][226]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_100-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"100\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_101-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"101\" style=\"display:none;\"><div id=\"wpforms-2865-field_101\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Central Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_153-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"153\" style=\"display:none;\"><div id=\"wpforms-2865-field_153\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_145-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"145\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_105-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"105\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_105\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_105\" class=\"wpforms-field-large\" name=\"wpforms[fields][105]\" ><\/div><div id=\"wpforms-2865-field_119-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"119\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_119\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_119\" class=\"wpforms-field-large\" name=\"wpforms[fields][119]\" ><\/div><div id=\"wpforms-2865-field_211-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"211\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_211\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_211\" class=\"wpforms-field-large\" name=\"wpforms[fields][211]\" ><\/div><div id=\"wpforms-2865-field_103-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"103\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_103\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_103\" class=\"wpforms-field-large\" name=\"wpforms[fields][103]\" ><\/div><div id=\"wpforms-2865-field_236-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"236\" style=\"display:none;\"><div id=\"wpforms-2865-field_236\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_237-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"237\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_117-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"117\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_117\">&lt;24 hours <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_117\" class=\"wpforms-field-large\" name=\"wpforms[fields][117]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_121-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"121\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_121\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_121\" class=\"wpforms-field-large\" name=\"wpforms[fields][121]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_102-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"102\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_102\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_102\" class=\"wpforms-field-large\" name=\"wpforms[fields][102]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_104-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_104\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_104\" class=\"wpforms-field-large\" name=\"wpforms[fields][104]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_118-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_118\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_118\" class=\"wpforms-field-large\" name=\"wpforms[fields][118]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_110-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"110\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_110\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_110\" class=\"wpforms-field-large\" name=\"wpforms[fields][110]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_246-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"246\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_246\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_246\" class=\"wpforms-field-large\" name=\"wpforms[fields][246]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_225-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"225\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_225\">East-central areas available to interpret <\/label><input type=\"text\" id=\"wpforms-2865-field_225\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"225\" data-text-limit=\"20\" name=\"wpforms[fields][225]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_115-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"115\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_130-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"130\" style=\"display:none;\"><div id=\"wpforms-2865-field_130\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">South Florida Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_154-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"154\" style=\"display:none;\"><div id=\"wpforms-2865-field_154\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_146-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"146\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_116-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"116\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_116\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_116\" class=\"wpforms-field-large\" name=\"wpforms[fields][116]\" ><\/div><div id=\"wpforms-2865-field_108-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"108\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_108\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_108\" class=\"wpforms-field-large\" name=\"wpforms[fields][108]\" ><\/div><div id=\"wpforms-2865-field_111-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"111\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_111\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_111\" class=\"wpforms-field-large\" name=\"wpforms[fields][111]\" ><\/div><div id=\"wpforms-2865-field_113-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"113\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_113\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_113\" class=\"wpforms-field-large\" name=\"wpforms[fields][113]\" ><\/div><div id=\"wpforms-2865-field_238-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"238\" style=\"display:none;\"><div id=\"wpforms-2865-field_238\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_106-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"106\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_106\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_106\" class=\"wpforms-field-large\" name=\"wpforms[fields][106]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_109-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"109\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_109\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_109\" class=\"wpforms-field-large\" name=\"wpforms[fields][109]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_114-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"114\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_114\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_114\" class=\"wpforms-field-large\" name=\"wpforms[fields][114]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_112-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"112\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_112\">Conference<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_112\" class=\"wpforms-field-large\" name=\"wpforms[fields][112]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_107-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_107\">Tactile<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_107\" class=\"wpforms-field-large\" name=\"wpforms[fields][107]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_123-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"123\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_123\">Televised<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_123\" class=\"wpforms-field-large\" name=\"wpforms[fields][123]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_247-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"247\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_247\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_247\" class=\"wpforms-field-large\" name=\"wpforms[fields][247]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_227-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"227\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_227\">SF Areas available to interpret<\/label><input type=\"text\" id=\"wpforms-2865-field_227\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"227\" data-text-limit=\"20\" name=\"wpforms[fields][227]\" placeholder=\"e.g., towns, counties, etc\" ><\/div><div id=\"wpforms-2865-field_249-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"249\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_271-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"271\" style=\"display:none;\"><div id=\"wpforms-2865-field_271\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Remote Rates<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_264-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-firstwpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"264\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_264\">Minimum billable time<\/label><input type=\"text\" id=\"wpforms-2865-field_264\" class=\"wpforms-field-large\" name=\"wpforms[fields][264]\" ><\/div><div id=\"wpforms-2865-field_265-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-firstwpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"265\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_265\">Billable increments<\/label><input type=\"text\" id=\"wpforms-2865-field_265\" class=\"wpforms-field-large\" name=\"wpforms[fields][265]\" ><\/div><div id=\"wpforms-2865-field_269-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"269\" style=\"display:none;\"><div id=\"wpforms-2865-field_269\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Please enter your standard base rates below. <br \/>Standard rates include but are not limited to educational, employment, routine medical, and community settings.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_250-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"250\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_250\">Weekday (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_250\" class=\"wpforms-field-large\" name=\"wpforms[fields][250]\" ><\/div><div id=\"wpforms-2865-field_251-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"251\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_251\">Weekday (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_251\" class=\"wpforms-field-large\" name=\"wpforms[fields][251]\" ><\/div><div id=\"wpforms-2865-field_252-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"252\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_252\">Weekend (day)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_252\" class=\"wpforms-field-large\" name=\"wpforms[fields][252]\" ><\/div><div id=\"wpforms-2865-field_253-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"253\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_253\">Weekend (night)<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_253\" class=\"wpforms-field-large\" name=\"wpforms[fields][253]\" ><\/div><div id=\"wpforms-2865-field_254-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"254\" style=\"display:none;\"><div id=\"wpforms-2865-field_254\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\"><br \/>Enter your differential rates to be <strong>added<\/strong> to your base rates. <br \/>For example: to add $5 to all base rates for Emergency requests, enter &quot;5&quot;, if no differential is charged or the item is not applicable, enter 0.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_255-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"255\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_255\">&lt;24 hours<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_255\" class=\"wpforms-field-large\" name=\"wpforms[fields][255]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_256-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"256\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_256\">National holiday<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_256\" class=\"wpforms-field-large\" name=\"wpforms[fields][256]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_257-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"257\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_257\">Legal<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_257\" class=\"wpforms-field-large\" name=\"wpforms[fields][257]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_258-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"258\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_258\">Conference <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_258\" class=\"wpforms-field-large\" name=\"wpforms[fields][258]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_259-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"259\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_259\">Televised <\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_259\" class=\"wpforms-field-large\" name=\"wpforms[fields][259]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_260-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"260\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_260\">Trilingual<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-2865-field_260\" class=\"wpforms-field-large\" name=\"wpforms[fields][260]\" placeholder=\"e.g., 0, 5, 10\" ><\/div><div id=\"wpforms-2865-field_263-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"263\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_263\">Platforms used for interpreting<\/label><input type=\"text\" id=\"wpforms-2865-field_263\" class=\"wpforms-field-large\" name=\"wpforms[fields][263]\" placeholder=\"Zoom, Teams, WebEx, Go-To Meeting, FaceTime, etc.\" ><\/div><div id=\"wpforms-2865-field_61-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"61\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"2\" data-formid=\"2865\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"2865\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-2865-field_135-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"135\" style=\"display:none;\"><div id=\"wpforms-2865-field_135\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Documentation<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_219-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"219\" style=\"display:none;\"><div id=\"wpforms-2865-field_219\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 20px;\">Please submit a new W9 if a change was made to your name, address, or business. A W-9 form can be downloaded from the IRS website https:\/\/www.irs.gov\/pub\/irs-pdf\/fw9.pdf<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_147-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"147\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_218-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"218\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_218\">Have you taken Vocational Rehabilitation (VR) assignments for CCI?<\/label><ul id=\"wpforms-2865-field_218\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_218_1\" name=\"wpforms[fields][218]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_218_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_218_2\" name=\"wpforms[fields][218]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_218_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_8-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"8\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_8\">Are you interested in accepting VR assignments?<\/label><ul id=\"wpforms-2865-field_8\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_8_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_10-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_10\">Are you currently approved to provide services to VR individually or through another agency?<\/label><ul id=\"wpforms-2865-field_10\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_10_1\" name=\"wpforms[fields][10]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_10_2\" name=\"wpforms[fields][10]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_10_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2865-field_10_3\" name=\"wpforms[fields][10]\" value=\"I don&#039;t know\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_10_3\">I don't know<\/label><\/li><\/ul><div class=\"wpforms-field-description\">If you are providing services for VR, much less information needs to be added to CCI's roster.<\/div><\/div><div id=\"wpforms-2865-field_212-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"212\" style=\"display:none;\"><div id=\"wpforms-2865-field_212\"><p><span style=\"font-size: 16px;\">ASL Interpreters already in the system will only need provide CCI your date of birth, SSN, proof of certification, and current RID membership card. Please make sure to upload an image of your ID and RID card if CCI doesn't have a current copy.\r\n\r\nSpoken Language interpreters must submit the certification, resume, and document of highest diploma\/degree obtained.<\/span><\/p><\/div><\/div><div id=\"wpforms-2865-field_128-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"128\" style=\"display:none;\"><div id=\"wpforms-2865-field_128\"><p><span style=\"font-size: 16px;\">All ASL interpreter must get fingerprinted and have a background check to accept assignments for Vocational Rehabilitation and their vendors. Please submit the documents listed below.<\/span><\/p><\/div><\/div><div id=\"wpforms-2865-field_129-container\" class=\"wpforms-field wpforms-field-html wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"129\" style=\"display:none;\"><div id=\"wpforms-2865-field_129\"><ul>\r\n    <li><span style=\"font-size: 16px;\">Proof of membership to RID<\/span><\/li>\r\n    <li><span style=\"font-size: 16px;\">Certification<\/span>\r\n        <ul>\r\n            <li><span style=\"font-size: 16px;\">RID membership<\/span><\/li>\r\n            <li><span style=\"font-size: 16px;\">EIPA 4.0 (secondary)<\/span><\/li>\r\n            <li><span style=\"font-size: 16px;\">BEI<\/span><\/li>\r\n        <\/ul>\r\n    <\/li>\r\n    <li><span style=\"font-size: 16px;\">Background Check Information<\/span>\r\n        <ul>\r\n            <li><span style=\"font-size: 16px;\">Demographics on your ID<\/span><\/li>\r\n            <li><span style=\"font-size: 16px;\">State you were born<\/span><\/li>\r\n            <li><span style=\"font-size: px;\">Weight<\/span><\/li>\r\n            <li><span style=\"font-size: 16px;\">Hair color<\/span><\/li>\r\n<li><span style=\"font-size: 16px;\">Eye color<\/span><\/li>\r\n<li><span style=\"font-size: 16px;\">SSN (not submitted online)<\/span><\/li>\r\n        <\/ul>\r\n    <\/li>\r\n<\/ul><\/div><\/div><div id=\"wpforms-2865-field_210-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"210\" style=\"display:none;\"><div id=\"wpforms-2865-field_210\"><p><span style=\"font-size: 16px;\">Since, you indicated you have a business name, your W-9 will not contain your SSN. Therefore, Rose Coman will reach out to you to obtain it over the phone or in a manner you feel comfortable.<\/span><\/p><\/div><\/div><div id=\"wpforms-2865-field_194-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"194\"><\/div><div id=\"wpforms-2865-field_217-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"217\" style=\"display:none;\"><div id=\"wpforms-2865-field_217\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 20px;\">Please click \"next\" to continue.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_193-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"193\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_193\">Place of birth<\/label><select id=\"wpforms-2865-field_193\" class=\"wpforms-field-large\" name=\"wpforms[fields][193]\"><option value=\"Select one\" >Select one<\/option><option value=\"Alabama\" >Alabama<\/option><option value=\"Alaska\" >Alaska<\/option><option value=\"Arizona\" >Arizona<\/option><option value=\"Arkansas\" >Arkansas<\/option><option value=\"British Virgin Islands\" >British Virgin Islands<\/option><option value=\"California\" >California<\/option><option value=\"Colorado\" >Colorado<\/option><option value=\"Connecticut\" >Connecticut<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"Delaware\" >Delaware<\/option><option value=\"District of Columbia\" >District of Columbia<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"England\" >England<\/option><option value=\"Florida\" >Florida<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hawaii\" >Hawaii<\/option><option value=\"Idaho\" >Idaho<\/option><option value=\"Illinois\" >Illinois<\/option><option value=\"Indiana\" >Indiana<\/option><option value=\"Iowa\" >Iowa<\/option><option value=\"Jamaca\" >Jamaca<\/option><option value=\"Kansas\" >Kansas<\/option><option value=\"Kentucky\" >Kentucky<\/option><option value=\"Louisiana\" >Louisiana<\/option><option value=\"Maine\" >Maine<\/option><option value=\"Maryland\" >Maryland<\/option><option value=\"Massachusetts\" >Massachusetts<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Michigan\" >Michigan<\/option><option value=\"Minnesota\" >Minnesota<\/option><option value=\"Mississippi\" >Mississippi<\/option><option value=\"Missouri\" >Missouri<\/option><option value=\"MontanaNebraska\" >MontanaNebraska<\/option><option value=\"Nevada\" >Nevada<\/option><option value=\"New Hampshire\" >New Hampshire<\/option><option value=\"New Jersey\" >New Jersey<\/option><option value=\"New Mexico\" >New Mexico<\/option><option value=\"New York\" >New York<\/option><option value=\"North Carolina\" >North Carolina<\/option><option value=\"North Dakota\" >North Dakota<\/option><option value=\"Ohio\" >Ohio<\/option><option value=\"Oklahoma\" >Oklahoma<\/option><option value=\"Oregon\" >Oregon<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Pennsylvania\" >Pennsylvania<\/option><option value=\"Rhode Island\" >Rhode Island<\/option><option value=\"South Carolina\" >South Carolina<\/option><option value=\"South Dakota\" >South Dakota<\/option><option value=\"Tennessee\" >Tennessee<\/option><option value=\"Texas\" >Texas<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\" >United States<\/option><option value=\"US Virgin Islands\" >US Virgin Islands<\/option><option value=\"Utah\" >Utah<\/option><option value=\"Vermont\" >Vermont<\/option><option value=\"Virginia\" >Virginia<\/option><option value=\"Washington\" >Washington<\/option><option value=\"West Virginia\" >West Virginia<\/option><option value=\"Wisconsin\" >Wisconsin<\/option><option value=\"Wyoming\" >Wyoming<\/option><option value=\"Other\" >Other<\/option><option value=\"\" ><\/option><\/select><\/div><div id=\"wpforms-2865-field_274-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"274\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_274\">Birthdate<\/label><input type=\"text\" id=\"wpforms-2865-field_274\" class=\"wpforms-field-large\" name=\"wpforms[fields][274]\" ><\/div><div id=\"wpforms-2865-field_195-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"195\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_195\">Hair color<\/label><select id=\"wpforms-2865-field_195\" class=\"wpforms-field-large\" name=\"wpforms[fields][195]\"><option value=\"Select one\" >Select one<\/option><option value=\"Bald\" >Bald<\/option><option value=\"Black\" >Black<\/option><option value=\"Blonde \/ Strawberry\" >Blonde \/ Strawberry<\/option><option value=\"Blue\" >Blue<\/option><option value=\"Brown\" >Brown<\/option><option value=\"Gray \/ partially gray\" >Gray \/ partially gray<\/option><option value=\"Green\" >Green<\/option><option value=\"Orange\" >Orange<\/option><option value=\"Purple\" >Purple<\/option><option value=\"Pink\" >Pink<\/option><option value=\"Red \/ Auburn\" >Red \/ Auburn<\/option><option value=\"Sandy\" >Sandy<\/option><option value=\"White\" >White<\/option><option value=\"Unknown\" >Unknown<\/option><option value=\"\" ><\/option><\/select><\/div><div id=\"wpforms-2865-field_196-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"196\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_196\">Weight<\/label><input type=\"text\" id=\"wpforms-2865-field_196\" class=\"wpforms-field-large\" name=\"wpforms[fields][196]\" ><\/div><div id=\"wpforms-2865-field_197-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"197\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_197\">Eye color<\/label><select id=\"wpforms-2865-field_197\" class=\"wpforms-field-large\" name=\"wpforms[fields][197]\"><option value=\"Select one\" >Select one<\/option><option value=\"Black\" >Black<\/option><option value=\"Blue\" >Blue<\/option><option value=\"Brown\" >Brown<\/option><option value=\"Gray\" >Gray<\/option><option value=\"Green\" >Green<\/option><option value=\"Hazel\" >Hazel<\/option><option value=\"Maroon\" >Maroon<\/option><option value=\"Multi-colored\" >Multi-colored<\/option><option value=\"Pink\" >Pink<\/option><option value=\"Unknown\" >Unknown<\/option><option value=\"\" ><\/option><\/select><\/div><div id=\"wpforms-2865-field_205-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"205\" style=\"display:none;\"><div id=\"wpforms-2865-field_205\"><br \/><hr \/><\/div><\/div><div id=\"wpforms-2865-field_198-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"198\" style=\"display:none;\"><\/div><div id=\"wpforms-2865-field_19-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_19\">Certification<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"19\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_19\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_19\"\n\t\tname=\"wpforms_2865_19\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_24-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_24\">Resume<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"24\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_24\"\n\t\tdata-extensions=\"pdf,doc,docx,jpg,jpeg,png\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_24\"\n\t\tname=\"wpforms_2865_24\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_26-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_26\">Additional Credentials<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"26\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_26\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"10485760\"\n\t\tdata-max-file-number=\"3\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 3 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_26\"\n\t\tname=\"wpforms_2865_26\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_21-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_21\">Photo<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"21\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_21\"\n\t\tdata-extensions=\"jpg,jpeg,png\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_21\"\n\t\tname=\"wpforms_2865_21\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_25-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_25\">W9<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"25\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_25\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"4194304\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_25\"\n\t\tname=\"wpforms_2865_25\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_23-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_23\">Letter of Recommendation(s)<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"23\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_23\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"5242880\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 2 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_23\"\n\t\tname=\"wpforms_2865_23\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_20-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"20\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_20\">Driver&#039;s license<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"20\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_20\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_20\"\n\t\tname=\"wpforms_2865_20\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_22-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_22\">Liability Insurance<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"22\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_22\"\n\t\tdata-extensions=\"pdf,jpg,jpeg,png\"\n\t\tdata-max-size=\"3145728\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_22\"\n\t\tname=\"wpforms_2865_22\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_137-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"137\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_137\">Misc.<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"137\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_137\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"20971520\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_137\"\n\t\tname=\"wpforms_2865_137\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_37-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_37\">Interpreting Sample(s)<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"37\"\n\t\tdata-form-id=\"2865\"\n\t\tdata-input-name=\"wpforms_2865_37\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"20971520\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-2865-field_37\"\n\t\tname=\"wpforms_2865_37\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-2865-field_18-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"18\"><\/div><div id=\"wpforms-2865-field_63-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"63\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"3\" data-formid=\"2865\" disabled>Previous<\/button><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"2865\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4 last \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-2865-field_131-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"131\" style=\"display:none;\"><div id=\"wpforms-2865-field_131\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Preferences<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_214-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"214\" style=\"display:none;\"><div id=\"wpforms-2865-field_214\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 20px;\">You indicated that you do not need to update your preferences and conflicts of interests at this time.<br \/> Please click \"submit.\"<br \/> You will receive a copy of this update in the mail shortly. <br \/> Thanks! <\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_202-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"202\"><\/div><div id=\"wpforms-2865-field_148-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"148\"><\/div><div id=\"wpforms-2865-field_132-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"132\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_132\">Conference<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_132_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_132_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][132]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_132_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_132_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][132]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_132_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_132_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][132]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_132_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_132_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][132]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_132_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_132_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][132]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_156-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"156\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_156\">Conference comment<\/label><input type=\"text\" id=\"wpforms-2865-field_156\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"156\" data-text-limit=\"20\" name=\"wpforms[fields][156]\" placeholder=\"Conference comments\" ><\/div><div id=\"wpforms-2865-field_155-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"155\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_155\">Cruise<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_155_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_155_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][155]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_155_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_155_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][155]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_155_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_155_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][155]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_155_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_155_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][155]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_155_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_155_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][155]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_133-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"133\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_133\">Cruise comment<\/label><input type=\"text\" id=\"wpforms-2865-field_133\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"133\" data-text-limit=\"20\" name=\"wpforms[fields][133]\" placeholder=\"Cruise comments\" ><\/div><div id=\"wpforms-2865-field_157-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"157\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_157\">Employment<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_157_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_157_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][157]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_157_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_157_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][157]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_157_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_157_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][157]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_157_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_157_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][157]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_157_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_157_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][157]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_159-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"159\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_159\">Employment comment<\/label><input type=\"text\" id=\"wpforms-2865-field_159\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"159\" data-text-limit=\"20\" name=\"wpforms[fields][159]\" placeholder=\"Employment comments\" ><\/div><div id=\"wpforms-2865-field_160-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"160\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_160\">K-12<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_160_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_160_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][160]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_160_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_160_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][160]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_160_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_160_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][160]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_160_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_160_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][160]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_160_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_160_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][160]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_158-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"158\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_158\">K-12 comment<\/label><input type=\"text\" id=\"wpforms-2865-field_158\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"158\" data-text-limit=\"20\" name=\"wpforms[fields][158]\" placeholder=\"K-12 comments\" ><\/div><div id=\"wpforms-2865-field_161-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"161\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_161\">Legal<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_161_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_161_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][161]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_161_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_161_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][161]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_161_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_161_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][161]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_161_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_161_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][161]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_161_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_161_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][161]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_162-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"162\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_162\">Legal comments<\/label><input type=\"text\" id=\"wpforms-2865-field_162\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"162\" data-text-limit=\"20\" name=\"wpforms[fields][162]\" placeholder=\"Legal comment\" ><\/div><div id=\"wpforms-2865-field_163-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"163\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_163\">Medical (hospital)<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_163_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_163_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][163]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_163_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_163_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][163]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_163_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_163_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][163]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_163_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_163_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][163]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_163_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_163_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][163]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_164-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"164\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_164\">Medical (hospital) comments<\/label><input type=\"text\" id=\"wpforms-2865-field_164\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"164\" data-text-limit=\"20\" name=\"wpforms[fields][164]\" placeholder=\"Medical (hospital) comment\" ><\/div><div id=\"wpforms-2865-field_165-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"165\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_165\">Medical (office)<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_165_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_165_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][165]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_165_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_165_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][165]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_165_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_165_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][165]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_165_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_165_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][165]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_165_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_165_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][165]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_166-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"166\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_166\">Medical (office) comment <\/label><input type=\"text\" id=\"wpforms-2865-field_166\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"166\" data-text-limit=\"20\" name=\"wpforms[fields][166]\" placeholder=\"Medical (office) comments \" ><\/div><div id=\"wpforms-2865-field_167-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"167\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_167\">Mental Health<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_167_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_167_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][167]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_167_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_167_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][167]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_167_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_167_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][167]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_167_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_167_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][167]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_167_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_167_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][167]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_168-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"168\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_168\">Mental Health comment<\/label><input type=\"text\" id=\"wpforms-2865-field_168\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"168\" data-text-limit=\"20\" name=\"wpforms[fields][168]\" placeholder=\"Mental Health comments\" ><\/div><div id=\"wpforms-2865-field_169-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"169\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_169\">Performance<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_169_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_169_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][169]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_169_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_169_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][169]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_169_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_169_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][169]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_169_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_169_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][169]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_169_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_169_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][169]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_170-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"170\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_170\">Performance comment<\/label><input type=\"text\" id=\"wpforms-2865-field_170\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"170\" data-text-limit=\"20\" name=\"wpforms[fields][170]\" placeholder=\"Performance comments\" ><\/div><div id=\"wpforms-2865-field_171-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"171\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_171\">Political<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_171_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_171_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][171]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_171_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_171_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][171]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_171_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_171_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][171]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_171_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_171_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][171]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_171_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_171_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][171]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_172-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"172\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_172\">Political comment  <\/label><input type=\"text\" id=\"wpforms-2865-field_172\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"172\" data-text-limit=\"20\" name=\"wpforms[fields][172]\" placeholder=\"Political comments \" ><\/div><div id=\"wpforms-2865-field_173-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"173\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_173\">Post-secondary<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_173_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_173_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][173]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_173_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_173_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][173]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_173_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_173_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][173]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_173_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_173_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][173]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_173_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_173_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][173]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_174-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"174\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_174\">Post-secondary comment<\/label><input type=\"text\" id=\"wpforms-2865-field_174\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"174\" data-text-limit=\"20\" name=\"wpforms[fields][174]\" placeholder=\"Post-secondary comments\" ><\/div><div id=\"wpforms-2865-field_176-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"176\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_176\">Religious<\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-2865-field_176_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_176_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][176]\" value=\"1\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-2865-field_176_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_176_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][176]\" value=\"2\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-2865-field_176_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_176_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][176]\" value=\"3\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-2865-field_176_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_176_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][176]\" value=\"4\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-2865-field_176_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-2865-field_176_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][176]\" value=\"5\" ><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#d6a844\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M320 1344q0-26-19-45t-45-19q-27 0-45.5 19t-18.5 45q0 27 18.5 45.5t45.5 18.5q26 0 45-18.5t19-45.5zm160-512v640q0 26-19 45t-45 19h-288q-26 0-45-19t-19-45v-640q0-26 19-45t45-19h288q26 0 45 19t19 45zm1184 0q0 86-55 149 15 44 15 76 3 76-43 137 17 56 0 117-15 57-54 94 9 112-49 181-64 76-197 78h-129q-66 0-144-15.5t-121.5-29-120.5-39.5q-123-43-158-44-26-1-45-19.5t-19-44.5v-641q0-25 18-43.5t43-20.5q24-2 76-59t101-121q68-87 101-120 18-18 31-48t17.5-48.5 13.5-60.5q7-39 12.5-61t19.5-52 34-50q19-19 45-19 46 0 82.5 10.5t60 26 40 40.5 24 45 12 50 5 45 .5 39q0 38-9.5 76t-19 60-27.5 56q-3 6-10 18t-11 22-8 24h277q78 0 135 57t57 135z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-2865-field_177-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"177\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2865-field_177\">Religious comment <\/label><input type=\"text\" id=\"wpforms-2865-field_177\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"177\" data-text-limit=\"20\" name=\"wpforms[fields][177]\" placeholder=\"Religious comments\" ><\/div><div id=\"wpforms-2865-field_185-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"185\" style=\"display:none;\"><div id=\"wpforms-2865-field_185\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\">Below you can communicate any preferences. No explanation is needed.<\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><br \/><\/div><\/div><div id=\"wpforms-2865-field_181-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"181\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_181\">Preferred Interpreter(s)<\/label><input type=\"text\" id=\"wpforms-2865-field_181\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"181\" data-text-limit=\"20\" name=\"wpforms[fields][181]\" placeholder=\"Names of preferred team interpreters\" ><\/div><div id=\"wpforms-2865-field_182-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"182\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_182\">Preferred Language Consumer(s)<\/label><input type=\"text\" id=\"wpforms-2865-field_182\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"182\" data-text-limit=\"20\" name=\"wpforms[fields][182]\" placeholder=\"Who do you enjoy working with? Who typically requests you?\" ><\/div><div id=\"wpforms-2865-field_183-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"183\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_183\">Preferred Client(s) \/ Locations(s) \/ Topic(s)<\/label><input type=\"text\" id=\"wpforms-2865-field_183\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"183\" data-text-limit=\"20\" name=\"wpforms[fields][183]\" placeholder=\"Where do you like to go and what topics do you enjoy?\" ><\/div><div id=\"wpforms-2865-field_221-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"221\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_221\">Typical availability<\/label><input type=\"text\" id=\"wpforms-2865-field_221\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"221\" data-text-limit=\"20\" name=\"wpforms[fields][221]\" placeholder=\"e.g., no on-goings at the time, available Mondays and Wednesday, etc.\" ><\/div><div id=\"wpforms-2865-field_203-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"203\"><\/div><div id=\"wpforms-2865-field_136-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"136\" style=\"display:none;\"><div id=\"wpforms-2865-field_136\"><p><br \/><\/p>\r\n<table style=\"width: 100%;\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; vertical-align: bottom; background-color: rgb(142, 19, 22);\">\r\n                <p style=\"text-align: center; line-height: 1.15;\"><br \/><\/p>\r\n                <p style=\"text-align: center; line-height: 1.15;\"><strong><span style=\"font-size: 30px; background-color: rgb(142, 19, 22); color: rgb(214, 168, 68); line-height: 1.15;\">Conflicts of Interests<\/span><\/strong><\/p><br \/>\r\n            <\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_187-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"187\" style=\"display:none;\"><div id=\"wpforms-2865-field_187\"><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: left;\"><span style=\"font-size: 18px;\">Below you can communicate any conflicts of interest below. This will be held in the strictest confidence and will be used to offer you the most appropriate assignments. NO EXPLANATIONS NEEDED<\/span><\/td>\r\n        <\/tr><br \/>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_189-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"189\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_189\">Interpreter(s) (conflict)<\/label><input type=\"text\" id=\"wpforms-2865-field_189\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"189\" data-text-limit=\"30\" name=\"wpforms[fields][189]\" placeholder=\"If you would like to make notes of any interpreters that are not the best team for you, list the names here. \" ><\/div><div id=\"wpforms-2865-field_190-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"190\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_190\">Language Consumer(s) (conflict)<\/label><input type=\"text\" id=\"wpforms-2865-field_190\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"190\" data-text-limit=\"30\" name=\"wpforms[fields][190]\" placeholder=\"If you would like to make notes of any Consumers that you cannot interpret for, you can list them here. (e.g. a family member, an ex-partner, etc.)\" ><\/div><div id=\"wpforms-2865-field_191-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"191\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_191\">Client(s) \/ Locations(s) \/ Topic(s) (conflict)<\/label><input type=\"text\" id=\"wpforms-2865-field_191\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"2865\" data-field-id=\"191\" data-text-limit=\"30\" name=\"wpforms[fields][191]\" placeholder=\"If you would like to make notes of any Clients or locations that you cannot interpret for, you can list them here. (e.g. jail, radiology, rehab). \" ><\/div><div id=\"wpforms-2865-field_179-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"179\"><\/div><div id=\"wpforms-2865-field_239-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"239\"><label class=\"wpforms-field-label\" for=\"wpforms-2865-field_239\">Are you ready to submit? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2865-field_239\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2865-field_239_1\" name=\"wpforms[fields][239][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2865-field_239_1\">Yes<\/label><\/li><\/ul><\/div><div id=\"wpforms-2865-field_180-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"180\" style=\"display:none;\"><div id=\"wpforms-2865-field_180\"><br \/><table style=\"width: 100%; margin-left: calc(0\t%);\">\r\n    <tbody>\r\n        <tr>\r\n            <td style=\"width: 100%; text-align: center;\"><span style=\"font-size: 20px;\"> Please click \"submit.\"<br \/> You will receive a copy of this update in the mail shortly. <br \/> Thanks! <\/span><\/td>\r\n        <\/tr>\r\n    <\/tbody>\r\n<\/table><\/div><\/div><div id=\"wpforms-2865-field_14-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"14\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"4\" data-formid=\"2865\" disabled>Previous<\/button><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-2865-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-2865-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"2865\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2865\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-full-width-page-builder.php","meta":{"footnotes":""},"class_list":["post-1108","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/pages\/1108","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/comments?post=1108"}],"version-history":[{"count":40,"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/pages\/1108\/revisions"}],"predecessor-version":[{"id":2901,"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/pages\/1108\/revisions\/2901"}],"wp:attachment":[{"href":"https:\/\/cci4asl.com\/home\/wp-json\/wp\/v2\/media?parent=1108"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}