{"id":5138,"date":"2024-05-07T01:38:24","date_gmt":"2024-05-07T06:38:24","guid":{"rendered":"https:\/\/chapters.theprimetimersww.com\/kansascity\/?page_id=5138"},"modified":"2026-04-04T11:02:14","modified_gmt":"2026-04-04T16:02:14","slug":"elementor-5138","status":"publish","type":"page","link":"https:\/\/chapters.theprimetimersww.com\/kansascity\/elementor-5138\/","title":{"rendered":"Membership Application"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5138\" class=\"elementor elementor-5138\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cb47a66 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cb47a66\" 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-d484607\" data-id=\"d484607\" 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-b78c71e elementor-widget elementor-widget-heading\" data-id=\"b78c71e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Welcome To The PTKC Membership Application Page<\/h1>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3867cc2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3867cc2\" 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-085e103\" data-id=\"085e103\" 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-3619622 elementor-widget elementor-widget-heading\" data-id=\"3619622\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">On this page you can:<\/h2>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7411110 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7411110\" 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-f0518ca\" data-id=\"f0518ca\" 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-2fad563 elementor-widget elementor-widget-text-editor\" data-id=\"2fad563\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><span style=\"color: #ff0000;\">\u25a0<\/span> <a href=\"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-content\/uploads\/2025\/10\/2026-Membership-Application-Individual.pdf\" target=\"_blank\" rel=\"noopener\">Download and print the paper version of the <span style=\"color: #ff0000;\"><strong>1 person Membership Application<\/strong><\/span> form<\/a>. Then you can complete the form and send it, along with your check for dues payment, by regular mail.<\/h5><h5><span style=\"color: #ff0000;\">\u25a0<\/span> <a href=\"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-content\/uploads\/2025\/10\/2026-Membership-Application-Couple.pdf\" target=\"_blank\" rel=\"noopener\">Download and print the paper version of the <strong><span style=\"color: #ff0000;\">2\u00a0person Membership Application<\/span><\/strong> form<\/a>. Then you can complete the form and send it, along with your check for dues payment, by regular mail.<\/h5>\t\t\t\t\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7893ece elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7893ece\" 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-a82c8b6\" data-id=\"a82c8b6\" 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-276e2d6 elementor-widget elementor-widget-text-editor\" data-id=\"276e2d6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #ff0000;\">\u25a0 <\/span>\u2193 Complete and submit the Online Membership Application Form Below \u2193<\/p>\t\t\t\t\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fa74b49 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fa74b49\" 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-67ab097\" data-id=\"67ab097\" 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-2764a72 elementor-widget__width-inherit elementor-widget elementor-widget-wpforms\" data-id=\"2764a72\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-2764a72\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-2764a72 {\n\t\t\t\t--wpforms-field-background-color: #FFF;\n--wpforms-field-size-input-height: 50px;\n--wpforms-field-size-input-spacing: 20px;\n--wpforms-field-size-font-size: 18px;\n--wpforms-field-size-line-height: 21px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 18px;\n--wpforms-field-size-sublabel-spacing: 10px;\n--wpforms-field-size-icon-size: 1.25;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-5276\"><form id=\"wpforms-form-5276\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"5276\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/kansascity\/wp-json\/wp\/v2\/pages\/5138?wpforms_form_id=5276\" data-token=\"ac660e6355b371cb5501cb213485afaf\" data-token-time=\"1780091526\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"12\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 12<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:8.3333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-5276-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"8\"><\/div><div id=\"wpforms-5276-field_83-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"83\"><div id=\"wpforms-5276-field_83\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_83-error\"><h1><strong><span style=\"color:#ff0000\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0New Member Application<\/span><\/strong><\/h1>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_80-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"80\"><div id=\"wpforms-5276-field_80\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_80-error\"><h6>You can use this form to submit a <span style=\"color:#ff0000\">New Member Application<\/span>, for 1 or 2 people.<\/h6>\n<p>Just answer the questions. The form will guide you through the process.<\/p>\n<p>When you select the \"Submit\" button at the end of the form, you will receive an email that will contain a copy of the information that you have submitted. It will also be submitted to PTKC. The email will be sent to the address that you entered in your \"email\" box.<\/p>\n<p>You will be sent to the Payments Options page, where you will then have the opportunity to pay online, or by check. Just select the appropriate button at the bottom of the page. You will be sent to the Stripe payments site where you can securely pay online, if you wish. Otherwise, you can send your dues, by check, using the US mail or hand it to a member of the Board.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_5-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Is This New Member Application for 1 person or 2 People? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_5_1\" name=\"wpforms[fields][5]\" value=\"1 person\" aria-errormessage=\"wpforms-5276-field_5_1-error\" aria-describedby=\"wpforms-5276-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_5_1\">1 person<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_5_2\" name=\"wpforms[fields][5]\" value=\"2 people\" aria-errormessage=\"wpforms-5276-field_5_2-error\" aria-describedby=\"wpforms-5276-field_5-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_5_2\">2 people<\/label><\/li><\/ul><div id=\"wpforms-5276-field_5-description\" class=\"wpforms-field-description\">Please choose one of the above<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_7-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"7\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-5276-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Your Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" aria-errormessage=\"wpforms-5276-field_6-error\" aria-describedby=\"wpforms-5276-field_6-description\" required><label for=\"wpforms-5276-field_6\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" aria-errormessage=\"wpforms-5276-field_6-last-error\" aria-describedby=\"wpforms-5276-field_6-description\" required><label for=\"wpforms-5276-field_6-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-5276-field_6-description\" class=\"wpforms-field-description\">Please enter your name. If you have a nickname, please place that in quotation marks with your first name.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_11-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_11\">Your Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5276-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" spellcheck=\"false\" aria-errormessage=\"wpforms-5276-field_11-error\" aria-describedby=\"wpforms-5276-field_11-description\" required><div id=\"wpforms-5276-field_11-description\" class=\"wpforms-field-description\">Please enter your full email address<\/div><\/div><div id=\"wpforms-5276-field_13-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_13\">Your Mobile Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5276-field_13\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][13]\" aria-label=\"Your Mobile Phone\" aria-errormessage=\"wpforms-5276-field_13-error\" aria-describedby=\"wpforms-5276-field_13-description\" required><div id=\"wpforms-5276-field_13-description\" class=\"wpforms-field-description\">Please enter your mobile phone number, area code first<\/div><\/div><div id=\"wpforms-5276-field_10-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"10\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Name For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_10\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][10][first]\" aria-errormessage=\"wpforms-5276-field_10-error\" aria-describedby=\"wpforms-5276-field_10-description\" required><label for=\"wpforms-5276-field_10\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_10-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][10][last]\" aria-errormessage=\"wpforms-5276-field_10-last-error\" aria-describedby=\"wpforms-5276-field_10-description\" required><label for=\"wpforms-5276-field_10-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-5276-field_10-description\" class=\"wpforms-field-description\">Please enter the name of person 2. If you have a nickname, please place that in quotation marks with your first name.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_1-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"1\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_1\">Email 2 For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5276-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-5276-field_1-error\" aria-describedby=\"wpforms-5276-field_1-description\" required><div id=\"wpforms-5276-field_1-description\" class=\"wpforms-field-description\">Please enter the full email address for person 2<\/div><\/div><div id=\"wpforms-5276-field_14-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_14\">Mobile Phone For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5276-field_14\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][14]\" aria-label=\"Mobile Phone For Person 2\" aria-errormessage=\"wpforms-5276-field_14-error\" aria-describedby=\"wpforms-5276-field_14-description\" required><div id=\"wpforms-5276-field_14-description\" class=\"wpforms-field-description\">Please enter the mobile phone number for person 2, area code first<\/div><\/div><div id=\"wpforms-5276-field_15-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_15\">Home Phone<\/label><input type=\"tel\" id=\"wpforms-5276-field_15\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][15]\" aria-label=\"Home Phone\" aria-errormessage=\"wpforms-5276-field_15-error\" aria-describedby=\"wpforms-5276-field_15-description\" ><div id=\"wpforms-5276-field_15-description\" class=\"wpforms-field-description\">If you have a home phone number, please enter it here, area code first.<\/div><\/div><div id=\"wpforms-5276-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"16\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-5276-field_17-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Your Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5276-field_17\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][17][address1]\" aria-errormessage=\"wpforms-5276-field_17-error\" aria-describedby=\"wpforms-5276-field_17-description\" required><label for=\"wpforms-5276-field_17\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5276-field_17-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][17][address2]\" aria-errormessage=\"wpforms-5276-field_17-address2-error\" aria-describedby=\"wpforms-5276-field_17-description\" ><label for=\"wpforms-5276-field_17-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5276-field_17-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][17][city]\" aria-errormessage=\"wpforms-5276-field_17-city-error\" aria-describedby=\"wpforms-5276-field_17-description\" required><label for=\"wpforms-5276-field_17-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5276-field_17-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][17][state]\" aria-errormessage=\"wpforms-5276-field_17-state-error\" aria-describedby=\"wpforms-5276-field_17-description\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><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-5276-field_17-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5276-field_17-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][17][postal]\" aria-errormessage=\"wpforms-5276-field_17-postal-error\" aria-describedby=\"wpforms-5276-field_17-description\" required><label for=\"wpforms-5276-field_17-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div id=\"wpforms-5276-field_17-description\" class=\"wpforms-field-description\">Please complete the above information<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"18\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Do both of you live at the same address? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" aria-errormessage=\"wpforms-5276-field_18_1-error\" aria-describedby=\"wpforms-5276-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" aria-errormessage=\"wpforms-5276-field_18_2-error\" aria-describedby=\"wpforms-5276-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_18_2\">No<\/label><\/li><\/ul><div id=\"wpforms-5276-field_18-description\" class=\"wpforms-field-description\">Please select the appropriate response<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_19-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"19\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Address For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5276-field_19\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][19][address1]\" aria-errormessage=\"wpforms-5276-field_19-error\" aria-describedby=\"wpforms-5276-field_19-description\" required><label for=\"wpforms-5276-field_19\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5276-field_19-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][19][address2]\" aria-errormessage=\"wpforms-5276-field_19-address2-error\" aria-describedby=\"wpforms-5276-field_19-description\" ><label for=\"wpforms-5276-field_19-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5276-field_19-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][19][city]\" aria-errormessage=\"wpforms-5276-field_19-city-error\" aria-describedby=\"wpforms-5276-field_19-description\" required><label for=\"wpforms-5276-field_19-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5276-field_19-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][19][state]\" aria-errormessage=\"wpforms-5276-field_19-state-error\" aria-describedby=\"wpforms-5276-field_19-description\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><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-5276-field_19-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5276-field_19-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][19][postal]\" aria-errormessage=\"wpforms-5276-field_19-postal-error\" aria-describedby=\"wpforms-5276-field_19-description\" required><label for=\"wpforms-5276-field_19-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div id=\"wpforms-5276-field_19-description\" class=\"wpforms-field-description\">Please complete the above information for Person 2<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_21-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Your Birthday <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][21][date][m]\" id=\"wpforms-5276-field_21-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><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><\/select><select name=\"wpforms[fields][21][date][d]\" id=\"wpforms-5276-field_21-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><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><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][21][date][y]\" id=\"wpforms-5276-field_21-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-5276-field_21-description\" class=\"wpforms-field-description\">Please enter your birthday<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_22-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"22\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Birthday For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][22][date][m]\" id=\"wpforms-5276-field_22-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><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><\/select><select name=\"wpforms[fields][22][date][d]\" id=\"wpforms-5276-field_22-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><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><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][22][date][y]\" id=\"wpforms-5276-field_22-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-5276-field_22-description\" class=\"wpforms-field-description\">Please enter the birthday for person 2<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_23-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Are You Married or Do You Have a Partner? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes, I am married\" aria-errormessage=\"wpforms-5276-field_23_1-error\" aria-describedby=\"wpforms-5276-field_23-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_23_1\">Yes, I am married<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_23_2\" name=\"wpforms[fields][23]\" value=\"No, I am not married\" aria-errormessage=\"wpforms-5276-field_23_2-error\" aria-describedby=\"wpforms-5276-field_23-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_23_2\">No, I am not married<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_23_5\" name=\"wpforms[fields][23]\" value=\"Yes, I have a partner\" aria-errormessage=\"wpforms-5276-field_23_5-error\" aria-describedby=\"wpforms-5276-field_23-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_23_5\">Yes, I have a partner<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_23_4\" name=\"wpforms[fields][23]\" value=\"No, I do not have a partner\" aria-errormessage=\"wpforms-5276-field_23_4-error\" aria-describedby=\"wpforms-5276-field_23-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_23_4\">No, I do not have a partner<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_23_6\" name=\"wpforms[fields][23]\" value=\"I neither have a partner nor am I married\" aria-errormessage=\"wpforms-5276-field_23_6-error\" aria-describedby=\"wpforms-5276-field_23-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_23_6\">I neither have a partner nor am I married<\/label><\/li><\/ul><div id=\"wpforms-5276-field_23-description\" class=\"wpforms-field-description\">Please select one answer<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_24-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"24\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Anniversary Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][24][date][m]\" id=\"wpforms-5276-field_24-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><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><\/select><select name=\"wpforms[fields][24][date][d]\" id=\"wpforms-5276-field_24-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><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><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][24][date][y]\" id=\"wpforms-5276-field_24-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-5276-field_24-description\" class=\"wpforms-field-description\">Please enter your anniversary date<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_25-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_25\">Please Enter Your Husband or Partner&#039;s Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_25\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-5276-field_25-error\" aria-describedby=\"wpforms-5276-field_25-description\" required><div id=\"wpforms-5276-field_25-description\" class=\"wpforms-field-description\">Enter your husband or partner's name<\/div><\/div><div id=\"wpforms-5276-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_26\">Your Occupation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_26\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-5276-field_26-error\" aria-describedby=\"wpforms-5276-field_26-description\" required><div id=\"wpforms-5276-field_26-description\" class=\"wpforms-field-description\">Please enter your current or previous life's work<\/div><\/div><div id=\"wpforms-5276-field_27-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">I am ... <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_27_1\" name=\"wpforms[fields][27]\" value=\"Currently working\" aria-errormessage=\"wpforms-5276-field_27_1-error\" aria-describedby=\"wpforms-5276-field_27-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_27_1\">Currently working<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_27_2\" name=\"wpforms[fields][27]\" value=\"Semi-retired\" aria-errormessage=\"wpforms-5276-field_27_2-error\" aria-describedby=\"wpforms-5276-field_27-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_27_2\">Semi-retired<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_27_3\" name=\"wpforms[fields][27]\" value=\"Retired\" aria-errormessage=\"wpforms-5276-field_27_3-error\" aria-describedby=\"wpforms-5276-field_27-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_27_3\">Retired<\/label><\/li><\/ul><div id=\"wpforms-5276-field_27-description\" class=\"wpforms-field-description\">Please enter your current work status<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_28\">Occupation For Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_28\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-5276-field_28-error\" aria-describedby=\"wpforms-5276-field_28-description\" required><div id=\"wpforms-5276-field_28-description\" class=\"wpforms-field-description\">Please enter the current or previous life's work for Person 2<\/div><\/div><div id=\"wpforms-5276-field_29-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"29\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Person 2 is... <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_29\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_29_1\" name=\"wpforms[fields][29]\" value=\"Currently working\" aria-errormessage=\"wpforms-5276-field_29_1-error\" aria-describedby=\"wpforms-5276-field_29-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_29_1\">Currently working<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_29_2\" name=\"wpforms[fields][29]\" value=\"Semi-retired\" aria-errormessage=\"wpforms-5276-field_29_2-error\" aria-describedby=\"wpforms-5276-field_29-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_29_2\">Semi-retired<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_29_3\" name=\"wpforms[fields][29]\" value=\"Retired\" aria-errormessage=\"wpforms-5276-field_29_3-error\" aria-describedby=\"wpforms-5276-field_29-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_29_3\">Retired<\/label><\/li><\/ul><div id=\"wpforms-5276-field_29-description\" class=\"wpforms-field-description\">Please enter the current work status for person 2<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_30-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"30\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-5276-field_31-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"31\"><div id=\"wpforms-5276-field_31\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_31-error\"><h4>At PTKC privacy is very important to us and we take it\u00a0 very seriously. We do not share this information with, nor distribute it to, any other organization. The Membership Directory is distributed only to other PTKC members. The Membership Directory is published once a year and occasionally updated. Electronic copies, including updates, are distributed directly to our members, via email, and posted in the password protected, Members Only portion of our website. Your last name will not be listed in the newsletter, only your last initial.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_32-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">Your Privacy Choices <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_32\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_32_1\" name=\"wpforms[fields][32]\" value=\"I wish to be listed normally, with all information\" aria-errormessage=\"wpforms-5276-field_32_1-error\" aria-describedby=\"wpforms-5276-field_32-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_32_1\">I wish to be listed normally, with all information<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_32_2\" name=\"wpforms[fields][32]\" value=\"Please list me, but with the following restrictions\" aria-errormessage=\"wpforms-5276-field_32_2-error\" aria-describedby=\"wpforms-5276-field_32-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_32_2\">Please list me, but with the following restrictions<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_32_3\" name=\"wpforms[fields][32]\" value=\"I do not wish to be listed in the directory (not recommended)\" aria-errormessage=\"wpforms-5276-field_32_3-error\" aria-describedby=\"wpforms-5276-field_32-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_32_3\">I do not wish to be listed in the directory (not recommended)<\/label><\/li><\/ul><div id=\"wpforms-5276-field_32-description\" class=\"wpforms-field-description\">Please select one<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_33-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"33\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Restriction Choices (click all that apply). List me in the PTKC Directory, but do not include:<\/legend><ul id=\"wpforms-5276-field_33\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_33_1\" name=\"wpforms[fields][33][]\" value=\"Last Name, use the initial of my last name only\" aria-errormessage=\"wpforms-5276-field_33_1-error\" aria-describedby=\"wpforms-5276-field_33-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_33_1\">Last Name, use the initial of my last name only<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_33_2\" name=\"wpforms[fields][33][]\" value=\"Street Address\" aria-errormessage=\"wpforms-5276-field_33_2-error\" aria-describedby=\"wpforms-5276-field_33-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_33_2\">Street Address<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_33_3\" name=\"wpforms[fields][33][]\" value=\"City and State\" aria-errormessage=\"wpforms-5276-field_33_3-error\" aria-describedby=\"wpforms-5276-field_33-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_33_3\">City and State<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_33_4\" name=\"wpforms[fields][33][]\" value=\"Phone Number(s)\" aria-errormessage=\"wpforms-5276-field_33_4-error\" aria-describedby=\"wpforms-5276-field_33-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_33_4\">Phone Number(s)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_33_5\" name=\"wpforms[fields][33][]\" value=\"Email Address.\" aria-errormessage=\"wpforms-5276-field_33_5-error\" aria-describedby=\"wpforms-5276-field_33-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_33_5\">Email Address.<\/label><\/li><\/ul><div id=\"wpforms-5276-field_33-description\" class=\"wpforms-field-description\">Please select all that apply<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_34-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"34\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Privacy Choices for Person 2 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_34_1\" name=\"wpforms[fields][34]\" value=\"I wish to be listed normally, with all information\" aria-errormessage=\"wpforms-5276-field_34_1-error\" aria-describedby=\"wpforms-5276-field_34-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_34_1\">I wish to be listed normally, with all information<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_34_2\" name=\"wpforms[fields][34]\" value=\"Please list me, but with the following restrictions\" aria-errormessage=\"wpforms-5276-field_34_2-error\" aria-describedby=\"wpforms-5276-field_34-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_34_2\">Please list me, but with the following restrictions<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_34_3\" name=\"wpforms[fields][34]\" value=\"I do not wish to be listed in the directory (not recommended)\" aria-errormessage=\"wpforms-5276-field_34_3-error\" aria-describedby=\"wpforms-5276-field_34-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_34_3\">I do not wish to be listed in the directory (not recommended)<\/label><\/li><\/ul><div id=\"wpforms-5276-field_34-description\" class=\"wpforms-field-description\">Please select one<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_35-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"35\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Restriction Choices for Person 2 (click all that apply). List me in the PTKC Directory, but do not include: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_35_1\" name=\"wpforms[fields][35][]\" value=\"Last Name, use the initial of my last name only\" aria-errormessage=\"wpforms-5276-field_35_1-error\" aria-describedby=\"wpforms-5276-field_35-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_35_1\">Last Name, use the initial of my last name only<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_35_2\" name=\"wpforms[fields][35][]\" value=\"Street Address\" aria-errormessage=\"wpforms-5276-field_35_2-error\" aria-describedby=\"wpforms-5276-field_35-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_35_2\">Street Address<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_35_3\" name=\"wpforms[fields][35][]\" value=\"City and State\" aria-errormessage=\"wpforms-5276-field_35_3-error\" aria-describedby=\"wpforms-5276-field_35-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_35_3\">City and State<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_35_4\" name=\"wpforms[fields][35][]\" value=\"Phone Number(s)\" aria-errormessage=\"wpforms-5276-field_35_4-error\" aria-describedby=\"wpforms-5276-field_35-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_35_4\">Phone Number(s)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_35_5\" name=\"wpforms[fields][35][]\" value=\"Email Address.\" aria-errormessage=\"wpforms-5276-field_35_5-error\" aria-describedby=\"wpforms-5276-field_35-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_35_5\">Email Address.<\/label><\/li><\/ul><div id=\"wpforms-5276-field_35-description\" class=\"wpforms-field-description\">Please select all that apply<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_36-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"36\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-5276-field_37-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"37\"><fieldset><legend class=\"wpforms-field-label\">Your Picture: Do you want Your Picture To appear in the PTKC Membership Directory? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_37\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_37_1\" name=\"wpforms[fields][37][]\" value=\"Yes, I would like to send 1 or two pictures to use in the PTKC Directory (.png or .jpg only please).\" aria-errormessage=\"wpforms-5276-field_37_1-error\" aria-describedby=\"wpforms-5276-field_37-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_37_1\">Yes, I would like to send 1 or two pictures to use in the PTKC Directory (.png or .jpg only please).<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_37_2\" name=\"wpforms[fields][37][]\" value=\"Yes, I want my picture included in the PTKC Directory, but I don&#039;t want to send a picture at this time. Or, you can use the picture that I have already sent  to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimerskc@gmail.com) (.png or .jpg only please).\" aria-errormessage=\"wpforms-5276-field_37_2-error\" aria-describedby=\"wpforms-5276-field_37-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_37_2\">Yes, I want my picture included in the PTKC Directory, but I don't want to send a picture at this time. Or, you can use the picture that I have already sent  to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimerskc@gmail.com) (.png or .jpg only please).<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_37_3\" name=\"wpforms[fields][37][]\" value=\"No, I do not want my picture included in the directory.\" aria-errormessage=\"wpforms-5276-field_37_3-error\" aria-describedby=\"wpforms-5276-field_37-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_37_3\">No, I do not want my picture included in the directory.<\/label><\/li><\/ul><div id=\"wpforms-5276-field_37-description\" class=\"wpforms-field-description\">Please select the one answer that applies to you. Most PTKC members include their picture in the roster.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_39-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"39\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Picture For person 2: Do you want Your Picture To appear in the PTKC Membership Directory?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_39\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_39_1\" name=\"wpforms[fields][39][]\" value=\"Yes, I would like to send 1 or two pictures to use in the PTKC Directory\" aria-errormessage=\"wpforms-5276-field_39_1-error\" aria-describedby=\"wpforms-5276-field_39-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_39_1\">Yes, I would like to send 1 or two pictures to use in the PTKC Directory<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_39_2\" name=\"wpforms[fields][39][]\" value=\"Yes, I want my picture included in the PTKC Directory, but I don&#039;t want to send a picture at this time. Or, you can use the picture that I have already sent  to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimeerskc@gmail.com;.\" aria-errormessage=\"wpforms-5276-field_39_2-error\" aria-describedby=\"wpforms-5276-field_39-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_39_2\">Yes, I want my picture included in the PTKC Directory, but I don't want to send a picture at this time. Or, you can use the picture that I have already sent  to PTKC. (Note: You can send a picture later, if you wish. Send it to primetimeerskc@gmail.com;.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_39_3\" name=\"wpforms[fields][39][]\" value=\"No, I do not want my picture included in the directory.\" aria-errormessage=\"wpforms-5276-field_39_3-error\" aria-describedby=\"wpforms-5276-field_39-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_39_3\">No, I do not want my picture included in the directory.<\/label><\/li><\/ul><div id=\"wpforms-5276-field_39-description\" class=\"wpforms-field-description\">Please select the one answer that applies to you.  Most PTKC members include their picture in the roster.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_42-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"42\"><div id=\"wpforms-5276-field_42\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_42-error\"><h4>PTKC Newsletter: Copies of our newsletter may be shared with other PrimeTimer chapters and may be distributed at other places for publicity or member recruitment. Last names are always omitted from our website, newsletter, and Facebook page. We only use last ititials.<\/h4>\n<h4>Note: If you do not want your picture to appear in the newsletter, on the website, or on the our Facebook page, please inform the photographer at the time the picture is taken.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_79-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"file-upload\" data-field-id=\"79\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_79\">File Upload<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"79\"\n\t\tdata-form-id=\"5276\"\n\t\tdata-input-name=\"wpforms_5276_79\"\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,jpg\"\n\t\tdata-max-size=\"5242880\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"1073741824\"\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 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/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\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\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-5276-field_79\"\n\t\tname=\"wpforms_5276_79\" \t\tvalue=\"\">\n<div id=\"wpforms-5276-field_79-description\" class=\"wpforms-field-description\">Please upload  up to 4 picture files here.<\/div><\/div><div id=\"wpforms-5276-field_41-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"41\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-5276-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">How Did You Learn About PTKC? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_43_1\" name=\"wpforms[fields][43]\" value=\"I was referred by someone\" aria-errormessage=\"wpforms-5276-field_43_1-error\" aria-describedby=\"wpforms-5276-field_43-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_43_1\">I was referred by someone<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_43_2\" name=\"wpforms[fields][43]\" value=\"Web search\" aria-errormessage=\"wpforms-5276-field_43_2-error\" aria-describedby=\"wpforms-5276-field_43-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_43_2\">Web search<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_43_3\" name=\"wpforms[fields][43]\" value=\"Advertisement\" aria-errormessage=\"wpforms-5276-field_43_3-error\" aria-describedby=\"wpforms-5276-field_43-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_43_3\">Advertisement<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_43_4\" name=\"wpforms[fields][43]\" value=\"Other\" aria-errormessage=\"wpforms-5276-field_43_4-error\" aria-describedby=\"wpforms-5276-field_43-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_43_4\">Other<\/label><\/li><\/ul><div id=\"wpforms-5276-field_43-description\" class=\"wpforms-field-description\">Please select one<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_45-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"45\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_45\">Who Referred You To PTKC? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_45\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-5276-field_45-error\" aria-describedby=\"wpforms-5276-field_45-description\" required><div id=\"wpforms-5276-field_45-description\" class=\"wpforms-field-description\">Please enter the name of the person that referred you<\/div><\/div><div id=\"wpforms-5276-field_44-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_44\">You Selected &quot;Other&quot; Referral Above,  Please Specify. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_44\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-5276-field_44-error\" aria-describedby=\"wpforms-5276-field_44-description\" required><div id=\"wpforms-5276-field_44-description\" class=\"wpforms-field-description\">Please Enter the \"Other\" Information<\/div><\/div><div id=\"wpforms-5276-field_46-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"46\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"6\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-5276-field_47-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"47\"><div id=\"wpforms-5276-field_47\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_47-error\"><h4><span style=\"font-size:16px\">PTKC has many activities of interest for our members. Here are some current activities. Please check those that interest you or suggest other interest(s).<\/span><\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_48-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"48\"><fieldset><legend class=\"wpforms-field-label\">Your Interests: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_48\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_1\" name=\"wpforms[fields][48][]\" value=\"Antiques\" aria-errormessage=\"wpforms-5276-field_48_1-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_1\">Antiques<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_2\" name=\"wpforms[fields][48][]\" value=\"Architecture\" aria-errormessage=\"wpforms-5276-field_48_2-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_2\">Architecture<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_3\" name=\"wpforms[fields][48][]\" value=\"Art\" aria-errormessage=\"wpforms-5276-field_48_3-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_3\">Art<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_7\" name=\"wpforms[fields][48][]\" value=\"Ballet\" aria-errormessage=\"wpforms-5276-field_48_7-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_7\">Ballet<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_6\" name=\"wpforms[fields][48][]\" value=\"Bicycling\" aria-errormessage=\"wpforms-5276-field_48_6-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_6\">Bicycling<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_5\" name=\"wpforms[fields][48][]\" value=\"Book Group\" aria-errormessage=\"wpforms-5276-field_48_5-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_5\">Book Group<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_4\" name=\"wpforms[fields][48][]\" value=\"Bowling\" aria-errormessage=\"wpforms-5276-field_48_4-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_4\">Bowling<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_15\" name=\"wpforms[fields][48][]\" value=\"Bridge\" aria-errormessage=\"wpforms-5276-field_48_15-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_15\">Bridge<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_14\" name=\"wpforms[fields][48][]\" value=\"Computers\" aria-errormessage=\"wpforms-5276-field_48_14-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_14\">Computers<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_13\" name=\"wpforms[fields][48][]\" value=\"Concerts\" aria-errormessage=\"wpforms-5276-field_48_13-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_13\">Concerts<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_12\" name=\"wpforms[fields][48][]\" value=\"Cooking\" aria-errormessage=\"wpforms-5276-field_48_12-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_12\">Cooking<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_11\" name=\"wpforms[fields][48][]\" value=\"Dancing\" aria-errormessage=\"wpforms-5276-field_48_11-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_11\">Dancing<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_10\" name=\"wpforms[fields][48][]\" value=\"Dining Out\" aria-errormessage=\"wpforms-5276-field_48_10-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_10\">Dining Out<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_9\" name=\"wpforms[fields][48][]\" value=\"Dominoes\" aria-errormessage=\"wpforms-5276-field_48_9-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_9\">Dominoes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_8\" name=\"wpforms[fields][48][]\" value=\"Flea Market\" aria-errormessage=\"wpforms-5276-field_48_8-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_8\">Flea Market<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_23\" name=\"wpforms[fields][48][]\" value=\"Gardening\" aria-errormessage=\"wpforms-5276-field_48_23-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_23\">Gardening<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_22\" name=\"wpforms[fields][48][]\" value=\"Hearts\" aria-errormessage=\"wpforms-5276-field_48_22-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_22\">Hearts<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_21\" name=\"wpforms[fields][48][]\" value=\"Movies\" aria-errormessage=\"wpforms-5276-field_48_21-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_21\">Movies<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_20\" name=\"wpforms[fields][48][]\" value=\"Museums\" aria-errormessage=\"wpforms-5276-field_48_20-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_20\">Museums<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_19\" name=\"wpforms[fields][48][]\" value=\"Opera\" aria-errormessage=\"wpforms-5276-field_48_19-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_19\">Opera<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_18\" name=\"wpforms[fields][48][]\" value=\"Photography\" aria-errormessage=\"wpforms-5276-field_48_18-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_18\">Photography<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_17\" name=\"wpforms[fields][48][]\" value=\"Pickleball\" aria-errormessage=\"wpforms-5276-field_48_17-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_17\">Pickleball<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_29\" name=\"wpforms[fields][48][]\" value=\"Pinochle\" aria-errormessage=\"wpforms-5276-field_48_29-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_29\">Pinochle<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_28\" name=\"wpforms[fields][48][]\" value=\"Poker\" aria-errormessage=\"wpforms-5276-field_48_28-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_28\">Poker<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_27\" name=\"wpforms[fields][48][]\" value=\"Potluck\" aria-errormessage=\"wpforms-5276-field_48_27-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_27\">Potluck<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_25\" name=\"wpforms[fields][48][]\" value=\"Swimming\" aria-errormessage=\"wpforms-5276-field_48_25-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_25\">Swimming<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_24\" name=\"wpforms[fields][48][]\" value=\"Sports\" aria-errormessage=\"wpforms-5276-field_48_24-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_24\">Sports<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_16\" name=\"wpforms[fields][48][]\" value=\"Theatre\" aria-errormessage=\"wpforms-5276-field_48_16-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_16\">Theatre<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_33\" name=\"wpforms[fields][48][]\" value=\"Travel\" aria-errormessage=\"wpforms-5276-field_48_33-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_33\">Travel<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_32\" name=\"wpforms[fields][48][]\" value=\"Walking\" aria-errormessage=\"wpforms-5276-field_48_32-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_32\">Walking<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_31\" name=\"wpforms[fields][48][]\" value=\"Wine\" aria-errormessage=\"wpforms-5276-field_48_31-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_31\">Wine<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_48_30\" name=\"wpforms[fields][48][]\" value=\"Other\" aria-errormessage=\"wpforms-5276-field_48_30-error\" aria-describedby=\"wpforms-5276-field_48-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_48_30\">Other<\/label><\/li><\/ul><div id=\"wpforms-5276-field_48-description\" class=\"wpforms-field-description\">Please select all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_50-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"50\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_50\">Your Other Interests: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_50\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-5276-field_50-error\" aria-describedby=\"wpforms-5276-field_50-description\" required><div id=\"wpforms-5276-field_50-description\" class=\"wpforms-field-description\">Please specify<\/div><\/div><div id=\"wpforms-5276-field_49-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"49\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Person 2 Interests:<\/legend><ul id=\"wpforms-5276-field_49\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_1\" name=\"wpforms[fields][49][]\" value=\"Antiques\" aria-errormessage=\"wpforms-5276-field_49_1-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_1\">Antiques<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_2\" name=\"wpforms[fields][49][]\" value=\"Architecture\" aria-errormessage=\"wpforms-5276-field_49_2-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_2\">Architecture<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_3\" name=\"wpforms[fields][49][]\" value=\"Art\" aria-errormessage=\"wpforms-5276-field_49_3-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_3\">Art<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_7\" name=\"wpforms[fields][49][]\" value=\"Ballet\" aria-errormessage=\"wpforms-5276-field_49_7-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_7\">Ballet<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_6\" name=\"wpforms[fields][49][]\" value=\"Bicycling\" aria-errormessage=\"wpforms-5276-field_49_6-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_6\">Bicycling<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_5\" name=\"wpforms[fields][49][]\" value=\"Book Group\" aria-errormessage=\"wpforms-5276-field_49_5-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_5\">Book Group<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_4\" name=\"wpforms[fields][49][]\" value=\"Bowling\" aria-errormessage=\"wpforms-5276-field_49_4-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_4\">Bowling<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_15\" name=\"wpforms[fields][49][]\" value=\"Bridge\" aria-errormessage=\"wpforms-5276-field_49_15-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_15\">Bridge<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_14\" name=\"wpforms[fields][49][]\" value=\"Computers\" aria-errormessage=\"wpforms-5276-field_49_14-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_14\">Computers<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_13\" name=\"wpforms[fields][49][]\" value=\"Concerts\" aria-errormessage=\"wpforms-5276-field_49_13-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_13\">Concerts<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_12\" name=\"wpforms[fields][49][]\" value=\"Cooking\" aria-errormessage=\"wpforms-5276-field_49_12-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_12\">Cooking<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_11\" name=\"wpforms[fields][49][]\" value=\"Dancing\" aria-errormessage=\"wpforms-5276-field_49_11-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_11\">Dancing<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_10\" name=\"wpforms[fields][49][]\" value=\"Dining Out\" aria-errormessage=\"wpforms-5276-field_49_10-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_10\">Dining Out<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_9\" name=\"wpforms[fields][49][]\" value=\"Dominoes\" aria-errormessage=\"wpforms-5276-field_49_9-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_9\">Dominoes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_8\" name=\"wpforms[fields][49][]\" value=\"Flea Market\" aria-errormessage=\"wpforms-5276-field_49_8-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_8\">Flea Market<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_23\" name=\"wpforms[fields][49][]\" value=\"Gardening\" aria-errormessage=\"wpforms-5276-field_49_23-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_23\">Gardening<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_22\" name=\"wpforms[fields][49][]\" value=\"Hearts\" aria-errormessage=\"wpforms-5276-field_49_22-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_22\">Hearts<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_21\" name=\"wpforms[fields][49][]\" value=\"Movies\" aria-errormessage=\"wpforms-5276-field_49_21-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_21\">Movies<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_20\" name=\"wpforms[fields][49][]\" value=\"Museums\" aria-errormessage=\"wpforms-5276-field_49_20-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_20\">Museums<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_19\" name=\"wpforms[fields][49][]\" value=\"Opera\" aria-errormessage=\"wpforms-5276-field_49_19-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_19\">Opera<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_18\" name=\"wpforms[fields][49][]\" value=\"Photography\" aria-errormessage=\"wpforms-5276-field_49_18-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_18\">Photography<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_17\" name=\"wpforms[fields][49][]\" value=\"Pickleball\" aria-errormessage=\"wpforms-5276-field_49_17-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_17\">Pickleball<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_29\" name=\"wpforms[fields][49][]\" value=\"Pinochle\" aria-errormessage=\"wpforms-5276-field_49_29-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_29\">Pinochle<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_28\" name=\"wpforms[fields][49][]\" value=\"Poker\" aria-errormessage=\"wpforms-5276-field_49_28-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_28\">Poker<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_27\" name=\"wpforms[fields][49][]\" value=\"Potluck\" aria-errormessage=\"wpforms-5276-field_49_27-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_27\">Potluck<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_26\" name=\"wpforms[fields][49][]\" value=\"Social Nudism\" aria-errormessage=\"wpforms-5276-field_49_26-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_26\">Social Nudism<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_25\" name=\"wpforms[fields][49][]\" value=\"Swimming\" aria-errormessage=\"wpforms-5276-field_49_25-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_25\">Swimming<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_24\" name=\"wpforms[fields][49][]\" value=\"Sports\" aria-errormessage=\"wpforms-5276-field_49_24-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_24\">Sports<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_16\" name=\"wpforms[fields][49][]\" value=\"Theatre\" aria-errormessage=\"wpforms-5276-field_49_16-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_16\">Theatre<\/label><\/li><li class=\"choice-33 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_33\" name=\"wpforms[fields][49][]\" value=\"Travel\" aria-errormessage=\"wpforms-5276-field_49_33-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_33\">Travel<\/label><\/li><li class=\"choice-32 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_32\" name=\"wpforms[fields][49][]\" value=\"Walking\" aria-errormessage=\"wpforms-5276-field_49_32-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_32\">Walking<\/label><\/li><li class=\"choice-31 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_31\" name=\"wpforms[fields][49][]\" value=\"Wine\" aria-errormessage=\"wpforms-5276-field_49_31-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_31\">Wine<\/label><\/li><li class=\"choice-30 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_49_30\" name=\"wpforms[fields][49][]\" value=\"Other\" aria-errormessage=\"wpforms-5276-field_49_30-error\" aria-describedby=\"wpforms-5276-field_49-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_49_30\">Other<\/label><\/li><\/ul><div id=\"wpforms-5276-field_49-description\" class=\"wpforms-field-description\">Please select all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_52-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_52\">Person 2 Other Interests: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_52\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][52]\" aria-errormessage=\"wpforms-5276-field_52-error\" aria-describedby=\"wpforms-5276-field_52-description\" required><div id=\"wpforms-5276-field_52-description\" class=\"wpforms-field-description\">Please specify \"Other\" interests<\/div><\/div><div id=\"wpforms-5276-field_53-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"53\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"7\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"7\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-5276-field_54-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"54\"><div id=\"wpforms-5276-field_54\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_54-error\"><h4>PTKC is an all volunteer organization. Therefore, we need everyone's help for many of our activities. While PTKC has a Board of Directors who plan many of our activities, we couldn't operate without other members pitching in and helping. How are you willing to help?<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_55-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Your Volunteer Preferences: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_55\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_1\" name=\"wpforms[fields][55][]\" value=\"Host a PTKC event\" aria-errormessage=\"wpforms-5276-field_55_1-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_1\">Host a PTKC event<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_2\" name=\"wpforms[fields][55][]\" value=\"Organize an event\" aria-errormessage=\"wpforms-5276-field_55_2-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_2\">Organize an event<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_3\" name=\"wpforms[fields][55][]\" value=\"Help at an event\" aria-errormessage=\"wpforms-5276-field_55_3-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_3\">Help at an event<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_7\" name=\"wpforms[fields][55][]\" value=\"Serve on a committee\" aria-errormessage=\"wpforms-5276-field_55_7-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_7\">Serve on a committee<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_6\" name=\"wpforms[fields][55][]\" value=\"Serve on the Board\" aria-errormessage=\"wpforms-5276-field_55_6-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_6\">Serve on the Board<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_5\" name=\"wpforms[fields][55][]\" value=\"Serve as the Webmaster\" aria-errormessage=\"wpforms-5276-field_55_5-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_5\">Serve as the Webmaster<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_4\" name=\"wpforms[fields][55][]\" value=\"Serve as the Newsletter Editor\" aria-errormessage=\"wpforms-5276-field_55_4-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_4\">Serve as the Newsletter Editor<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_9\" name=\"wpforms[fields][55][]\" value=\"Be profiled in the Newsletter\" aria-errormessage=\"wpforms-5276-field_55_9-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_9\">Be profiled in the Newsletter<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_8\" name=\"wpforms[fields][55][]\" value=\"I have a car and am willing to help other members without transportation\" aria-errormessage=\"wpforms-5276-field_55_8-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_8\">I have a car and am willing to help other members without transportation<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_55_10\" name=\"wpforms[fields][55][]\" value=\"Other\" aria-errormessage=\"wpforms-5276-field_55_10-error\" aria-describedby=\"wpforms-5276-field_55-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_55_10\">Other<\/label><\/li><\/ul><div id=\"wpforms-5276-field_55-description\" class=\"wpforms-field-description\">Please check all that apply<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_58-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"58\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_58\">In what other way(s) would you like to help? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_58\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-5276-field_58-error\" aria-describedby=\"wpforms-5276-field_58-description\" required><div id=\"wpforms-5276-field_58-description\" class=\"wpforms-field-description\">Specify your choice(s)<\/div><\/div><div id=\"wpforms-5276-field_59-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"59\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Committee Preferences: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_1\" name=\"wpforms[fields][59][]\" value=\"Care Committee\" aria-errormessage=\"wpforms-5276-field_59_1-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_1\">Care Committee<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_2\" name=\"wpforms[fields][59][]\" value=\"Events Committee\" aria-errormessage=\"wpforms-5276-field_59_2-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_2\">Events Committee<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_3\" name=\"wpforms[fields][59][]\" value=\"Financial Audit Committee\" aria-errormessage=\"wpforms-5276-field_59_3-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_3\">Financial Audit Committee<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_5\" name=\"wpforms[fields][59][]\" value=\"Nominating Committee\" aria-errormessage=\"wpforms-5276-field_59_5-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_5\">Nominating Committee<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_4\" name=\"wpforms[fields][59][]\" value=\"Website Committee\" aria-errormessage=\"wpforms-5276-field_59_4-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_4\">Website Committee<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_59_6\" name=\"wpforms[fields][59][]\" value=\"I am not interested in serving on any committies\" aria-errormessage=\"wpforms-5276-field_59_6-error\" aria-describedby=\"wpforms-5276-field_59-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_59_6\">I am not interested in serving on any committies<\/label><\/li><\/ul><div id=\"wpforms-5276-field_59-description\" class=\"wpforms-field-description\">Please select all that apply<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_61\">Would you be willing to speak to a PTKC gathering or teach a class? If so, please specify your interest. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_61\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-5276-field_61-error\" aria-describedby=\"wpforms-5276-field_61-description\" required><div id=\"wpforms-5276-field_61-description\" class=\"wpforms-field-description\">Please enter your area(s) of expertise<\/div><\/div><div id=\"wpforms-5276-field_57-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"57\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Person 2 Volunteer Preferences: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_57\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_1\" name=\"wpforms[fields][57][]\" value=\"Host a PTKC event\" aria-errormessage=\"wpforms-5276-field_57_1-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_1\">Host a PTKC event<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_2\" name=\"wpforms[fields][57][]\" value=\"Organize an event\" aria-errormessage=\"wpforms-5276-field_57_2-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_2\">Organize an event<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_3\" name=\"wpforms[fields][57][]\" value=\"Help at an event\" aria-errormessage=\"wpforms-5276-field_57_3-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_3\">Help at an event<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_7\" name=\"wpforms[fields][57][]\" value=\"Serve on a committee\" aria-errormessage=\"wpforms-5276-field_57_7-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_7\">Serve on a committee<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_6\" name=\"wpforms[fields][57][]\" value=\"Serve on the Board\" aria-errormessage=\"wpforms-5276-field_57_6-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_6\">Serve on the Board<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_5\" name=\"wpforms[fields][57][]\" value=\"Serve as the Webmaster\" aria-errormessage=\"wpforms-5276-field_57_5-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_5\">Serve as the Webmaster<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_4\" name=\"wpforms[fields][57][]\" value=\"Serve as the Newsletter Editor\" aria-errormessage=\"wpforms-5276-field_57_4-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_4\">Serve as the Newsletter Editor<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_9\" name=\"wpforms[fields][57][]\" value=\"Be profiled in the Newsletter\" aria-errormessage=\"wpforms-5276-field_57_9-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_9\">Be profiled in the Newsletter<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_8\" name=\"wpforms[fields][57][]\" value=\"I have a car and am willing to help other members without transportation\" aria-errormessage=\"wpforms-5276-field_57_8-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_8\">I have a car and am willing to help other members without transportation<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_57_10\" name=\"wpforms[fields][57][]\" value=\"Other\" aria-errormessage=\"wpforms-5276-field_57_10-error\" aria-describedby=\"wpforms-5276-field_57-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_57_10\">Other<\/label><\/li><\/ul><div id=\"wpforms-5276-field_57-description\" class=\"wpforms-field-description\">Please check all that apply<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_56-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"56\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_56\">Person 2, In what other way(s) would you like to help? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_56\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-5276-field_56-error\" aria-describedby=\"wpforms-5276-field_56-description\" required><div id=\"wpforms-5276-field_56-description\" class=\"wpforms-field-description\">Specify your choice(s)<\/div><\/div><div id=\"wpforms-5276-field_60-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"checkbox\" data-field-id=\"60\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Person 2 Committee Preferences: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_60\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_1\" name=\"wpforms[fields][60][]\" value=\"Care Committee\" aria-errormessage=\"wpforms-5276-field_60_1-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_1\">Care Committee<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_2\" name=\"wpforms[fields][60][]\" value=\"Events Committee\" aria-errormessage=\"wpforms-5276-field_60_2-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_2\">Events Committee<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_3\" name=\"wpforms[fields][60][]\" value=\"Financial Audit Committee\" aria-errormessage=\"wpforms-5276-field_60_3-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_3\">Financial Audit Committee<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_5\" name=\"wpforms[fields][60][]\" value=\"Nominating Committee\" aria-errormessage=\"wpforms-5276-field_60_5-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_5\">Nominating Committee<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_4\" name=\"wpforms[fields][60][]\" value=\"Website Committee\" aria-errormessage=\"wpforms-5276-field_60_4-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_4\">Website Committee<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-5276-field_60_6\" name=\"wpforms[fields][60][]\" value=\"I am not interested in serving on any committies\" aria-errormessage=\"wpforms-5276-field_60_6-error\" aria-describedby=\"wpforms-5276-field_60-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_60_6\">I am not interested in serving on any committies<\/label><\/li><\/ul><div id=\"wpforms-5276-field_60-description\" class=\"wpforms-field-description\">Please select all that apply for person 2<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_62-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"62\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_62\">Would Person 2 be willing to speak to a PTKC gathering or teach a class? If so, please specify your interest. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_62\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][62]\" aria-errormessage=\"wpforms-5276-field_62-error\" aria-describedby=\"wpforms-5276-field_62-description\" required><div id=\"wpforms-5276-field_62-description\" class=\"wpforms-field-description\">Please enter your area(s) of expertise<\/div><\/div><div id=\"wpforms-5276-field_63-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"63\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"8\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"8\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-5276-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">Have you been convicted of a felony? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_88\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_88_2\" name=\"wpforms[fields][88]\" value=\"NO\" aria-errormessage=\"wpforms-5276-field_88_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_88_2\">NO<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_88_4\" name=\"wpforms[fields][88]\" value=\"YES. I have been convicted of a felony offence.\" aria-errormessage=\"wpforms-5276-field_88_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_88_4\">YES. I have been convicted of a felony offence.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5276-field_90-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"90\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_90\">You have stated that you have been convicted of a felony offence. Please indicate the nature, date, and  the current status of the conviction. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-5276-field_90\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-5276-field_90-error\" required><\/textarea><\/div><div id=\"wpforms-5276-field_92-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"92\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Has Person 2 has been convicted of a felony?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_92\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_92_2\" name=\"wpforms[fields][92]\" value=\"NO\" aria-errormessage=\"wpforms-5276-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_92_2\">NO<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_92_4\" name=\"wpforms[fields][92]\" value=\"YES. I have been convicted of a felony offence.\" aria-errormessage=\"wpforms-5276-field_92_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_92_4\">YES. I have been convicted of a felony offence.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5276-field_93-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"93\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_93\">You have stated that Person 2 been convicted of a felony offence. Please indicate the nature, date, and  the current status of the conviction. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-5276-field_93\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][93]\" aria-errormessage=\"wpforms-5276-field_93-error\" required><\/textarea><\/div><div id=\"wpforms-5276-field_89-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"89\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"9\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"9\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10  \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-5276-field_64-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"64\"><div id=\"wpforms-5276-field_64\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_64-error\"><h4>Many of our members live alone. Is there an emergency contact that you will want us to contact if we suspect you might be in trouble? If so, please provide the following information.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_65-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"65\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact Name For You<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_65\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][65][first]\" aria-errormessage=\"wpforms-5276-field_65-error\" aria-describedby=\"wpforms-5276-field_65-description\" ><label for=\"wpforms-5276-field_65\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_65-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][65][last]\" aria-errormessage=\"wpforms-5276-field_65-last-error\" aria-describedby=\"wpforms-5276-field_65-description\" ><label for=\"wpforms-5276-field_65-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-5276-field_65-description\" class=\"wpforms-field-description\">Please enter emergency contact name<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_67-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_67\">Relationship to You<\/label><input type=\"text\" id=\"wpforms-5276-field_67\" class=\"wpforms-field-small\" name=\"wpforms[fields][67]\" aria-errormessage=\"wpforms-5276-field_67-error\" aria-describedby=\"wpforms-5276-field_67-description\" ><div id=\"wpforms-5276-field_67-description\" class=\"wpforms-field-description\">Please enter the relationship<\/div><\/div><div id=\"wpforms-5276-field_66-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_66\">Your Emergency Contact Phone or Email<\/label><input type=\"text\" id=\"wpforms-5276-field_66\" class=\"wpforms-field-small\" name=\"wpforms[fields][66]\" aria-errormessage=\"wpforms-5276-field_66-error\" aria-describedby=\"wpforms-5276-field_66-description\" ><div id=\"wpforms-5276-field_66-description\" class=\"wpforms-field-description\">Please enter at least one specific way to contact this person<\/div><\/div><div id=\"wpforms-5276-field_68-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"68\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Emergency Contact Name For Person 2<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_68\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][68][first]\" aria-errormessage=\"wpforms-5276-field_68-error\" aria-describedby=\"wpforms-5276-field_68-description\" ><label for=\"wpforms-5276-field_68\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5276-field_68-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][68][last]\" aria-errormessage=\"wpforms-5276-field_68-last-error\" aria-describedby=\"wpforms-5276-field_68-description\" ><label for=\"wpforms-5276-field_68-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-5276-field_68-description\" class=\"wpforms-field-description\">Please enter emergency contact name<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_69-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"69\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_69\">Relationship to Person 2<\/label><input type=\"text\" id=\"wpforms-5276-field_69\" class=\"wpforms-field-small\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-5276-field_69-error\" aria-describedby=\"wpforms-5276-field_69-description\" ><div id=\"wpforms-5276-field_69-description\" class=\"wpforms-field-description\">Please enter the relationship<\/div><\/div><div id=\"wpforms-5276-field_70-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"70\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_70\">Your Emergency Contact Phone or Email For Person 2<\/label><input type=\"text\" id=\"wpforms-5276-field_70\" class=\"wpforms-field-small\" name=\"wpforms[fields][70]\" aria-errormessage=\"wpforms-5276-field_70-error\" aria-describedby=\"wpforms-5276-field_70-description\" ><div id=\"wpforms-5276-field_70-description\" class=\"wpforms-field-description\">Please enter at least one specific way to contact this person<\/div><\/div><div id=\"wpforms-5276-field_71-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"71\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"10\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"10\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-11  \" data-page=\"11\" style=\"display:none;\"><div id=\"wpforms-5276-field_86-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"86\"><fieldset><legend class=\"wpforms-field-label\">I (we) intend to pay my (our) annual dues using the following method: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5276-field_86\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_86_1\" name=\"wpforms[fields][86]\" value=\"Pay online using a credit card (follow the link as selecting the &quot;Submit&quot; button, below)\" aria-errormessage=\"wpforms-5276-field_86_1-error\" aria-describedby=\"wpforms-5276-field_86-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_86_1\">Pay online using a credit card (follow the link as selecting the \"Submit\" button, below)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_86_2\" name=\"wpforms[fields][86]\" value=\"I will send a check in the mail\" aria-errormessage=\"wpforms-5276-field_86_2-error\" aria-describedby=\"wpforms-5276-field_86-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_86_2\">I will send a check in the mail<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-5276-field_86_3\" name=\"wpforms[fields][86]\" value=\"I have paid in cash\" aria-errormessage=\"wpforms-5276-field_86_3-error\" aria-describedby=\"wpforms-5276-field_86-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5276-field_86_3\">I have paid in cash<\/label><\/li><\/ul><div id=\"wpforms-5276-field_86-description\" class=\"wpforms-field-description\">Please select your intended payment method<\/div><\/fieldset><\/div><div id=\"wpforms-5276-field_95-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"95\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_95\">Please provide the name of the person that you paid <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_95\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][95]\" aria-errormessage=\"wpforms-5276-field_95-error\" required><\/div><div id=\"wpforms-5276-field_96-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"96\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_96\">Please enter the date that you paid in cash <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-5276-field_96\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][96][date]\" aria-errormessage=\"wpforms-5276-field_96-error\" aria-describedby=\"wpforms-5276-field_96-description\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><div id=\"wpforms-5276-field_96-description\" class=\"wpforms-field-description\">Please enter the date you paid in cash<\/div><\/div><div id=\"wpforms-5276-field_72-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"72\"><div id=\"wpforms-5276-field_72\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_72-error\"><h4>By typing my signature below, I affirm that I will faithfully attend as many PTKC functions as possible and that I will help at as many PTKC events as possible.<\/h4>\n<h4>Also, in consideration for being allowed to participate in activities offered by PTKC, I hereby release, waive, discharge, and covenant not to sue PTKC officers, volunteers, agents, and successors in interest from any and all claims, damages, liabilities, costs, and expenses of any kind arising out of or in any way related to my participation in PTKC activities, including but not limited to personal injury, death, and property damage.<\/h4>\n<h4>I acknowledge that I understand that PTKC encourages me to stay healthy with the latest COVID and flu vaccines and that this suggestion will help keep all of our members healthy.<\/h4>\n<h4>I also understand that PTKC reserves the right to deny or revoke any membership for cause.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_73-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_73\">By typing my name here, I affirm my commitment to the above statements. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_73\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-5276-field_73-error\" aria-describedby=\"wpforms-5276-field_73-description\" required><div id=\"wpforms-5276-field_73-description\" class=\"wpforms-field-description\">Please type your name<\/div><\/div><div id=\"wpforms-5276-field_75-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_75\">Please Enter The Date You Signed <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-5276-field_75\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][75][date]\" aria-errormessage=\"wpforms-5276-field_75-error\" aria-describedby=\"wpforms-5276-field_75-description\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><div id=\"wpforms-5276-field_75-description\" class=\"wpforms-field-description\">Enter today's date<\/div><\/div><div id=\"wpforms-5276-field_74-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"74\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_74\">By typing my name here, I, Person 2, affirm my commitment to the above statements. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5276-field_74\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][74]\" aria-errormessage=\"wpforms-5276-field_74-error\" aria-describedby=\"wpforms-5276-field_74-description\" required><div id=\"wpforms-5276-field_74-description\" class=\"wpforms-field-description\">Please type your name<\/div><\/div><div id=\"wpforms-5276-field_76-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_76\">Please Enter The Date Person 2 Signed <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-5276-field_76\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][76][date]\" aria-errormessage=\"wpforms-5276-field_76-error\" aria-describedby=\"wpforms-5276-field_76-description\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><div id=\"wpforms-5276-field_76-description\" class=\"wpforms-field-description\">Please enter today's date<\/div><\/div><div id=\"wpforms-5276-field_77-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"77\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"11\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"11\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-12 last \" data-page=\"12\" style=\"display:none;\"><div id=\"wpforms-5276-field_78-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"78\"><div id=\"wpforms-5276-field_78\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5276-field_78-error\"><h4>Thank you for completing your PTKC New Member Application online. You can either pay your dues by check or online. After selecting the \"Submit\" button, below, you will be redirected to the Payment Options Page.<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5276-field_84-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-type=\"captcha\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-5276-field_84\">Custom Captcha <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label>\t\t\t<div class=\"wpforms-captcha-math\">\n\t\t\t\t<span id=\"wpforms-5276-field_84-question\" class=\"wpforms-captcha-equation\">\n\t\t\t\t\t<span class=\"n1\">15<\/span>\n\t\t\t\t\t\t\t<span class=\"cal\">*<\/span>\n\t\t\t\t\t\t\t<span class=\"n2\">7<\/span>\t\t\t\t\t<span class=\"e\">=<\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"text\" id=\"wpforms-5276-field_84\" class=\"wpforms-field-medium wpforms-field-required a\" data-rule-wpf-captcha=\"math\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][84][a]\" aria-errormessage=\"wpforms-5276-field_84-error\" aria-describedby=\"wpforms-5276-field_84-question\" required>\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][84][cal]\" class=\"cal\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][84][n2]\" class=\"n2\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][84][n1]\" class=\"n1\">\n\t\t\t<\/div>\n\t\t\t<\/div><div id=\"wpforms-5276-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"9\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"12\" data-formid=\"5276\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" style=\"display:none;\"><div class=\"g-recaptcha\" data-sitekey=\"6LfR9sMnAAAAACOlL6E6TeS8YHgd3984vGjJB0J0\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"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;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"5276\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/pages\/5138\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5276\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<div class=\"wpforms-save-resume-disclaimer\" id=\"wpforms-save-resume-disclaimer-5276\" style=\"display: none\">\n\t\t<div class=\"message\">\n\t\t<p>Heads up! Saving your progress now will store a copy of your entry on this server and PTKC may have access to it. For security reasons, sensitive information such as credit cards and mailing addresses, along with file uploads will have to be re-entered when you resume.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-form\">\n\t\t<button type=\"submit\" class=\"wpforms-save-resume-disclaimer-continue wpforms-submit\">\n\t\t\tContinue\t\t<\/button>\n\t\t<a href=\"#\" class=\"wpforms-save-resume-disclaimer-back\">\n\t\t\t<span>Go Back<\/span>\n\t\t<\/a>\n\t<\/div>\n\n\t<\/div>\n\n<div class=\"wpforms-save-resume-confirmation\" id=\"wpforms-save-resume-confirmation-5276\" style=\"display: none\">\n\n\t\n\t<div class=\"message\">\n\t\t<p>Your form entry has been saved and a unique link has been created which you can access to resume this form.<\/p>\n<p>Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.<\/p>\n<p>Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopy Link\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copy resume link to clipboard\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/kansascity\/wp-json\/wp\/v2\/pages\/5138\" data-token=\"cb6efe0ab14e9e9714b54ff0bf3d6fb9\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tEmail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"e98efe08a8\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/kansascity\/wp-json\/wp\/v2\/pages\/5138\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"5276\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[entry_id]\" class=\"wpforms-save-resume-entry-id\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tSend Link\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n\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":"<p>Welcome To The PTKC Membership Application Page On this page you can: \u25a0 Download and print the paper version of the 1 person Membership Application form. Then you can complete [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5138","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/pages\/5138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/comments?post=5138"}],"version-history":[{"count":5,"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/pages\/5138\/revisions"}],"predecessor-version":[{"id":9282,"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/pages\/5138\/revisions\/9282"}],"wp:attachment":[{"href":"https:\/\/chapters.theprimetimersww.com\/kansascity\/wp-json\/wp\/v2\/media?parent=5138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}