/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
 * Includes a Form with javascript
 * @param {Object} formId
 * @param {Object} initialHeight
 * @param {Object} iframeCode
 */
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
    this.formId = formId;
    this.initialHeight = initialHeight;
    this.iframeCode = iframeCode;
    this.frame = null;
    this.timeInterval= 200;
    this.appendTo = appendTo || false;
    
    // initialize function for object
    this.init = function(){
        this.createFrame();
        this.addFrameContent(this.iframeCode);
    };
    
    // Create the frame
    this.createFrame = function(){
        var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\"></if"+"rame>";
        if(this.appendTo === false){
            document.write(htmlCode);
        }else{
            var tmp = document.createElement('div');
            tmp.innerHTML = htmlCode;
            var a = this.appendTo;
            document.getElementById(a).appendChild(tmp.firstChild);            
        }
        // also get the frame for future use.
        this.frame = document.getElementById(this.formId);
        // set the time on the on load event of the frame
        this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
    };
    
    // add event function for different browsers
    this.addEvent = function( obj, type, fn ) {
        if ( obj.attachEvent ) {
            obj["e"+type+fn] = fn;
            obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
            obj.attachEvent( "on"+type, obj[type+fn] );
        }
        else{
            obj.addEventListener( type, fn, false );   
        }
    };
    
    this.addFrameContent = function (string){
        string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+
                '<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
                '<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
                'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
                ' }<'+'/script>');
        string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
        var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
        frameDocument.document.open();
        frameDocument.document.write(string);
        setTimeout( function(){
            frameDocument.document.close();
            try{
                if('JotFormFrameLoaded' in window){
                    JotFormFrameLoaded();
                }
            }catch(e){}
        },200);
    };
    
    this.setTimer = function(){
        var self = this;
        this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
    };
    
    this.changeHeight = function (){
        var actualHeight = this.getBodyHeight();
        var currentHeight = this.getViewPortHeight();
        if(actualHeight === undefined){
            this.frame.style.height = "100%";
            if(!this.frame.style.minHeight){
                this.frame.style.minHeight = "300px";
            }
        }else if  (Math.abs(actualHeight - currentHeight) > 18){
            this.frame.style.height = (actualHeight)+"px";
        }
        this.setTimer();
    };
    
    this.bindMethod = function(method, scope) {
        return function() {
            method.apply(scope,arguments);
        };
    };
    
    this.getBodyHeight = function (){
        var height;
        var scrollHeight;
        var offsetHeight;
        try{  // Prevent IE from throw errors
            if (this.frame.contentWindow.document.height){
                
                height = this.frame.contentWindow.document.height;
                //Emre: to prevent "iframe height"  problem (61059)
                if (this.frame.contentWindow.document.body.scrollHeight){
                    height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
                }
                
                if (this.frame.contentWindow.document.body.offsetHeight){
                    height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
                }
                
            } else if (this.frame.contentWindow.document.body){
                
                if (this.frame.contentWindow.document.body.scrollHeight){
                    height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
                }
                
                if (this.frame.contentWindow.document.body.offsetHeight){
                    height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
                }
                
                if (scrollHeight && offsetHeight){
                    height = Math.max(scrollHeight, offsetHeight);
                }
            }            
        }catch(e){ }
        return height;
    };
    
    this.getViewPortHeight = function(){
        var height = 0;
        try{ // Prevent IE from throw errors
            if (this.frame.contentWindow.window.innerHeight)
            {
                height = this.frame.contentWindow.window.innerHeight - 18;
            }
            else if ((this.frame.contentWindow.document.documentElement) &&
                     (this.frame.contentWindow.document.documentElement.clientHeight))
            {
                height = this.frame.contentWindow.document.documentElement.clientHeight;
            }
            else if ((this.frame.contentWindow.document.body) &&
                     (this.frame.contentWindow.document.body.clientHeight))
            {
                height = this.frame.contentWindow.document.body.clientHeight;
            }            
        }catch(e){ }
        return height;
    };
    
    this.init();
}
FrameBuilder.get = [];
var i1265733224 = new FrameBuilder("1265733224", false, "", "<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Form<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n    .form-label{\n        width:100px !important;\n    }\n    .form-label-left{\n        width:100px !important;\n    }\n    .form-line{\n        padding:10px;\n    }\n    .form-label-right{\n        width:100px !important;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:false;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:0px;\n        width:500px;\n        color:Black !important;\n        font-family:Arial;\n        font-size:12px;\n    }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.setConditions([{\"action\":{\"field\":\"162\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"88\",\"operator\":\"equals\",\"value\":\"I have a third KGMS student\"}],\"type\":\"field\"},{\"action\":{\"field\":\"39\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"33\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"153\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"65\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"121\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Significant Other\"}],\"type\":\"field\"},{\"action\":{\"field\":\"16\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"17\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"18\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"86\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"40\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"68\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"95\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"66\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"83\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"84\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"100\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"34\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"93\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"94\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"35\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"106\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"98\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"99\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"85\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"101\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"103\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Significant 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\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"143\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"144\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"150\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"151\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"116\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"41\",\"operator\":\"equals\",\"value\":\"Significant 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student\"}],\"type\":\"field\"},{\"action\":{\"field\":\"155\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"87\",\"operator\":\"equals\",\"value\":\"I have a second KGMS student\"}],\"type\":\"field\"},{\"action\":{\"field\":\"155\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"88\",\"operator\":\"equals\",\"value\":\"I have a third KGMS student\"}],\"type\":\"field\"},{\"action\":{\"field\":\"41\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"157\",\"operator\":\"equals\",\"value\":\"Child has parents living at another address.\"}],\"type\":\"field\"},{\"action\":{\"field\":\"160\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"161\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"87\",\"operator\":\"equals\",\"value\":\"I have a second KGMS student\"}],\"type\":\"field\"},{\"action\":{\"field\":\"163\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Mother\"}],\"type\":\"field\"},{\"action\":{\"field\":\"160\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Father\"}],\"type\":\"field\"},{\"action\":{\"field\":\"166\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Step-Parent\"}],\"type\":\"field\"},{\"action\":{\"field\":\"164\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"24\",\"operator\":\"equals\",\"value\":\"Significant Other\"}],\"type\":\"field\"}]);\n   JotForm.init(function(){\n      $('input_153').hint('ex: myname@example.com');\n      $('input_95').hint('ex: myname@example.com');\n      $('input_35').hint('ex: myname@example.com');\n      $('input_105').hint('ex: myname@example.com');\n      $('input_69').hint('ex: myname@example.com');\n      $('input_70').hint('ex: myname@example.com');\n      $('input_114').hint('ex: myname@example.com');\n      $('input_118').hint('ex: myname@example.com');\n   });\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_1265733224\" id=\"1265733224\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"1265733224\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section\">\n      <li id=\"cid_5\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h1 id=\"header_5\" class=\"form-header\">\n            Information Update Form\n          <\/h1>\n        <\/div>\n      <\/li>\n      <li id=\"cid_154\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h3 id=\"header_154\" class=\"form-header\">\n            Student's Information\n          <\/h3>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_28\">\n        <label class=\"form-label-left\" id=\"label_28\" for=\"input_28\">\n          Student's Name<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_28\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q28_studentsName28[first]\" id=\"first_28\" \/>\n            <label class=\"form-sub-label\" for=\"first_28\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q28_studentsName28[last]\" id=\"last_28\" \/>\n            <label class=\"form-sub-label\" for=\"last_28\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_21\">\n        <label class=\"form-label-left\" id=\"label_21\" for=\"input_21\">\n          Student Status<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_21\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_21_0\" name=\"q21_studentStatus21\" value=\"Present Student\" \/>\n              <label for=\"input_21_0\"> Present Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_21_1\" name=\"q21_studentStatus21\" value=\"Past Student\" \/>\n              <label for=\"input_21_1\"> Past Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_21_2\" name=\"q21_studentStatus21\" value=\"Prospective Student\" \/>\n              <label for=\"input_21_2\"> Prospective Student <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_87\">\n        <label class=\"form-label-left\" id=\"label_87\" for=\"input_87\"> Select to enter info <\/label>\n        <div id=\"cid_87\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_87_0\" name=\"q87_selectTo[]\" value=\"I have a second KGMS student\" \/>\n              <label for=\"input_87_0\"> I have a second KGMS student <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_161\">\n        <div id=\"cid_161\" class=\"form-input-wide\">\n          <div id=\"text_161\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_72\">\n        <label class=\"form-label-left\" id=\"label_72\" for=\"input_72\">\n          Student's Name<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_72\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q72_studentsName72[first]\" id=\"first_72\" \/>\n            <label class=\"form-sub-label\" for=\"first_72\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q72_studentsName72[last]\" id=\"last_72\" \/>\n            <label class=\"form-sub-label\" for=\"last_72\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_54\">\n        <label class=\"form-label-left\" id=\"label_54\" for=\"input_54\">\n          Student Status<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_54\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_54_0\" name=\"q54_studentStatus21\" value=\"Present Student\" \/>\n              <label for=\"input_54_0\"> Present Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_54_1\" name=\"q54_studentStatus21\" value=\"Past Student\" \/>\n              <label for=\"input_54_1\"> Past Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_54_2\" name=\"q54_studentStatus21\" value=\"Prospective Student\" \/>\n              <label for=\"input_54_2\"> Prospective Student <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_88\">\n        <label class=\"form-label-left\" id=\"label_88\" for=\"input_88\"> Select to enter info <\/label>\n        <div id=\"cid_88\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_88_0\" name=\"q88_selectTo[]\" value=\"I have a third KGMS student\" \/>\n              <label for=\"input_88_0\"> I have a third KGMS student <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_162\">\n        <div id=\"cid_162\" class=\"form-input-wide\">\n          <div id=\"text_162\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_73\">\n        <label class=\"form-label-left\" id=\"label_73\" for=\"input_73\">\n          Student's Name<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_73\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q73_studentsName73[first]\" id=\"first_73\" \/>\n            <label class=\"form-sub-label\" for=\"first_73\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q73_studentsName73[last]\" id=\"last_73\" \/>\n            <label class=\"form-sub-label\" for=\"last_73\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_58\">\n        <label class=\"form-label-left\" id=\"label_58\" for=\"input_58\">\n          Student Status<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_58\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_58_0\" name=\"q58_studentStatus21\" value=\"Present Student\" \/>\n              <label for=\"input_58_0\"> Present Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_58_1\" name=\"q58_studentStatus21\" value=\"Past Student\" \/>\n              <label for=\"input_58_1\"> Past Student <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_58_2\" name=\"q58_studentStatus21\" value=\"Prospective Student\" \/>\n              <label for=\"input_58_2\"> Prospective Student <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_155\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h3 id=\"header_155\" class=\"form-header\">\n            Address Information\n          <\/h3>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_29\">\n        <label class=\"form-label-left\" id=\"label_29\" for=\"input_29\">\n          Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_29\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q29_address29[addr_line1]\" id=\"input_29_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_29_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q29_address29[addr_line2]\" id=\"input_29_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_29_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q29_address29[city]\" id=\"input_29_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_29_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q29_address29[state]\" id=\"input_29_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_29_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q29_address29[postal]\" id=\"input_29_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_29_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q29_address29[country]\" id=\"input_29_country\">\n                    <option selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option selected=\"selected\" value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_29_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_32\">\n        <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\"> Home Tel <\/label>\n        <div id=\"cid_32\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q32_homeTel32[area]\" id=\"input_32_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_32_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q32_homeTel32[phone]\" id=\"input_32_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_32_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li id=\"cid_158\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h3 id=\"header_158\" class=\"form-header\">\n            Parent's Information\n          <\/h3>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_24\">\n        <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\">\n          Indicate Parents who live with child at above address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_24\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_0\" name=\"q24_indicateParents24[]\" value=\"Mother\" \/>\n              <label for=\"input_24_0\"> Mother <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_1\" name=\"q24_indicateParents24[]\" value=\"Father\" \/>\n              <label for=\"input_24_1\"> Father <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_2\" name=\"q24_indicateParents24[]\" value=\"Step-Parent\" \/>\n              <label for=\"input_24_2\"> Step-Parent <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_3\" name=\"q24_indicateParents24[]\" value=\"Significant Other\" \/>\n              <label for=\"input_24_3\"> Significant Other <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_121\">\n        <label class=\"form-label-left\" id=\"label_121\" for=\"input_121\">\n          Other-Specify<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_121\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_121\" name=\"q121_otherspecify121\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_157\">\n        <label class=\"form-label-left\" id=\"label_157\" for=\"input_157\"> Select to enter info <\/label>\n        <div id=\"cid_157\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_157_0\" name=\"q157_selectTo157[]\" value=\"Child has parents living at another address.\" \/>\n              <label for=\"input_157_0\"> Child has parents living at another address. <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_41\">\n        <label class=\"form-label-left\" id=\"label_41\" for=\"input_41\"> Indicate Parents who live at another address <\/label>\n        <div id=\"cid_41\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_41_0\" name=\"q41_indicateParents41[]\" value=\"Mother\" \/>\n              <label for=\"input_41_0\"> Mother <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_41_1\" name=\"q41_indicateParents41[]\" value=\"Father\" \/>\n              <label for=\"input_41_1\"> Father <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_41_2\" name=\"q41_indicateParents41[]\" value=\"Step-Parent\" \/>\n              <label for=\"input_41_2\"> Step-Parent <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_41_3\" name=\"q41_indicateParents41[]\" value=\"Significant Other\" \/>\n              <label for=\"input_41_3\"> Significant Other <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_62\">\n        <label class=\"form-label-left\" id=\"label_62\" for=\"input_62\">\n          Other-Specify<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_62\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_62\" name=\"q62_otherspecify\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_163\">\n        <div id=\"cid_163\" class=\"form-input-wide\">\n          <div id=\"text_163\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_39\">\n        <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\">\n          Mother<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_39\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q39_mother[first]\" id=\"first_39\" \/>\n            <label class=\"form-sub-label\" for=\"first_39\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q39_mother[last]\" id=\"last_39\" \/>\n            <label class=\"form-sub-label\" for=\"last_39\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_33\">\n        <label class=\"form-label-left\" id=\"label_33\" for=\"input_33\"> Mobile Tel <\/label>\n        <div id=\"cid_33\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q33_mobileTel[area]\" id=\"input_33_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_33_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q33_mobileTel[phone]\" id=\"input_33_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_33_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_153\">\n        <label class=\"form-label-left\" id=\"label_153\" for=\"input_153\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_153\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_153\" name=\"q153_email153\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_65\">\n        <label class=\"form-label-left\" id=\"label_65\" for=\"input_65\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_65\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_65_0\" name=\"q65_wouldYou65\" value=\"Yes\" \/>\n              <label for=\"input_65_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_65_1\" name=\"q65_wouldYou65\" value=\"No\" \/>\n              <label for=\"input_65_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_16\">\n        <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\"> Occupation <\/label>\n        <div id=\"cid_16\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_16\" name=\"q16_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_17\">\n        <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Title <\/label>\n        <div id=\"cid_17\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_17\" name=\"q17_title17\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_18\">\n        <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\"> Company <\/label>\n        <div id=\"cid_18\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_18\" name=\"q18_company\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_86\">\n        <label class=\"form-label-left\" id=\"label_86\" for=\"input_86\"> Work Tel <\/label>\n        <div id=\"cid_86\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q86_workTel86[area]\" id=\"input_86_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_86_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q86_workTel86[phone]\" id=\"input_86_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_86_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_160\">\n        <div id=\"cid_160\" class=\"form-input-wide\">\n          <div id=\"text_160\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_40\">\n        <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\">\n          Father<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_40\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q40_father[first]\" id=\"first_40\" \/>\n            <label class=\"form-sub-label\" for=\"first_40\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q40_father[last]\" id=\"last_40\" \/>\n            <label class=\"form-sub-label\" for=\"last_40\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_68\">\n        <label class=\"form-label-left\" id=\"label_68\" for=\"input_68\"> Mobile Tel <\/label>\n        <div id=\"cid_68\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q68_mobileTel[area]\" id=\"input_68_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_68_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q68_mobileTel[phone]\" id=\"input_68_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_68_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_95\">\n        <label class=\"form-label-left\" id=\"label_95\" for=\"input_95\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_95\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_95\" name=\"q95_email95\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_66\">\n        <label class=\"form-label-left\" id=\"label_66\" for=\"input_66\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_66\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_66_0\" name=\"q66_wouldYou66\" value=\"Yes\" \/>\n              <label for=\"input_66_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_66_1\" name=\"q66_wouldYou66\" value=\"No\" \/>\n              <label for=\"input_66_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_83\">\n        <label class=\"form-label-left\" id=\"label_83\" for=\"input_83\"> Occupation <\/label>\n        <div id=\"cid_83\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_83\" name=\"q83_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_84\">\n        <label class=\"form-label-left\" id=\"label_84\" for=\"input_84\"> Title <\/label>\n        <div id=\"cid_84\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_84\" name=\"q84_title84\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_100\">\n        <label class=\"form-label-left\" id=\"label_100\" for=\"input_100\"> Company <\/label>\n        <div id=\"cid_100\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_100\" name=\"q100_company100\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_34\">\n        <label class=\"form-label-left\" id=\"label_34\" for=\"input_34\"> Work Tel <\/label>\n        <div id=\"cid_34\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q34_workTel34[area]\" id=\"input_34_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_34_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q34_workTel34[phone]\" id=\"input_34_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_34_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_166\">\n        <div id=\"cid_166\" class=\"form-input-wide\">\n          <div id=\"text_166\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_93\">\n        <label class=\"form-label-left\" id=\"label_93\" for=\"input_93\">\n          Step-Parent<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_93\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q93_stepparent[first]\" id=\"first_93\" \/>\n            <label class=\"form-sub-label\" for=\"first_93\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q93_stepparent[last]\" id=\"last_93\" \/>\n            <label class=\"form-sub-label\" for=\"last_93\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_94\">\n        <label class=\"form-label-left\" id=\"label_94\" for=\"input_94\"> Mobile Tel <\/label>\n        <div id=\"cid_94\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q94_mobileTel[area]\" id=\"input_94_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_94_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q94_mobileTel[phone]\" id=\"input_94_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_94_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_35\">\n        <label class=\"form-label-left\" id=\"label_35\" for=\"input_35\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_35\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_35\" name=\"q35_email\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_106\">\n        <label class=\"form-label-left\" id=\"label_106\" for=\"input_106\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_106\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_106_0\" name=\"q106_wouldYou106\" value=\"Yes\" \/>\n              <label for=\"input_106_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_106_1\" name=\"q106_wouldYou106\" value=\"No\" \/>\n              <label for=\"input_106_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_98\">\n        <label class=\"form-label-left\" id=\"label_98\" for=\"input_98\"> Occupation <\/label>\n        <div id=\"cid_98\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_98\" name=\"q98_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_99\">\n        <label class=\"form-label-left\" id=\"label_99\" for=\"input_99\"> Title <\/label>\n        <div id=\"cid_99\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_99\" name=\"q99_title99\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_85\">\n        <label class=\"form-label-left\" id=\"label_85\" for=\"input_85\"> Company <\/label>\n        <div id=\"cid_85\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_85\" name=\"q85_company85\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_101\">\n        <label class=\"form-label-left\" id=\"label_101\" for=\"input_101\"> Work Tel <\/label>\n        <div id=\"cid_101\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q101_workTel101[area]\" id=\"input_101_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_101_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q101_workTel101[phone]\" id=\"input_101_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_101_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_164\">\n        <div id=\"cid_164\" class=\"form-input-wide\">\n          <div id=\"text_164\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_103\">\n        <label class=\"form-label-left\" id=\"label_103\" for=\"input_103\">\n          Significant Other<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_103\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q103_significantOther[first]\" id=\"first_103\" \/>\n            <label class=\"form-sub-label\" for=\"first_103\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q103_significantOther[last]\" id=\"last_103\" \/>\n            <label class=\"form-sub-label\" for=\"last_103\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_104\">\n        <label class=\"form-label-left\" id=\"label_104\" for=\"input_104\"> Mobile Tel <\/label>\n        <div id=\"cid_104\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q104_mobileTel[area]\" id=\"input_104_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_104_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q104_mobileTel[phone]\" id=\"input_104_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_104_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_105\">\n        <label class=\"form-label-left\" id=\"label_105\" for=\"input_105\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_105\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_105\" name=\"q105_email\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_96\">\n        <label class=\"form-label-left\" id=\"label_96\" for=\"input_96\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_96\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_96_0\" name=\"q96_wouldYou96\" value=\"Yes\" \/>\n              <label for=\"input_96_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_96_1\" name=\"q96_wouldYou96\" value=\"No\" \/>\n              <label for=\"input_96_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_108\">\n        <label class=\"form-label-left\" id=\"label_108\" for=\"input_108\"> Occupation <\/label>\n        <div id=\"cid_108\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_108\" name=\"q108_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_134\">\n        <label class=\"form-label-left\" id=\"label_134\" for=\"input_134\"> Title <\/label>\n        <div id=\"cid_134\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_134\" name=\"q134_title134\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_110\">\n        <label class=\"form-label-left\" id=\"label_110\" for=\"input_110\"> Company <\/label>\n        <div id=\"cid_110\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_110\" name=\"q110_company110\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_136\">\n        <label class=\"form-label-left\" id=\"label_136\" for=\"input_136\"> Work Tel <\/label>\n        <div id=\"cid_136\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q136_workTel136[area]\" id=\"input_136_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_136_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q136_workTel136[phone]\" id=\"input_136_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_136_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_167\">\n        <div id=\"cid_167\" class=\"form-input-wide\">\n          <div id=\"text_167\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_42\">\n        <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\">\n          Mother<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_42\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q42_mother42[first]\" id=\"first_42\" \/>\n            <label class=\"form-sub-label\" for=\"first_42\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q42_mother42[last]\" id=\"last_42\" \/>\n            <label class=\"form-sub-label\" for=\"last_42\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_43\">\n        <label class=\"form-label-left\" id=\"label_43\" for=\"input_43\">\n          Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_43\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q43_address[addr_line1]\" id=\"input_43_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_43_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q43_address[addr_line2]\" id=\"input_43_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_43_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q43_address[city]\" id=\"input_43_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_43_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q43_address[state]\" id=\"input_43_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_43_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q43_address[postal]\" id=\"input_43_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_43_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q43_address[country]\" id=\"input_43_country\">\n                    <option selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option selected=\"selected\" value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_43_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_48\">\n        <label class=\"form-label-left\" id=\"label_48\" for=\"input_48\"> Home Tel <\/label>\n        <div id=\"cid_48\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q48_homeTel48[area]\" id=\"input_48_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_48_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q48_homeTel48[phone]\" id=\"input_48_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_48_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_122\">\n        <label class=\"form-label-left\" id=\"label_122\" for=\"input_122\"> Mobile Tel <\/label>\n        <div id=\"cid_122\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q122_mobileTel122[area]\" id=\"input_122_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_122_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q122_mobileTel122[phone]\" id=\"input_122_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_122_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_69\">\n        <label class=\"form-label-left\" id=\"label_69\" for=\"input_69\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_69\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_69\" name=\"q69_email69\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_20\">\n        <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_20\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_20_0\" name=\"q20_wouldYou\" value=\"Yes\" \/>\n              <label for=\"input_20_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_20_1\" name=\"q20_wouldYou\" value=\"No\" \/>\n              <label for=\"input_20_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_133\">\n        <label class=\"form-label-left\" id=\"label_133\" for=\"input_133\"> Occupation <\/label>\n        <div id=\"cid_133\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_133\" name=\"q133_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_109\">\n        <label class=\"form-label-left\" id=\"label_109\" for=\"input_109\"> Title <\/label>\n        <div id=\"cid_109\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_109\" name=\"q109_title109\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_135\">\n        <label class=\"form-label-left\" id=\"label_135\" for=\"input_135\"> Company <\/label>\n        <div id=\"cid_135\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_135\" name=\"q135_company135\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_111\">\n        <label class=\"form-label-left\" id=\"label_111\" for=\"input_111\"> Work Tel <\/label>\n        <div id=\"cid_111\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q111_workTel111[area]\" id=\"input_111_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_111_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q111_workTel111[phone]\" id=\"input_111_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_111_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_168\">\n        <div id=\"cid_168\" class=\"form-input-wide\">\n          <div id=\"text_168\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_44\">\n        <label class=\"form-label-left\" id=\"label_44\" for=\"input_44\">\n          Father<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_44\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q44_father44[first]\" id=\"first_44\" \/>\n            <label class=\"form-sub-label\" for=\"first_44\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q44_father44[last]\" id=\"last_44\" \/>\n            <label class=\"form-sub-label\" for=\"last_44\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_123\">\n        <label class=\"form-label-left\" id=\"label_123\" for=\"input_123\">\n          Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_123\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q123_address[addr_line1]\" id=\"input_123_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_123_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q123_address[addr_line2]\" id=\"input_123_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_123_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q123_address[city]\" id=\"input_123_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_123_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q123_address[state]\" id=\"input_123_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_123_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q123_address[postal]\" id=\"input_123_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_123_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q123_address[country]\" id=\"input_123_country\">\n                    <option selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option selected=\"selected\" value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_123_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_49\">\n        <label class=\"form-label-left\" id=\"label_49\" for=\"input_49\"> Home Tel <\/label>\n        <div id=\"cid_49\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q49_homeTel49[area]\" id=\"input_49_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_49_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q49_homeTel49[phone]\" id=\"input_49_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_49_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_124\">\n        <label class=\"form-label-left\" id=\"label_124\" for=\"input_124\"> Mobile Tel <\/label>\n        <div id=\"cid_124\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q124_mobileTel124[area]\" id=\"input_124_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_124_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q124_mobileTel124[phone]\" id=\"input_124_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_124_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_70\">\n        <label class=\"form-label-left\" id=\"label_70\" for=\"input_70\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_70\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_70\" name=\"q70_email69\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_63\">\n        <label class=\"form-label-left\" id=\"label_63\" for=\"input_63\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_63\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_63_0\" name=\"q63_wouldYou63\" value=\"Yes\" \/>\n              <label for=\"input_63_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_63_1\" name=\"q63_wouldYou63\" value=\"No\" \/>\n              <label for=\"input_63_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_139\">\n        <label class=\"form-label-left\" id=\"label_139\" for=\"input_139\"> Occupation <\/label>\n        <div id=\"cid_139\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_139\" name=\"q139_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_140\">\n        <label class=\"form-label-left\" id=\"label_140\" for=\"input_140\"> Title <\/label>\n        <div id=\"cid_140\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_140\" name=\"q140_title140\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_145\">\n        <label class=\"form-label-left\" id=\"label_145\" for=\"input_145\"> Company <\/label>\n        <div id=\"cid_145\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_145\" name=\"q145_company145\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_138\">\n        <label class=\"form-label-left\" id=\"label_138\" for=\"input_138\"> Work Tel <\/label>\n        <div id=\"cid_138\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q138_workTel138[area]\" id=\"input_138_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_138_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q138_workTel138[phone]\" id=\"input_138_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_138_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_169\">\n        <div id=\"cid_169\" class=\"form-input-wide\">\n          <div id=\"text_169\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_112\">\n        <label class=\"form-label-left\" id=\"label_112\" for=\"input_112\">\n          Step-Parent<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_112\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q112_stepparent112[first]\" id=\"first_112\" \/>\n            <label class=\"form-sub-label\" for=\"first_112\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q112_stepparent112[last]\" id=\"last_112\" \/>\n            <label class=\"form-sub-label\" for=\"last_112\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_125\">\n        <label class=\"form-label-left\" id=\"label_125\" for=\"input_125\">\n          Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_125\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q125_address125[addr_line1]\" id=\"input_125_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_125_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q125_address125[addr_line2]\" id=\"input_125_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_125_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q125_address125[city]\" id=\"input_125_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_125_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q125_address125[state]\" id=\"input_125_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_125_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q125_address125[postal]\" id=\"input_125_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_125_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q125_address125[country]\" id=\"input_125_country\">\n                    <option selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option selected=\"selected\" value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_125_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_113\">\n        <label class=\"form-label-left\" id=\"label_113\" for=\"input_113\"> Home Tel <\/label>\n        <div id=\"cid_113\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q113_homeTel113[area]\" id=\"input_113_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_113_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q113_homeTel113[phone]\" id=\"input_113_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_113_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_126\">\n        <label class=\"form-label-left\" id=\"label_126\" for=\"input_126\"> Mobile Tel <\/label>\n        <div id=\"cid_126\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q126_mobileTel126[area]\" id=\"input_126_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_126_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q126_mobileTel126[phone]\" id=\"input_126_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_126_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_114\">\n        <label class=\"form-label-left\" id=\"label_114\" for=\"input_114\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_114\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_114\" name=\"q114_email69\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_115\">\n        <label class=\"form-label-left\" id=\"label_115\" for=\"input_115\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_115\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_115_0\" name=\"q115_wouldYou63\" value=\"Yes\" \/>\n              <label for=\"input_115_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_115_1\" name=\"q115_wouldYou63\" value=\"No\" \/>\n              <label for=\"input_115_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_143\">\n        <label class=\"form-label-left\" id=\"label_143\" for=\"input_143\"> Occupation <\/label>\n        <div id=\"cid_143\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_143\" name=\"q143_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_144\">\n        <label class=\"form-label-left\" id=\"label_144\" for=\"input_144\"> Title <\/label>\n        <div id=\"cid_144\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_144\" name=\"q144_title144\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_150\">\n        <label class=\"form-label-left\" id=\"label_150\" for=\"input_150\"> Company <\/label>\n        <div id=\"cid_150\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_150\" name=\"q150_company150\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_151\">\n        <label class=\"form-label-left\" id=\"label_151\" for=\"input_151\"> Work Tel <\/label>\n        <div id=\"cid_151\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q151_workTel151[area]\" id=\"input_151_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_151_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q151_workTel151[phone]\" id=\"input_151_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_151_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_170\">\n        <div id=\"cid_170\" class=\"form-input-wide\">\n          <div id=\"text_170\" class=\"form-html\">\n            <hr \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_116\">\n        <label class=\"form-label-left\" id=\"label_116\" for=\"input_116\">\n          Significant Other<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_116\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q116_significantOther116[first]\" id=\"first_116\" \/>\n            <label class=\"form-sub-label\" for=\"first_116\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q116_significantOther116[last]\" id=\"last_116\" \/>\n            <label class=\"form-sub-label\" for=\"last_116\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_128\">\n        <label class=\"form-label-left\" id=\"label_128\" for=\"input_128\">\n          Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_128\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q128_address128[addr_line1]\" id=\"input_128_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_128_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q128_address128[addr_line2]\" id=\"input_128_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_128_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q128_address128[city]\" id=\"input_128_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_128_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q128_address128[state]\" id=\"input_128_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_128_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q128_address128[postal]\" id=\"input_128_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_128_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q128_address128[country]\" id=\"input_128_country\">\n                    <option selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Abkhazia\"> Abkhazia <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh <\/option>\n                    <option value=\"Barbados\"> Barbados <\/option>\n                    <option value=\"Belarus\"> Belarus <\/option>\n                    <option value=\"Belgium\"> Belgium <\/option>\n                    <option value=\"Belize\"> Belize <\/option>\n                    <option value=\"Benin\"> Benin <\/option>\n                    <option value=\"Bermuda\"> Bermuda <\/option>\n                    <option value=\"Bhutan\"> Bhutan <\/option>\n                    <option value=\"Bolivia\"> Bolivia <\/option>\n                    <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                    <option value=\"Botswana\"> Botswana <\/option>\n                    <option value=\"Brazil\"> Brazil <\/option>\n                    <option value=\"Brunei\"> Brunei <\/option>\n                    <option value=\"Bulgaria\"> Bulgaria <\/option>\n                    <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                    <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option selected=\"selected\" value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                    <option value=\"Colombia\"> Colombia <\/option>\n                    <option value=\"Comoros\"> Comoros <\/option>\n                    <option value=\"Congo\"> Congo <\/option>\n                    <option value=\"Cook Islands\"> Cook Islands <\/option>\n                    <option value=\"Costa Rica\"> Costa Rica <\/option>\n                    <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Denmark\"> Denmark <\/option>\n                    <option value=\"Djibouti\"> Djibouti <\/option>\n                    <option value=\"Dominica\"> Dominica <\/option>\n                    <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                    <option value=\"Ecuador\"> Ecuador <\/option>\n                    <option value=\"Egypt\"> Egypt <\/option>\n                    <option value=\"El Salvador\"> El Salvador <\/option>\n                    <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                    <option value=\"Eritrea\"> Eritrea <\/option>\n                    <option value=\"Estonia\"> Estonia <\/option>\n                    <option value=\"Ethiopia\"> Ethiopia <\/option>\n                    <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                    <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                    <option value=\"Fiji\"> Fiji <\/option>\n                    <option value=\"Finland\"> Finland <\/option>\n                    <option value=\"France\"> France <\/option>\n                    <option value=\"French Polynesia\"> French Polynesia <\/option>\n                    <option value=\"Gabon\"> Gabon <\/option>\n                    <option value=\"The Gambia\"> The Gambia <\/option>\n                    <option value=\"Georgia\"> Georgia <\/option>\n                    <option value=\"Germany\"> Germany <\/option>\n                    <option value=\"Ghana\"> Ghana <\/option>\n                    <option value=\"Gibraltar\"> Gibraltar <\/option>\n                    <option value=\"Greece\"> Greece <\/option>\n                    <option value=\"Greenland\"> Greenland <\/option>\n                    <option value=\"Grenada\"> Grenada <\/option>\n                    <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                    <option value=\"Guam\"> Guam <\/option>\n                    <option value=\"Guatemala\"> Guatemala <\/option>\n                    <option value=\"Guernsey\"> Guernsey <\/option>\n                    <option value=\"Guinea\"> Guinea <\/option>\n                    <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                    <option value=\"Guyana\"> Guyana <\/option>\n                    <option value=\"Haiti\"> Haiti <\/option>\n                    <option value=\"Honduras\"> Honduras <\/option>\n                    <option value=\"Hong Kong\"> Hong Kong <\/option>\n                    <option value=\"Hungary\"> Hungary <\/option>\n                    <option value=\"Iceland\"> Iceland <\/option>\n                    <option value=\"India\"> India <\/option>\n                    <option value=\"Indonesia\"> Indonesia <\/option>\n                    <option value=\"Iran\"> Iran <\/option>\n                    <option value=\"Iraq\"> Iraq <\/option>\n                    <option value=\"Ireland\"> Ireland <\/option>\n                    <option value=\"Israel\"> Israel <\/option>\n                    <option value=\"Italy\"> Italy <\/option>\n                    <option value=\"Jamaica\"> Jamaica <\/option>\n                    <option value=\"Japan\"> Japan <\/option>\n                    <option value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n                    <option value=\"Libya\"> Libya <\/option>\n                    <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                    <option value=\"Lithuania\"> Lithuania <\/option>\n                    <option value=\"Luxembourg\"> Luxembourg <\/option>\n                    <option value=\"Macau\"> Macau <\/option>\n                    <option value=\"Macedonia\"> Macedonia <\/option>\n                    <option value=\"Madagascar\"> Madagascar <\/option>\n                    <option value=\"Malawi\"> Malawi <\/option>\n                    <option value=\"Malaysia\"> Malaysia <\/option>\n                    <option value=\"Maldives\"> Maldives <\/option>\n                    <option value=\"Mali\"> Mali <\/option>\n                    <option value=\"Malta\"> Malta <\/option>\n                    <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                    <option value=\"Martinique\"> Martinique <\/option>\n                    <option value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_128_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_117\">\n        <label class=\"form-label-left\" id=\"label_117\" for=\"input_117\"> Home Tel <\/label>\n        <div id=\"cid_117\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q117_homeTel117[area]\" id=\"input_117_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_117_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q117_homeTel117[phone]\" id=\"input_117_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_117_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_127\">\n        <label class=\"form-label-left\" id=\"label_127\" for=\"input_127\"> Mobile Tel <\/label>\n        <div id=\"cid_127\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q127_mobileTel127[area]\" id=\"input_127_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_127_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q127_mobileTel127[phone]\" id=\"input_127_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_127_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_118\">\n        <label class=\"form-label-left\" id=\"label_118\" for=\"input_118\">\n          Email<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_118\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_118\" name=\"q118_email69\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_119\">\n        <label class=\"form-label-left\" id=\"label_119\" for=\"input_119\">\n          Would you like to receive the KGMS Alumni Newsletter electronically?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_119\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_119_0\" name=\"q119_wouldYou63\" value=\"Yes\" \/>\n              <label for=\"input_119_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_119_1\" name=\"q119_wouldYou63\" value=\"No\" \/>\n              <label for=\"input_119_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_148\">\n        <label class=\"form-label-left\" id=\"label_148\" for=\"input_148\"> Occupation <\/label>\n        <div id=\"cid_148\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_148\" name=\"q148_occupation\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_149\">\n        <label class=\"form-label-left\" id=\"label_149\" for=\"input_149\"> Title <\/label>\n        <div id=\"cid_149\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_149\" name=\"q149_title\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_141\">\n        <label class=\"form-label-left\" id=\"label_141\" for=\"input_141\"> Company <\/label>\n        <div id=\"cid_141\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_141\" name=\"q141_company141\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_146\">\n        <label class=\"form-label-left\" id=\"label_146\" for=\"input_146\"> Work Tel <\/label>\n        <div id=\"cid_146\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q146_workTel[area]\" id=\"input_146_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_146_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q146_workTel[phone]\" id=\"input_146_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_146_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li id=\"cid_156\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h3 id=\"header_156\" class=\"form-header\">\n            Additional Information\n          <\/h3>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_25\">\n        <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Comments <\/label>\n        <div id=\"cid_25\" class=\"form-input\">\n          <textarea id=\"input_25\" class=\"form-textarea\" name=\"q25_comments\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"margin-left:106px\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\">\n              Submit Form\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"1265733224\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1265733224-1265733224\";\n  <\/script>\n<\/form><\/body>\n<\/html>\n");