/*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(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"><'+'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 i1612728205 = new FrameBuilder("1612728205", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2422\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:10px;\n }\n .form-label-right{\n width:150px !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:550px;\n color:Black !important;\n font-family:Verdana;\n font-size:12px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2422\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n $('input_6').hint('ex: myname@example.com');\n JotForm.initCaptcha('input_28');\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\" enctype=\"multipart\/form-data\" name=\"form_1612728205\" id=\"1612728205\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"1612728205\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_1\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_1\" class=\"form-header\">\n CVAN Membership Application\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_3\">\n <div id=\"cid_3\" class=\"form-input-wide\">\n <div id=\"text_3\" class=\"form-html\">\n Fill out and submit the form below to become a member of the Canadian Virtual Assistant Network.\n <br>\n <br>\n You have two options for your directory listing:\n <br>\n <br>\n 1) Basic listing included in your annual membership of $60.00 CDN - that's only $5 per month (payable annually in Canadian funds).\n <br>\n <br>\n 2) An enhanced listing is an additional one-time payment of $25.00 (Contact information, list of services, a link to a separate page with your logo\/or picture, description of your business, VA bio and your specialties.\n <br>\n <br>\n Payment Information\n <br>\n We use PayPal for you to pay for your membership by credit card or PayPal balance.\n <br>\n <br>\n Please complete all fields marked with an * \n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_4\">\n <label class=\"form-label-left\" id=\"label_4\" for=\"input_4\">\n Full Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q4_fullName4[first]\" id=\"first_4\" \/>\n <label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q4_fullName4[last]\" id=\"last_4\" \/>\n <label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\"> Company Name <\/label>\n <div id=\"cid_9\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_9\" name=\"q9_companyName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_6\">\n <label class=\"form-label-left\" id=\"label_6\" for=\"input_6\">\n E-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_6\" class=\"form-input\">\n <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_6\" name=\"q6_email6\" size=\"30\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_8\">\n <label class=\"form-label-left\" id=\"label_8\" for=\"input_8\"> Website <\/label>\n <div id=\"cid_8\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_8\" name=\"q8_website\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_5\">\n <label class=\"form-label-left\" id=\"label_5\" for=\"input_5\">\n Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" 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=\"q5_address5[addr_line1]\" id=\"input_5_addr_line1\" \/>\n <label class=\"form-sub-label\" for=\"input_5_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=\"q5_address5[addr_line2]\" id=\"input_5_addr_line2\" size=\"46\" \/>\n <label class=\"form-sub-label\" for=\"input_5_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=\"q5_address5[city]\" id=\"input_5_city\" size=\"21\" \/>\n <label class=\"form-sub-label\" for=\"input_5_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=\"q5_address5[state]\" id=\"input_5_state\" size=\"22\" \/>\n <label class=\"form-sub-label\" for=\"input_5_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=\"q5_address5[postal]\" id=\"input_5_postal\" size=\"10\" \/>\n <label class=\"form-sub-label\" for=\"input_5_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=\"q5_address5[country]\" id=\"input_5_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 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=\"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\"> Guyana Guyana <\/option>\n <option value=\"Haiti Haiti\"> 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=\"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=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/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=\"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_5_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n <\/td>\n <\/tr>\n <\/table>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_7\">\n <label class=\"form-label-left\" id=\"label_7\" for=\"input_7\">\n Phone Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_7\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q7_phoneNumber7[area]\" id=\"input_7_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_7_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q7_phoneNumber7[phone]\" id=\"input_7_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_7_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\"> Fax Number <\/label>\n <div id=\"cid_10\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q10_faxNumber[area]\" id=\"input_10_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_10_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q10_faxNumber[phone]\" id=\"input_10_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_10_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <div id=\"cid_11\" class=\"form-input-wide\">\n <div id=\"text_11\" class=\"form-html\">\n ABOUT YOUR BUSINESS \n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <label class=\"form-label-left\" id=\"label_12\" for=\"input_12\">\n How long have you been in business?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_12\" 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_12_0\" name=\"q12_howLong\" value=\"0 - 6 months\" \/>\n <label for=\"input_12_0\"> 0 - 6 months <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_1\" name=\"q12_howLong\" value=\"6 months - 1 year\" \/>\n <label for=\"input_12_1\"> 6 months - 1 year <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_2\" name=\"q12_howLong\" value=\"1 - 2 years\" \/>\n <label for=\"input_12_2\"> 1 - 2 years <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_3\" name=\"q12_howLong\" value=\"2 - 5 years\" \/>\n <label for=\"input_12_3\"> 2 - 5 years <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_4\" name=\"q12_howLong\" value=\"5 - 10 years\" \/>\n <label for=\"input_12_4\"> 5 - 10 years <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_5\" name=\"q12_howLong\" value=\"10+ years\" \/>\n <label for=\"input_12_5\"> 10+ years <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_13\">\n <label class=\"form-label-left\" id=\"label_13\" for=\"input_13\">\n Why would you like to become a CVAN member?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_13\" class=\"form-input\">\n <textarea id=\"input_13\" class=\"form-textarea validate[required]\" name=\"q13_whyWould\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\">\n Click to edit<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_14\" 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_14_0\" name=\"q14_clickTo14[]\" value=\"Accounting\/Bookkeeping\" \/>\n <label for=\"input_14_0\"> Accounting\/Bookkeeping <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_1\" name=\"q14_clickTo14[]\" value=\"Advertising Assistance\" \/>\n <label for=\"input_14_1\"> Advertising Assistance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_2\" name=\"q14_clickTo14[]\" value=\"Affiliate Management\" \/>\n <label for=\"input_14_2\"> Affiliate Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_3\" name=\"q14_clickTo14[]\" value=\"Affiliate Recruitment\" \/>\n <label for=\"input_14_3\"> Affiliate Recruitment <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_4\" name=\"q14_clickTo14[]\" value=\"Article Submission Services\" \/>\n <label for=\"input_14_4\"> Article Submission Services <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_5\" name=\"q14_clickTo14[]\" value=\"Audio Editing\" \/>\n <label for=\"input_14_5\"> Audio Editing <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_6\" name=\"q14_clickTo14[]\" value=\"Author's Assistant\" \/>\n <label for=\"input_14_6\"> Author's Assistant <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_7\" name=\"q14_clickTo14[]\" value=\"Autoresponder Creation & Management\" \/>\n <label for=\"input_14_7\"> Autoresponder Creation & Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_8\" name=\"q14_clickTo14[]\" value=\"Blog Maintenance\" \/>\n <label for=\"input_14_8\"> Blog Maintenance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_9\" name=\"q14_clickTo14[]\" value=\"Blog Set up & Customization\" \/>\n <label for=\"input_14_9\"> Blog Set up & Customization <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_10\" name=\"q14_clickTo14[]\" value=\"Coach's Assistant\" \/>\n <label for=\"input_14_10\"> Coach's Assistant <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_11\" name=\"q14_clickTo14[]\" value=\"Contact Management\" \/>\n <label for=\"input_14_11\"> Contact Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_12\" name=\"q14_clickTo14[]\" value=\"Copywriting\" \/>\n <label for=\"input_14_12\"> Copywriting <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_13\" name=\"q14_clickTo14[]\" value=\"Customer Service Support\" \/>\n <label for=\"input_14_13\"> Customer Service Support <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_14\" name=\"q14_clickTo14[]\" value=\"Data Entry\" \/>\n <label for=\"input_14_14\"> Data Entry <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_15\" name=\"q14_clickTo14[]\" value=\"Database Management\" \/>\n <label for=\"input_14_15\"> Database Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_16\" name=\"q14_clickTo14[]\" value=\"Desktop Publishing (i.e., MS Publisher)\" \/>\n <label for=\"input_14_16\"> Desktop Publishing (i.e., MS Publisher) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_17\" name=\"q14_clickTo14[]\" value=\"Editing\" \/>\n <label for=\"input_14_17\"> Editing <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_18\" name=\"q14_clickTo14[]\" value=\"Email Management\" \/>\n <label for=\"input_14_18\"> Email Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_19\" name=\"q14_clickTo14[]\" value=\"Ezine Creation\" \/>\n <label for=\"input_14_19\"> Ezine Creation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_20\" name=\"q14_clickTo14[]\" value=\"Ghostwriting\" \/>\n <label for=\"input_14_20\"> Ghostwriting <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_21\" name=\"q14_clickTo14[]\" value=\"Graphic Design\" \/>\n <label for=\"input_14_21\"> Graphic Design <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_22\" name=\"q14_clickTo14[]\" value=\"Internet Research\" \/>\n <label for=\"input_14_22\"> Internet Research <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_23\" name=\"q14_clickTo14[]\" value=\"Launch Implementation\" \/>\n <label for=\"input_14_23\"> Launch Implementation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_24\" name=\"q14_clickTo14[]\" value=\"Launch Management\" \/>\n <label for=\"input_14_24\"> Launch Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_25\" name=\"q14_clickTo14[]\" value=\"Legal Assistance\" \/>\n <label for=\"input_14_25\"> Legal Assistance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_26\" name=\"q14_clickTo14[]\" value=\"List Building\" \/>\n <label for=\"input_14_26\"> List Building <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_27\" name=\"q14_clickTo14[]\" value=\"Live Phone Support\" \/>\n <label for=\"input_14_27\"> Live Phone Support <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_28\" name=\"q14_clickTo14[]\" value=\"Market Research & Compilation\" \/>\n <label for=\"input_14_28\"> Market Research & Compilation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_29\" name=\"q14_clickTo14[]\" value=\"Marketing Assistance\" \/>\n <label for=\"input_14_29\"> Marketing Assistance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_30\" name=\"q14_clickTo14[]\" value=\"Medical Transcription\" \/>\n <label for=\"input_14_30\"> Medical Transcription <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_31\" name=\"q14_clickTo14[]\" value=\"Meeting & Event Management\" \/>\n <label for=\"input_14_31\"> Meeting & Event Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_32\" name=\"q14_clickTo14[]\" value=\"Online Business Management\" \/>\n <label for=\"input_14_32\"> Online Business Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_33\" name=\"q14_clickTo14[]\" value=\"Presentation Creation\" \/>\n <label for=\"input_14_33\"> Presentation Creation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_34\" name=\"q14_clickTo14[]\" value=\"Project Management\" \/>\n <label for=\"input_14_34\"> Project Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_35\" name=\"q14_clickTo14[]\" value=\"Public Relations\" \/>\n <label for=\"input_14_35\"> Public Relations <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_36\" name=\"q14_clickTo14[]\" value=\"Resume Writing\" \/>\n <label for=\"input_14_36\"> Resume Writing <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_37\" name=\"q14_clickTo14[]\" value=\"Schedule Management\" \/>\n <label for=\"input_14_37\"> Schedule Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_38\" name=\"q14_clickTo14[]\" value=\"Search Engine Optimization\" \/>\n <label for=\"input_14_38\"> Search Engine Optimization <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_39\" name=\"q14_clickTo14[]\" value=\"Shopping Cart Set up & Management\" \/>\n <label for=\"input_14_39\"> Shopping Cart Set up & Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_40\" name=\"q14_clickTo14[]\" value=\"Social Media Marketing Management\" \/>\n <label for=\"input_14_40\"> Social Media Marketing Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_41\" name=\"q14_clickTo14[]\" value=\"Social Media Marketing Planning\" \/>\n <label for=\"input_14_41\"> Social Media Marketing Planning <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_42\" name=\"q14_clickTo14[]\" value=\"Speaker's Assistant\" \/>\n <label for=\"input_14_42\"> Speaker's Assistant <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_43\" name=\"q14_clickTo14[]\" value=\"System & Process Documentation\" \/>\n <label for=\"input_14_43\"> System & Process Documentation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_44\" name=\"q14_clickTo14[]\" value=\"Team Management\" \/>\n <label for=\"input_14_44\"> Team Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_45\" name=\"q14_clickTo14[]\" value=\"Teleclass Set up & Management\" \/>\n <label for=\"input_14_45\"> Teleclass Set up & Management <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_46\" name=\"q14_clickTo14[]\" value=\"Transcription\" \/>\n <label for=\"input_14_46\"> Transcription <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_47\" name=\"q14_clickTo14[]\" value=\"Travel Planning & Arrangement\" \/>\n <label for=\"input_14_47\"> Travel Planning & Arrangement <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_48\" name=\"q14_clickTo14[]\" value=\"Video Editing\" \/>\n <label for=\"input_14_48\"> Video Editing <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_49\" name=\"q14_clickTo14[]\" value=\"Website Design\" \/>\n <label for=\"input_14_49\"> Website Design <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_50\" name=\"q14_clickTo14[]\" value=\"Website Maintenance\" \/>\n <label for=\"input_14_50\"> Website Maintenance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_14_51\" name=\"q14_clickTo14[]\" value=\"Wordprocessing\" \/>\n <label for=\"input_14_51\"> Wordprocessing <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\"> Other services offered (not listed above) <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <textarea id=\"input_15\" class=\"form-textarea\" name=\"q15_otherServices\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <div id=\"cid_16\" class=\"form-input-wide\">\n <div id=\"text_16\" class=\"form-html\">\n <hr>\n ENHANCED DIRECTORY LISTING\n <br>\n Upgrade to an enhanced directory listing for additional visability.\n <br>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Get noticed! <\/label>\n <div id=\"cid_17\" 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_17_0\" name=\"q17_getNoticed[]\" value=\"Please sign me up for the Enhanced Directory Listing. I am aware an additional cost of $25.00 will be added to the $60.00 membership fee.\" \/>\n <label for=\"input_17_0\"> Please sign me up for the Enhanced Directory Listing. I am aware an additional cost of $25.00 will be added to the $60.00 membership fee. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <div id=\"cid_18\" class=\"form-input-wide\">\n <div id=\"text_18\" class=\"form-html\">\n Please complete the following information for your enhanced listing: \n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Business Description <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <textarea id=\"input_19\" class=\"form-textarea\" name=\"q19_businessDescription\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\"> VA Bio <\/label>\n <div id=\"cid_20\" class=\"form-input\">\n <textarea id=\"input_20\" class=\"form-textarea\" name=\"q20_vaBio\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_21\">\n <label class=\"form-label-left\" id=\"label_21\" for=\"input_21\"> Who I work with (types of industries) <\/label>\n <div id=\"cid_21\" class=\"form-input\">\n <textarea id=\"input_21\" class=\"form-textarea\" name=\"q21_whoI\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <label class=\"form-label-left\" id=\"label_22\" for=\"input_22\"> Describe your ideal client <\/label>\n <div id=\"cid_22\" class=\"form-input\">\n <textarea id=\"input_22\" class=\"form-textarea\" name=\"q22_describeYour\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\"> What's your unique proposition? Why should prospective clients consider you and your services over another VA provider? <\/label>\n <div id=\"cid_23\" class=\"form-input\">\n <textarea id=\"input_23\" class=\"form-textarea\" name=\"q23_whatsYour\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_29\">\n <label class=\"form-label-left\" id=\"label_29\" for=\"input_29\"> Why I love what I do <\/label>\n <div id=\"cid_29\" class=\"form-input\">\n <textarea id=\"input_29\" class=\"form-textarea\" name=\"q29_whyI\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_30\">\n <label class=\"form-label-left\" id=\"label_30\" for=\"input_30\"> What email address would you like your contact form directed to when prospective clients complete one? <\/label>\n <div id=\"cid_30\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_30\" name=\"q30_whatEmail\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_31\">\n <label class=\"form-label-left\" id=\"label_31\" for=\"input_31\"> Any other information you would like to include? <\/label>\n <div id=\"cid_31\" class=\"form-input\">\n <textarea id=\"input_31\" class=\"form-textarea\" name=\"q31_anyOther\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\"> Please upload your company logo or image to be included on your CVAN Enhanced Directory Listing Page <\/label>\n <div id=\"cid_32\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_32\" name=\"q32_pleaseUpload\" file-accept=\"pdf, doc, docx, xls, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif\" file-maxsize=\"500\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <div id=\"cid_24\" class=\"form-input-wide\">\n <div id=\"text_24\" class=\"form-html\">\n <hr>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Please check the below to signify that you have read and understood the conditions of membership (check all): * <\/label>\n <div id=\"cid_25\" 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_25_0\" name=\"q25_pleaseCheck[]\" value=\"I agree to abide by the CVAN Membership Ethics. If it is found that I have not, my CVAN membership will be revoked immediately without refund.\" \/>\n <label for=\"input_25_0\"> I agree to abide by the CVAN Membership Ethics. If it is found that I have not, my CVAN membership will be revoked immediately without refund. <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_25_1\" name=\"q25_pleaseCheck[]\" value=\"I understand that CVAN is a community solely provided as a networking resource and does NOT offer employment or guarantee clients to its members.\" \/>\n <label for=\"input_25_1\"> I understand that CVAN is a community solely provided as a networking resource and does NOT offer employment or guarantee clients to its members. <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\"> Any questions or comments about your new membership? You can enter them here! <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <textarea id=\"input_26\" class=\"form-textarea\" name=\"q26_anyQuestions\" cols=\"40\" rows=\"6\"><\/textarea>\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 Enter the message as it's shown<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_28\" class=\"form-input\">\n <div class=\"form-captcha\">\n <label for=\"input_28\"> <img alt=\"Captcha - Reload if it's not displayed\" id=\"input_28_captcha\" class=\"form-captcha-image\" style=\"background:url(http:\/\/www.jotform.com\/images\/loader-big.gif) no-repeat center;\" src=\"http:\/\/www.jotform.com\/images\/blank.gif\" width=\"150\" height=\"41\" \/> <\/label>\n <div style=\"white-space:nowrap;\">\n <input type=\"text\" id=\"input_28\" class=\"form-textbox validate[required]\" name=\"captcha\" style=\"width:130px;\" \/>\n <img src=\"http:\/\/www.jotform.com\/images\/reload.png\" alt=\"Reload\" align=\"absmiddle\" style=\"cursor:pointer\" onclick=\"JotForm.reloadCaptcha('input_28');\" \/>\n <input type=\"hidden\" name=\"captcha_id\" id=\"input_28_captcha_id\" value=\"0\">\n <\/div>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <div id=\"cid_27\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_27\" 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=\"1612728205\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1612728205-1612728205\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");