{"id":13936,"date":"2021-07-20T13:30:31","date_gmt":"2021-07-20T17:30:31","guid":{"rendered":"https:\/\/www.ramapo.edu\/mindfulness\/?page_id=13936"},"modified":"2021-10-22T14:38:45","modified_gmt":"2021-10-22T18:38:45","slug":"yoga-workshop-registration","status":"publish","type":"page","link":"https:\/\/www.ramapo.edu\/mindfulness\/yoga-workshops\/yoga-workshop-registration\/","title":{"rendered":"Yoga Workshop Registration"},"content":{"rendered":"\t\t<script type=\"text\/javascript\">\n\t\t\tjQuery(document).ready(function(){\n\t\t\t\tvar prmstr = window.location.search.substr(1);\n\t\t\t\tvar prmarr = prmstr.split (\"&\");\n\n\t\t\t\tfor ( var i = 0; i < prmarr.length; i++)\n\t\t\t\t{\n\t\t\t\t\tvar tmparr = prmarr[i].split(\"=\");\n\t\t\t\t\tvar origVal = decodeURIComponent(tmparr[1]);\n\t\t\t\t\tvar modifier = origVal.substr(0,1);\n\t\t\t\t\tvar theField = jQuery(\"#\"+tmparr[0]);\n\t\t\t\t\tif(modifier == '^')\n\t\t\t\t\t{\n\t\t\t\t\t\tvalue = origVal.substr(1);\n\t\t\t\t\t\ttheField.attr('readonly','readonly');\n\t\t\t\t\t}\n\t\t\t\t\telse\n\t\t\t\t\t{\n\t\t\t\t\t\tvalue = origVal;\n\t\t\t\t\t}\n\t\t\t\t\ttheField.val(value);\n\t\t\t\t}\n\t\t\t});\n\t\t<\/script>\n\t\t<link rel='stylesheet' id='formidable-css' href='https:\/\/www.ramapo.edu\/mindfulness\/wp-admin\/admin-ajax.php?action=frmpro_css&#038;ver=3131337' type='text\/css' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_28_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_freeonlinembsrorientation9ea73f4499\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Yoga Workshop<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"28\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_28\" id=\"frm_hide_fields_28\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"freeonlinembsrorientation9ea73f4499\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_28\" name=\"frm_submit_entry_28\" value=\"231a41d25f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/mindfulness\/wp-json\/wp\/v2\/pages\/13936\" \/><div id=\"frm_field_775_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label id=\"field_7qn2rd780f262b8_label\" class=\"frm_primary_label\" for=\"field_7qn2rd780f262b8\">First Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7qn2rd780f262b8\" name=\"item_meta[775]\" value=\"\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_776_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label id=\"field_ijo2d9854072e8c_label\" class=\"frm_primary_label\" for=\"field_ijo2d9854072e8c\">Last Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ijo2d9854072e8c\" name=\"item_meta[776]\" value=\"\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_777_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label id=\"field_r538haeddb3e5ef_label\" class=\"frm_primary_label\" for=\"field_r538haeddb3e5ef\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_r538haeddb3e5ef\" name=\"item_meta[777]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_778_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label id=\"field_bdy8i50894c4c72_label\" class=\"frm_primary_label\" for=\"field_bdy8i50894c4c72\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_bdy8i50894c4c72\" name=\"item_meta[778]\" value=\"\"  data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_857_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div id=\"field_9xwde_label\" class=\"frm_primary_label\" for=\"field_9xwde\">Are you signing up as our Community Member or Current Ramapo Students\/Alumni?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_857-0\">\t\t\t<label  for=\"field_9xwde-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[857]\" id=\"field_9xwde-0\" value=\"Community\"\n\t\t data-reqmsg=\"Are you signing up as our Community Member or Current Ramapo Students\/Alumni? cannot be blank.\" data-invmsg=\"Are you signing up as our Community Member or Current Ramapo Students\/Alumni? is invalid\"   \/> Community<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_857-1\">\t\t\t<label  for=\"field_9xwde-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[857]\" id=\"field_9xwde-1\" value=\"Current Ramapo Students\/Alumni\"\n\t\t data-reqmsg=\"Are you signing up as our Community Member or Current Ramapo Students\/Alumni? cannot be blank.\" data-invmsg=\"Are you signing up as our Community Member or Current Ramapo Students\/Alumni? is invalid\"   \/> Current Ramapo Students\/Alumni<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_856_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div id=\"field_w3y3m_label\" class=\"frm_primary_label\" for=\"field_w3y3m\">Choose the workshops you are registering for:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\">\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-0\"><label for=\"field_w3y3m-0\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-0\" value=\"Bandha Workshop with Allison Egan Datwani on Friday, October 22, 2021 from 6:00 PM  to 9:00 PM -$45\" aria-required=\"true\"  data-frmprice=\"$45\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Bandha Workshop with Allison Egan Datwani on Friday, October 22, 2021 from 6:00 PM  to 9:00 PM -$45<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-1\"><label for=\"field_w3y3m-1\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-1\" value=\"Yoga Nidra Workshop with Lena Madsen on Saturday, November 20, 2021 from  2:00 PM to 4:00 PM -$45\" data-frmprice=\"$45\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga Nidra Workshop with Lena Madsen on Saturday, November 20, 2021 from  2:00 PM to 4:00 PM -$45<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-2\"><label for=\"field_w3y3m-2\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-2\" value=\"Trauma and the Wisdom of Yoga  (YACEP Credit) with Sarah Couper on Friday December 3, 2021 from 6:00 PM  to 9:00 PM -$45\" data-frmprice=\"$45\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Trauma and the Wisdom of Yoga  (YACEP Credit) with Sarah Couper on Friday December 3, 2021 from 6:00 PM  to 9:00 PM -$45<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-3\"><label for=\"field_w3y3m-3\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-3\" value=\"Yoga Nidra Teaching Workshop (For Yoga Teachers and Trainees only) (YACEP Credit) with Lena Madsen on Saturday, December 5, 2021 from  2:00 PM to 6:00 PM -$75\" data-frmprice=\"$75\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga Nidra Teaching Workshop (For Yoga Teachers and Trainees only) (YACEP Credit) with Lena Madsen on Saturday, December 5, 2021 from  2:00 PM to 6:00 PM -$75<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-4\"><label for=\"field_w3y3m-4\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-4\" value=\"Vinyasa: Winter Solstice Yoga Flow and Restore with Allison Eagan Datwani on Saturday, December 11, 2021 2021 from  9:30 AM to 11:30 AM -$45\" data-frmprice=\"$45\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Vinyasa: Winter Solstice Yoga Flow and Restore with Allison Eagan Datwani on Saturday, December 11, 2021 2021 from  9:30 AM to 11:30 AM -$45<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_856-5\"><label for=\"field_w3y3m-5\">\t<input type=\"checkbox\" name=\"item_meta[856][]\" id=\"field_w3y3m-5\" value=\"Yoga with Children Workshop with Kat Benny on Saturday, January 8, 2022 from 2:00 PM to 4:30 PM -$45\" data-frmprice=\"$45\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga with Children Workshop with Kat Benny on Saturday, January 8, 2022 from 2:00 PM to 4:30 PM -$45<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_859_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div id=\"field_tilma_label\" class=\"frm_primary_label\" for=\"field_tilma\">Choose the workshops you are registering for:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\">\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-0\"><label for=\"field_tilma-0\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-0\" value=\"Bandha Workshop with Allison Egan Datwani on Friday, October 22, 2021 from 6:00 PM  to 9:00 PM -$25\" aria-required=\"true\"  data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Bandha Workshop with Allison Egan Datwani on Friday, October 22, 2021 from 6:00 PM  to 9:00 PM -$25<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-1\"><label for=\"field_tilma-1\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-1\" value=\"Yoga Nidra Workshop with Lena Madsen on Saturday, November 20, 2021 from  2:00 PM to 4:00 PM -$25\" data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga Nidra Workshop with Lena Madsen on Saturday, November 20, 2021 from  2:00 PM to 4:00 PM -$25<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-2\"><label for=\"field_tilma-2\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-2\" value=\"Trauma and the Wisdom of Yoga  (YACEP Credit) with Sarah Couper on Friday December 3, 2021 from 6:00 PM  to 9:00 PM -$25\" data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Trauma and the Wisdom of Yoga  (YACEP Credit) with Sarah Couper on Friday December 3, 2021 from 6:00 PM  to 9:00 PM -$25<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-3\"><label for=\"field_tilma-3\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-3\" value=\"Yoga Nidra Teaching Workshop (For Yoga Teachers and Trainees only) (YACEP Credit) with Lena Madsen on Saturday, December 5, 2021 from  2:00 PM to 6:00 PM -$25\" data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga Nidra Teaching Workshop (For Yoga Teachers and Trainees only) (YACEP Credit) with Lena Madsen on Saturday, December 5, 2021 from  2:00 PM to 6:00 PM -$25<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-4\"><label for=\"field_tilma-4\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-4\" value=\"Vinyasa: Winter Solstice Yoga Flow and Restore with Allison Eagan Datwani on Saturday, December 11, 2021 2021 from  9:30 AM to 11:30 AM -$25\" data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Vinyasa: Winter Solstice Yoga Flow and Restore with Allison Eagan Datwani on Saturday, December 11, 2021 2021 from  9:30 AM to 11:30 AM -$25<\/label><\/div>\n\t<div class=\"frm_checkbox\" id=\"frm_checkbox_859-5\"><label for=\"field_tilma-5\">\t<input type=\"checkbox\" name=\"item_meta[859][]\" id=\"field_tilma-5\" value=\"Yoga with Children Workshop with Kat Benny on Saturday, January 8, 2022 from 2:00 PM to 4:30 PM -$25\" data-frmprice=\"$25\"  data-reqmsg=\"Choose the workshops you are registering for: cannot be blank.\" data-invmsg=\"Choose the workshops you are registering for: is invalid\" aria-invalid=\"false\"   \/> Yoga with Children Workshop with Kat Benny on Saturday, January 8, 2022 from 2:00 PM to 4:30 PM -$25<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_783_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Payment<\/h3>\r\n\r\n\r\n<div id=\"frm_field_785_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <div id=\"field_zn7czc2da2ef32d_label\" class=\"frm_primary_label\" for=\"field_zn7czc2da2ef32d\">Total<\/div>\r\n    <p class=\"frm_total_formatted\"><\/p>\r\n    <input  type=\"hidden\" id=\"field_zn7czc2da2ef32d\" name=\"item_meta[785]\" value=\"\"  data-sectionid=\"783\"  data-frmtotal  data-invmsg=\"Total is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_860_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label id=\"field_lwgou_label\" class=\"frm_primary_label\" for=\"field_lwgou\">Total you will be charged today\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_lwgou\" name=\"item_meta[860]\" value=\"\" readonly=\"readonly\"  data-sectionid=\"783\"  data-reqmsg=\"Total you will be charged today cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_786_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div id=\"field_b3oc584d638a6b2_label\" class=\"frm_primary_label\" for=\"field_b3oc584d638a6b2\">Credit Card\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_b3oc584d638a6b2_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tCredit Card<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_786-cc_container\" class=\"frm_form_field form-field frm_full frm_cc_number\">\n\t<label for=\"field_b3oc584d638a6b2_cc\" class=\"frm_screen_reader frm_hidden\">\n\t\tCredit Card\t<\/label>\n\t\t<input type=\"tel\" id=\"field_b3oc584d638a6b2_cc\" value=\"\" name=\"item_meta[786][cc]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"783\"  data-reqmsg=\"Credit Card cannot be blank.\" aria-required=\"true\" data-invmsg=\"Credit Card is invalid\" aria-invalid=\"false\"   autocomplete=\"cc-number\" autocorrect=\"off\" spellcheck=\"off\" autocapitalize=\"off\" data-name=\"786-cc\" placeholder=\"\" \/>\n\t<\/div>\n<div id=\"frm_field_786-month_container\" class=\"frm_form_field form-field frm_third frm_first frm_cc_exp_month\">\n\t<label for=\"field_b3oc584d638a6b2_month\" class=\"frm_screen_reader frm_hidden\">\n\t\tCredit Card\t<\/label>\n\t\t\t<select name=\"item_meta[786][month]\" id=\"field_b3oc584d638a6b2_month\"  placeholder=\"Month\" data-placeholder=\"Month\" data-sectionid=\"783\"  data-reqmsg=\"Credit Card cannot be blank.\" aria-required=\"true\" data-invmsg=\"Credit Card is invalid\" aria-invalid=\"false\"  >\n\t\t\t<option value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\tMonth\t\t\t<\/option>\n\t\t\t<option  value=\"1\">1<\/option><option  value=\"2\">2<\/option><option  value=\"3\">3<\/option><option  value=\"4\">4<\/option><option  value=\"5\">5<\/option><option  value=\"6\">6<\/option><option  value=\"7\">7<\/option><option  value=\"8\">8<\/option><option  value=\"9\">9<\/option><option  value=\"10\">10<\/option><option  value=\"11\">11<\/option><option  value=\"12\">12<\/option>\t\t<\/select>\n\t<\/div>\n<div id=\"frm_field_786-year_container\" class=\"frm_form_field form-field frm_third frm_cc_exp_year\">\n\t<label for=\"field_b3oc584d638a6b2_year\" class=\"frm_screen_reader frm_hidden\">\n\t\tCredit Card\t<\/label>\n\t\t\t<select name=\"item_meta[786][year]\" id=\"field_b3oc584d638a6b2_year\"  placeholder=\"Year\" data-placeholder=\"Year\" data-sectionid=\"783\"  data-reqmsg=\"Credit Card cannot be blank.\" aria-required=\"true\" data-invmsg=\"Credit Card is invalid\" aria-invalid=\"false\"  >\n\t\t\t<option value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\tYear\t\t\t<\/option>\n\t\t\t<option  value=\"2026\">2026<\/option><option  value=\"2027\">2027<\/option><option  value=\"2028\">2028<\/option><option  value=\"2029\">2029<\/option><option  value=\"2030\">2030<\/option><option  value=\"2031\">2031<\/option><option  value=\"2032\">2032<\/option><option  value=\"2033\">2033<\/option><option  value=\"2034\">2034<\/option><option  value=\"2035\">2035<\/option><option  value=\"2036\">2036<\/option>\t\t<\/select>\n\t<\/div>\n<div id=\"frm_field_786-cvc_container\" class=\"frm_form_field form-field frm_third frm_cc_cvc\">\n\t<label for=\"field_b3oc584d638a6b2_cvc\" class=\"frm_screen_reader frm_hidden\">\n\t\tCredit Card\t<\/label>\n\t\t<input type=\"tel\" id=\"field_b3oc584d638a6b2_cvc\" value=\"\" name=\"item_meta[786][cvc]\"  placeholder=\"\" data-placeholder=\"\" data-sectionid=\"783\"  data-reqmsg=\"Credit Card cannot be blank.\" aria-required=\"true\" data-invmsg=\"Credit Card is invalid\" aria-invalid=\"false\"   spellcheck=\"off\" autocapitalize=\"off\" maxlength=\"4\" autocorrect=\"off\" autocomplete=\"off\" data-name=\"786-cvc\" placeholder=\"\" \/>\n\t<\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_787_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div id=\"field_vng2e5e58b11927_label\" class=\"frm_primary_label\" for=\"field_vng2e5e58b11927\">Billing Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_vng2e5e58b11927_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tBilling Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_787-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vng2e5e58b11927_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tBilling Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_vng2e5e58b11927_line1\" value=\"\" name=\"item_meta[787][line1]\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_787-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vng2e5e58b11927_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tBilling Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_vng2e5e58b11927_line2\" value=\"\" name=\"item_meta[787][line2]\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_787-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_vng2e5e58b11927_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_vng2e5e58b11927_city\" value=\"\" name=\"item_meta[787][city]\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_787-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_vng2e5e58b11927_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_vng2e5e58b11927_state\" value=\"\" name=\"item_meta[787][state]\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_787-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_vng2e5e58b11927_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_vng2e5e58b11927_zip\" value=\"\" name=\"item_meta[787][zip]\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<div id=\"frm_field_787-country_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_vng2e5e58b11927_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tCountry\t<\/label>\n\t\t\t<select name=\"item_meta[787][country]\" id=\"field_vng2e5e58b11927_country\"  data-sectionid=\"783\"  data-reqmsg=\"Billing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Billing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afghanistan\" data-code=\"AF\">Afghanistan<\/option><option  value=\"Aland Islands\" data-code=\"AX\">Aland Islands<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Algeria\" data-code=\"DZ\">Algeria<\/option><option  value=\"American Samoa\" data-code=\"AS\">American Samoa<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguilla\" data-code=\"AI\">Anguilla<\/option><option  value=\"Antarctica\" data-code=\"AQ\">Antarctica<\/option><option  value=\"Antigua and Barbuda\" data-code=\"AG\">Antigua and Barbuda<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaijan\" data-code=\"AZ\">Azerbaijan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bahrain\" data-code=\"BH\">Bahrain<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Bangladesh<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Belarus\" data-code=\"BY\">Belarus<\/option><option  value=\"Belgium\" data-code=\"BE\">Belgium<\/option><option  value=\"Belize\" data-code=\"BZ\">Belize<\/option><option  value=\"Benin\" data-code=\"BJ\">Benin<\/option><option  value=\"Bermuda\" data-code=\"BM\">Bermuda<\/option><option  value=\"Bhutan\" data-code=\"BT\">Bhutan<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option  value=\"Bosnia and Herzegovina\" data-code=\"BA\">Bosnia and Herzegovina<\/option><option  value=\"Botswana\" data-code=\"BW\">Botswana<\/option><option  value=\"Bouvet Island\" data-code=\"BV\">Bouvet Island<\/option><option  value=\"Brazil\" data-code=\"BR\">Brazil<\/option><option  value=\"British Indian Ocean Territory\" data-code=\"IO\">British Indian Ocean Territory<\/option><option  value=\"Brunei\" data-code=\"BN\">Brunei<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"C&ocirc;te d&#039;Ivoire\">C&ocirc;te d&#039;Ivoire<\/option><option  value=\"Cambodia\" data-code=\"KH\">Cambodia<\/option><option  value=\"Cameroon\" data-code=\"CM\">Cameroon<\/option><option  value=\"Canada\" data-code=\"CA\">Canada<\/option><option  value=\"Cape Verde\" data-code=\"CV\">Cape Verde<\/option><option  value=\"Cayman Islands\" data-code=\"KY\">Cayman Islands<\/option><option  value=\"Central African Republic\" data-code=\"CF\">Central African Republic<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">China<\/option><option  value=\"Christmas Island\" data-code=\"CX\">Christmas Island<\/option><option  value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoros\" data-code=\"KM\">Comoros<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Cook Islands\" data-code=\"CK\">Cook Islands<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Croatia\" data-code=\"HR\">Croatia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curacao\" data-code=\"CW\">Curacao<\/option><option  value=\"Cyprus\" data-code=\"CY\">Cyprus<\/option><option  value=\"Czech Republic\" data-code=\"CZ\">Czech Republic<\/option><option  value=\"Denmark\" data-code=\"DK\">Denmark<\/option><option  value=\"Djibouti\" data-code=\"DJ\">Djibouti<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Dominican Republic\" data-code=\"DO\">Dominican Republic<\/option><option  value=\"East Timor\" data-code=\"TL\">East Timor<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egypt\" data-code=\"EG\">Egypt<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Equatorial Guinea\" data-code=\"GQ\">Equatorial Guinea<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Ethiopia\" data-code=\"ET\">Ethiopia<\/option><option  value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option  value=\"Faroe Islands\" data-code=\"FO\">Faroe Islands<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiji<\/option><option  value=\"Finland\" data-code=\"FI\">Finland<\/option><option  value=\"France\" data-code=\"FR\">France<\/option><option  value=\"French Guiana\" data-code=\"GF\">French Guiana<\/option><option  value=\"French Polynesia\" data-code=\"PF\">French Polynesia<\/option><option  value=\"French Southern Territories\" data-code=\"TF\">French Southern Territories<\/option><option  value=\"Gabon\" data-code=\"GA\">Gabon<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Germany\" data-code=\"DE\">Germany<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Greece\" data-code=\"GR\">Greece<\/option><option  value=\"Greenland\" data-code=\"GL\">Greenland<\/option><option  value=\"Grenada\" data-code=\"GD\">Grenada<\/option><option  value=\"Guadeloupe\" data-code=\"GP\">Guadeloupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea-Bissau\" data-code=\"GW\">Guinea-Bissau<\/option><option  value=\"Guyana\" data-code=\"GY\">Guyana<\/option><option  value=\"Haiti\" data-code=\"HT\">Haiti<\/option><option  value=\"Heard Island and McDonald Islands\" data-code=\"HM\">Heard Island and McDonald Islands<\/option><option  value=\"Holy See\">Holy See<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungary\" data-code=\"HU\">Hungary<\/option><option  value=\"Iceland\" data-code=\"IS\">Iceland<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iran\" data-code=\"IR\">Iran<\/option><option  value=\"Iraq\" data-code=\"IQ\">Iraq<\/option><option  value=\"Ireland\" data-code=\"IE\">Ireland<\/option><option  value=\"Isle of Man\" data-code=\"IM\">Isle of Man<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italy\" data-code=\"IT\">Italy<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Japan\" data-code=\"JP\">Japan<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordan\" data-code=\"JO\">Jordan<\/option><option  value=\"Kazakhstan\" data-code=\"KZ\">Kazakhstan<\/option><option  value=\"Kenya\" data-code=\"KE\">Kenya<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Kyrgyzstan\" data-code=\"KG\">Kyrgyzstan<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Latvia\" data-code=\"LV\">Latvia<\/option><option  value=\"Lebanon\" data-code=\"LB\">Lebanon<\/option><option  value=\"Lesotho\" data-code=\"LS\">Lesotho<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libya\" data-code=\"LY\">Libya<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lithuania\" data-code=\"LT\">Lithuania<\/option><option  value=\"Luxembourg\" data-code=\"LU\">Luxembourg<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Macedonia\" data-code=\"MK\">Macedonia<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malawi\" data-code=\"MW\">Malawi<\/option><option  value=\"Malaysia\" data-code=\"MY\">Malaysia<\/option><option  value=\"Maldives\" data-code=\"MV\">Maldives<\/option><option  value=\"Mali\" data-code=\"ML\">Mali<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marshall Islands\" data-code=\"MH\">Marshall Islands<\/option><option  value=\"Martinique\" data-code=\"MQ\">Martinique<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mauritius\" data-code=\"MU\">Mauritius<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Mexico\" data-code=\"MX\">Mexico<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldova\" data-code=\"MD\">Moldova<\/option><option  value=\"Monaco\" data-code=\"MC\">Monaco<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Morocco\" data-code=\"MA\">Morocco<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Myanmar<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Netherlands\" data-code=\"NL\">Netherlands<\/option><option  value=\"New Caledonia\" data-code=\"NC\">New Caledonia<\/option><option  value=\"New Zealand\" data-code=\"NZ\">New Zealand<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Niger\" data-code=\"NE\">Niger<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Norfolk Island\" data-code=\"NF\">Norfolk Island<\/option><option  value=\"North Korea\" data-code=\"KP\">North Korea<\/option><option  value=\"Northern Mariana Islands\" data-code=\"MP\">Northern Mariana Islands<\/option><option  value=\"Norway\" data-code=\"NO\">Norway<\/option><option  value=\"Oman\" data-code=\"OM\">Oman<\/option><option  value=\"Pakistan\" data-code=\"PK\">Pakistan<\/option><option  value=\"Palau\" data-code=\"PW\">Palau<\/option><option  value=\"Palestine\">Palestine<\/option><option  value=\"Panama\" data-code=\"PA\">Panama<\/option><option  value=\"Papua New Guinea\" data-code=\"PG\">Papua New Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Peru\" data-code=\"PE\">Peru<\/option><option  value=\"Philippines\" data-code=\"PH\">Philippines<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Pitcairn<\/option><option  value=\"Poland\" data-code=\"PL\">Poland<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Qatar\" data-code=\"QA\">Qatar<\/option><option  value=\"Reunion\" data-code=\"RE\">Reunion<\/option><option  value=\"Romania\" data-code=\"RO\">Romania<\/option><option  value=\"Russia\" data-code=\"RU\">Russia<\/option><option  value=\"Rwanda\" data-code=\"RW\">Rwanda<\/option><option  value=\"Saint Barthelemy\" data-code=\"BL\">Saint Barthelemy<\/option><option  value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option  value=\"Saint Kitts and Nevis\" data-code=\"KN\">Saint Kitts and Nevis<\/option><option  value=\"Saint Lucia\" data-code=\"LC\">Saint Lucia<\/option><option  value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option  value=\"Saint Pierre and Miquelon\" data-code=\"PM\">Saint Pierre and Miquelon<\/option><option  value=\"Saint Vincent and the Grenadines\" data-code=\"VC\">Saint Vincent and the Grenadines<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"Sao Tome and Principe\" data-code=\"ST\">Sao Tome and Principe<\/option><option  value=\"Saudi Arabia\" data-code=\"SA\">Saudi Arabia<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leone\" data-code=\"SL\">Sierra Leone<\/option><option  value=\"Singapore\" data-code=\"SG\">Singapore<\/option><option  value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option  value=\"Slovakia\" data-code=\"SK\">Slovakia<\/option><option  value=\"Slovenia\" data-code=\"SI\">Slovenia<\/option><option  value=\"Solomon Islands\" data-code=\"SB\">Solomon Islands<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"South Africa\" data-code=\"ZA\">South Africa<\/option><option  value=\"South Georgia and the South Sandwich Islands\" data-code=\"GS\">South Georgia and the South Sandwich Islands<\/option><option  value=\"South Korea\" data-code=\"KR\">South Korea<\/option><option  value=\"South Sudan\" data-code=\"SS\">South Sudan<\/option><option  value=\"Spain\" data-code=\"ES\">Spain<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Sudan\" data-code=\"SD\">Sudan<\/option><option  value=\"Suriname\" data-code=\"SR\">Suriname<\/option><option  value=\"Svalbard and Jan Mayen\" data-code=\"SJ\">Svalbard and Jan Mayen<\/option><option  value=\"Swaziland\" data-code=\"SZ\">Swaziland<\/option><option  value=\"Sweden\" data-code=\"SE\">Sweden<\/option><option  value=\"Switzerland\" data-code=\"CH\">Switzerland<\/option><option  value=\"Syria\" data-code=\"SY\">Syria<\/option><option  value=\"Taiwan\" data-code=\"TW\">Taiwan<\/option><option  value=\"Tajikistan\" data-code=\"TJ\">Tajikistan<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Thailand\" data-code=\"TH\">Thailand<\/option><option  value=\"Timor-Leste\">Timor-Leste<\/option><option  value=\"Togo\" data-code=\"TG\">Togo<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad and Tobago\" data-code=\"TT\">Trinidad and Tobago<\/option><option  value=\"Tunisia\" data-code=\"TN\">Tunisia<\/option><option  value=\"Turkey\" data-code=\"TR\">Turkey<\/option><option  value=\"Turkmenistan\" data-code=\"TM\">Turkmenistan<\/option><option  value=\"Turks and Caicos Islands\" data-code=\"TC\">Turks and Caicos Islands<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Ukraine\" data-code=\"UA\">Ukraine<\/option><option  value=\"United Arab Emirates\" data-code=\"AE\">United Arab Emirates<\/option><option  value=\"United Kingdom\" data-code=\"GB\">United Kingdom<\/option><option  value=\"United States\" data-code=\"US\">United States<\/option><option  value=\"United States Minor Outlying Islands\" data-code=\"UM\">United States Minor Outlying Islands<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekistan\" data-code=\"UZ\">Uzbekistan<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Vatican City\">Vatican City<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Virgin Islands, British\">Virgin Islands, British<\/option><option  value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option  value=\"Wallis and Futuna\" data-code=\"WF\">Wallis and Futuna<\/option><option  value=\"Western Sahara\" data-code=\"EH\">Western Sahara<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabwe\" data-code=\"ZW\">Zimbabwe<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_781_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label id=\"field_247kd68fbc709ef_label\" class=\"frm_primary_label\" for=\"field_247kd68fbc709ef\">Yes, I would like to receive email updates. (You will be added to our mailing list)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[781][]\" id=\"field_247kd68fbc709ef\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t data-sectionid=\"783\"  data-invmsg=\"Yes, I would like to receive email updates. 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