/*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 i92705842264 = new FrameBuilder("92705842264", false, "", "\n\n\n\n\nForm<\/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:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:white;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:630px;\n background:white;\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?3.0.2435\" 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 JotForm.description('input_10', '* This information is used to help achieve a group representative of the entire state');\n JotForm.description('input_11', '* This information is used to help achieve a group representative of the entire state');\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_92705842264\" id=\"92705842264\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"92705842264\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_21\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_21\" class=\"form-header\">\n 2011 Leadership Kansas Nomination Form\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <div id=\"cid_22\" class=\"form-input-wide\">\n <div id=\"text_22\" class=\"form-html\">\n <p>\n I nominate the following individual, whom I consider to be an excellent candidate, to receive an informational packet and application for the 2011 Leadership Kansas Program. Information regarding this nomination will be sent to each nominee at the close of next year’s nomination process.\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_0\">\n <label class=\"form-label-left\" id=\"label_0\" for=\"input_0\">\n First Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_0\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_0\" name=\"q0_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <label class=\"form-label-left\" id=\"label_1\" for=\"input_1\">\n Last Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_1\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_1\" name=\"q1_lastName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_3\">\n <label class=\"form-label-left\" id=\"label_3\" for=\"input_3\">\n Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_3\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_3\" name=\"q3_address\" size=\"20\" maxlength=\"100\" \/>\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 City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_4\" name=\"q4_city\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\">\n Zip<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_19\" name=\"q19_zip\" size=\"20\" maxlength=\"100\" \/>\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 State<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_5\" name=\"q5_state\">\n <option> <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_2\">\n <label class=\"form-label-left\" id=\"label_2\" for=\"input_2\">\n E-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_2\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_2\" name=\"q2_email\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\">\n Occupation<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_9\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_9\" name=\"q9_occupation\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\"> Gender* <\/label>\n <div id=\"cid_10\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_10\" name=\"q10_gender\">\n <option> <\/option>\n <option value=\"Male\"> Male <\/option>\n <option value=\"Female\"> Female <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\"> Race\/Ethnicity* <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_11\" name=\"q11_raceethnicity\">\n <option> <\/option>\n <option value=\"African American\"> African American <\/option>\n <option value=\"American Indian\"> American Indian <\/option>\n <option value=\"Asian\"> Asian <\/option>\n <option value=\"Caucasian\"> Caucasian <\/option>\n <option value=\"Hispanic\"> Hispanic <\/option>\n <option value=\"Other\"> Other <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <div id=\"cid_20\" class=\"form-input-wide\">\n <div id=\"text_20\" class=\"form-html\">\n *This information is used to help achieve a group representative of the entire state.\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 Your Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_12\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_12\" name=\"q12_yourName\" size=\"20\" maxlength=\"100\" \/>\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 Company<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_13\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_13\" name=\"q13_company\" size=\"20\" maxlength=\"100\" \/>\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 Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_14\" name=\"q14_address14\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\">\n City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_15\" name=\"q15_city15\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\">\n State<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_16\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_16\" name=\"q16_state16\">\n <option> <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\">\n Zip<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_17\" name=\"q17_zip17\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\">\n Email<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_18\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_18\" name=\"q18_email18\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_8\">\n <div id=\"cid_8\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_8\" type=\"submit\" class=\"form-submit-button\">\n Submit\n <\/button>\n \n <button id=\"input_reset_8\" type=\"reset\" class=\"form-submit-reset\">\n Clear 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=\"92705842264\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"92705842264-92705842264\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");