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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=\"China\"> 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&#x27;Ivoire\"> Cote d&#x27;Ivoire <\/option>\n                    <option value=\"Croatia\"> Croatia <\/option>\n                    <option value=\"Cuba\"> Cuba <\/option>\n                    <option value=\"Curacao\"> Curacao <\/option>\n                    <option value=\"Cyprus\"> Cyprus <\/option>\n                    <option value=\"Czech Republic\"> Czech Republic <\/option>\n                    <option value=\"Democratic Republic of the Congo\"> Democratic Republic of the Congo <\/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=\"Republic of the Congo\"> Republic of the Congo <\/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=\"South Sudan\"> South Sudan <\/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=\"eSwatini\"> eSwatini <\/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=\"Isle of Man\"> Isle of Man <\/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_12_country\" id=\"sublabel_12_country\" style=\"min-height:13px\" aria-hidden=\"false\"> Country <\/label>\n                <\/span>\n              <\/span>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_36\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_36\" for=\"input_36\">\n          E-mail\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_36\" class=\"form-input jf-required\">\n          <input type=\"email\" id=\"input_36\" name=\"q36_email36\" class=\"form-textbox validate[required, Email]\" size=\"32\" value=\"\" placeholder=\"ex: myname@example.com\" data-component=\"email\" aria-labelledby=\"label_36\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_phone\" id=\"id_11\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_11\" for=\"input_11_area\">\n          Phone Number:\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_11\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"areaCode\">\n              <input type=\"tel\" id=\"input_11_area\" name=\"q11_phoneNumber[area]\" class=\"form-textbox validate[required]\" value=\"\" data-component=\"areaCode\" aria-labelledby=\"label_11 sublabel_11_area\" required=\"\" \/>\n              <span class=\"phone-separate\" aria-hidden=\"true\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"input_11_area\" id=\"sublabel_11_area\" style=\"min-height:13px\" aria-hidden=\"false\"> Area Code <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"phone\">\n              <input type=\"tel\" id=\"input_11_phone\" name=\"q11_phoneNumber[phone]\" class=\"form-textbox validate[required]\" value=\"\" data-component=\"phone\" aria-labelledby=\"label_11 sublabel_11_phone\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_11_phone\" id=\"sublabel_11_phone\" style=\"min-height:13px\" aria-hidden=\"false\"> Phone Number <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_paypal\" id=\"id_41\" data-payment=\"true\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_41\" for=\"input_41\">\n          Membership Options\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_41\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <div class=\"filter-container\">\n            <\/div>\n            <input type=\"hidden\" name=\"simple_fpc\" data-payment_type=\"paypal\" data-component=\"payment1\" value=\"41\" \/>\n            <input type=\"hidden\" name=\"payment_total_checksum\" id=\"payment_total_checksum\" data-component=\"payment2\" \/>\n            <div id=\"image-overlay\" class=\"overlay-content\" style=\"display:none\">\n              <img id=\"current-image\" \/>\n              <span class=\"lb-prev-button\">\n                prev\n              <\/span>\n              <span class=\"lb-next-button\">\n                next\n              <\/span>\n              <span class=\"lb-close-button\">\n                ( X )\n              <\/span>\n              <span class=\"image-overlay-product-container\">\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/kwame.jpg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/amy.jpeg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/amilcar.jpeg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/queen mother.jpeg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/frantz.jpg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/ida.jpg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/walter.jpeg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n                <ul class=\"form-overlay-item\" hasicon=\"false\" hasimages=\"true\" iconvalue=\"\">\n                  <li class=\"image-overlay-image\">\n                    <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/67402527_2399535077033997_6446529213016047616_o.jpg?nc=1\" \/>\n                  <\/li>\n                <\/ul>\n              <\/span>\n            <\/div>\n            <div data-wrapper-react=\"true\">\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1001\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/kwame.jpg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1001\" name=\"q41_membershipOptions[][id]\" value=\"1001\" \/>\n                  <label for=\"input_41_1001\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1001\">\n                        Kwame Nkrumah (Lifetime)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1001_price\">\n                              1,000.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1001\">\n                      This is AAPDEP&#x27;s only Lifetime Membership Level and includes membership card, newsletter, AAPDEP sticker, AAPDEP hat, AAPDEP t-shirt, 1\/2 page ad in AAPDEP Convention souvenir booklet, 30% off order at Zenzele Consignment once per year.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1002\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/amy.jpeg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1002\" name=\"q41_membershipOptions[][id]\" value=\"1002\" \/>\n                  <label for=\"input_41_1002\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1002\">\n                        Amy Jacque Garvey (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1002_price\">\n                              500.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1002\">\n                      Includes membership card, newsletter, AAPDEP sticker, AAPDEP hat, 1\/4 page size ad in AAPDEP Convention souvenir booklet and 25% off order at Zenzele Consignment once per year.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1003\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/amilcar.jpeg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1003\" name=\"q41_membershipOptions[][id]\" value=\"1003\" \/>\n                  <label for=\"input_41_1003\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1003\">\n                        Amilcar Cabral (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1003_price\">\n                              365.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1003\">\n                      Includes membership card, newsletter, AAPDEP sticker, AAPDEP hat, Business size ad in AAPDEP Convention souvenir booklet and 20% off order at Zenzele Consignment once per year.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1004\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/queen%20mother.jpeg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1004\" name=\"q41_membershipOptions[][id]\" value=\"1004\" \/>\n                  <label for=\"input_41_1004\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1004\">\n                        Queen Mother Moore (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1004_price\">\n                              250.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1004\">\n                      Includes membership card, newsletter, AAPDEP sticker, AAPDEP hat and 15 %off order at Zenzele Consignment once per year.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1005\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/frantz.jpg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1005\" name=\"q41_membershipOptions[][id]\" value=\"1005\" \/>\n                  <label for=\"input_41_1005\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1005\">\n                        Frantz Fanon (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1005_price\">\n                              120.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1005\">\n                      Includes membership card, newsletter, AAPDEP sticker, and 15% off Zenzele Consignment once per year.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1006\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/ida.jpg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1006\" name=\"q41_membershipOptions[][id]\" value=\"1006\" \/>\n                  <label for=\"input_41_1006\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1006\">\n                        Ida B. Wells (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1006_price\">\n                              60.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1006\">\n                      Includes membership card, newsletter and AAPDEP sticker\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1007\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/walter.jpeg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1007\" name=\"q41_membershipOptions[][id]\" value=\"1007\" \/>\n                  <label for=\"input_41_1007\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1007\">\n                        Walter Rodney (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1007_price\">\n                              25.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1007\">\n                      Includes membership card and newsletter.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n              <span class=\"form-product-item hover-product-item \" categories=\"non-categorized\" pid=\"1008\">\n                <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/67402527_2399535077033997_6446529213016047616_o.jpg?nc=1\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle\" \/>\n                <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                  <input type=\"radio\" class=\"form-radio validate[required]  form-product-input\" id=\"input_41_1008\" name=\"q41_membershipOptions[][id]\" value=\"1008\" checked=\"\" \/>\n                  <label for=\"input_41_1008\" class=\"form-product-container\">\n                    <span data-wrapper-react=\"true\">\n                      <span class=\"form-product-name\" id=\"product-name-input_41_1008\">\n                        Omowale Kefing (Annual)\n                      <\/span>\n                      <span class=\"form-product-details\">\n                        <b>\n                          <span data-wrapper-react=\"true\">\n                            $\n                            <span id=\"input_41_1008_price\">\n                              10.00\n                            <\/span>\n                          <\/span>\n                        <\/b>\n                      <\/span>\n                    <\/span>\n                    <div class=\"form-product-description\" id=\"product-name-description-input_41_1008\">\n                      This membership level is for our student and unemployed members. Includes membership card and newsletter.\n                    <\/div>\n                  <\/label>\n                <\/div>\n              <\/span>\n              <br\/>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_46\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_46\" type=\"button\" class=\"form-pagebreak-back  jf-form-buttons\" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_46\" type=\"button\" class=\"form-pagebreak-next  jf-form-buttons\" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both\" class=\"pageInfo form-sub-label\" id=\"pageInfo_46\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_55\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group  header-default\">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_55\" class=\"form-header\" data-component=\"header\">\n              Student Information\n            <\/h2>\n            <div id=\"subHeader_55\" class=\"form-subHeader\">\n              Please complete if you are currently earning a degree or other merit at a higher learning institution\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_48\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_48\" for=\"input_48\">\n          Are you a student?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_48\" class=\"form-input jf-required\">\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_48\" data-component=\"radio\">\n            <span class=\"form-radio-item\" style=\"clear:left\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_48_0\" name=\"q48_areYou\" value=\"Yes\" required=\"\" \/>\n              <label id=\"label_input_48_0\" for=\"input_48_0\"> Yes <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_48_1\" name=\"q48_areYou\" value=\"No\" required=\"\" \/>\n              <label id=\"label_input_48_1\" for=\"input_48_1\"> No <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_49\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_49\" for=\"input_49\"> School <\/label>\n        <div id=\"cid_49\" class=\"form-input\">\n          <input type=\"text\" id=\"input_49\" name=\"q49_school\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_49\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_50\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_50\" for=\"input_50\"> Major\/Minor <\/label>\n        <div id=\"cid_50\" class=\"form-input\">\n          <input type=\"text\" id=\"input_50\" name=\"q50_majorminor\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_50\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_51\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_51\" for=\"input_51\"> Specialization <\/label>\n        <div id=\"cid_51\" class=\"form-input\">\n          <input type=\"text\" id=\"input_51\" name=\"q51_specialization\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_51\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_52\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_52\" for=\"input_52\"> Classification <\/label>\n        <div id=\"cid_52\" class=\"form-input\">\n          <input type=\"text\" id=\"input_52\" name=\"q52_classification\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_52\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_53\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_53\" for=\"input_53\"> Degree <\/label>\n        <div id=\"cid_53\" class=\"form-input\">\n          <input type=\"text\" id=\"input_53\" name=\"q53_degree\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" aria-labelledby=\"label_53\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_datetime\" id=\"id_54\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_54\" for=\"lite_mode_54\"> Expected Graduation Date <\/label>\n        <div id=\"cid_54\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <div style=\"display:none\">\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                <input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"month_54\" name=\"q54_expectedGraduation[month]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_54 sublabel_54_month\" \/>\n                <span class=\"date-separate\" aria-hidden=\"true\">\n                  \u00a0-\n                <\/span>\n                <label class=\"form-sub-label\" for=\"month_54\" id=\"sublabel_54_month\" style=\"min-height:13px\" aria-hidden=\"false\"> Month <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                <input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"day_54\" name=\"q54_expectedGraduation[day]\" size=\"2\" data-maxlength=\"2\" data-age=\"\" maxLength=\"2\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_54 sublabel_54_day\" \/>\n                <span class=\"date-separate\" aria-hidden=\"true\">\n                  \u00a0-\n                <\/span>\n                <label class=\"form-sub-label\" for=\"day_54\" id=\"sublabel_54_day\" style=\"min-height:13px\" aria-hidden=\"false\"> Day <\/label>\n              <\/span>\n              <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n                <input type=\"tel\" class=\"form-textbox validate[limitDate]\" id=\"year_54\" name=\"q54_expectedGraduation[year]\" size=\"4\" data-maxlength=\"4\" data-age=\"\" maxLength=\"4\" value=\"\" autoComplete=\"off\" aria-labelledby=\"label_54 sublabel_54_year\" \/>\n                <label class=\"form-sub-label\" for=\"year_54\" id=\"sublabel_54_year\" style=\"min-height:13px\" aria-hidden=\"false\"> Year <\/label>\n              <\/span>\n            <\/div>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n              <input type=\"text\" class=\"form-textbox validate[limitDate, validateLiteDate]\" id=\"lite_mode_54\" size=\"12\" data-maxlength=\"12\" maxLength=\"12\" data-age=\"\" value=\"\" data-format=\"mmddyyyy\" data-seperator=\"-\" placeholder=\"mm-dd-yyyy\" autoComplete=\"off\" aria-labelledby=\"label_54 sublabel_54_litemode\" \/>\n              <img class=\" newDefaultTheme-dateIcon icon-liteMode\" alt=\"Pick a Date\" id=\"input_54_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" data-component=\"datetime\" aria-hidden=\"true\" data-allow-time=\"No\" data-version=\"v1\" \/>\n              <label class=\"form-sub-label\" for=\"lite_mode_54\" id=\"sublabel_54_litemode\" style=\"min-height:13px\" aria-hidden=\"false\"> Date <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_45\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_45\" type=\"button\" class=\"form-pagebreak-back  jf-form-buttons\" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_45\" type=\"button\" class=\"form-pagebreak-next  jf-form-buttons\" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both\" class=\"pageInfo form-sub-label\" id=\"pageInfo_45\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_56\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group  header-default\">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_56\" class=\"form-header\" data-component=\"header\">\n              Skills, Interest, and Community Organization\n            <\/h2>\n            <div id=\"subHeader_56\" class=\"form-subHeader\">\n              Please complete to give us a better idea of what skills you may have!\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_57\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_57\" for=\"input_57\"> Community <\/label>\n        <div id=\"cid_57\" class=\"form-input\">\n          <textarea id=\"input_57\" class=\"form-textarea\" name=\"q57_community\" cols=\"40\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_57\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_58\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_58\" for=\"input_58\"> Interests <\/label>\n        <div id=\"cid_58\" class=\"form-input\">\n          <textarea id=\"input_58\" class=\"form-textarea\" name=\"q58_community58\" cols=\"40\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_58\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_59\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_59\" for=\"input_59\"> Skills <\/label>\n        <div id=\"cid_59\" class=\"form-input\">\n          <textarea id=\"input_59\" class=\"form-textarea\" name=\"q59_skills\" cols=\"40\" rows=\"6\" data-component=\"textarea\" aria-labelledby=\"label_59\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_signature\" id=\"id_60\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_60\" for=\"input_60\">\n          Signature\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_60\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <div id=\"signature_pad_60\" class=\"signature-pad-wrapper\" style=\"width:402px;height:102px\">\n              <div data-wrapper-react=\"true\">\n                <!--[if IE 7]>\n                  <script type=\"text\/javascript\" src=\"\/js\/vendor\/json2.js\"><\/script>\n                <![endif]-->\n              <\/div>\n              <div class=\"signature-line signature-wrapper signature-placeholder\" data-component=\"signature\" style=\"width:402px;height:102px\">\n                <div id=\"sig_pad_60\" data-width=\"400\" data-height=\"100\" data-id=\"60\" data-required=\"true\" class=\"pad validate[required]\">\n                <\/div>\n                <input type=\"hidden\" name=\"q60_signature\" class=\"output4\" id=\"input_60\" \/>\n              <\/div>\n              <span class=\"clear-pad-btn clear-pad\" role=\"button\" tabindex=\"0\">\n                Clear\n              <\/span>\n            <\/div>\n            <div data-wrapper-react=\"true\">\n              <script type=\"text\/javascript\">\n              window.signatureForm = true\n              <\/script>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_32\">\n        <div id=\"cid_32\" class=\"form-input-wide\">\n          <div id=\"text_32\" class=\"form-html\" data-component=\"text\">\n            <p style=\"text-align:center;\"><span style=\"font-size:medium;\"><em>By clicking the &quot;Pay Now&quot; button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.\u00a0<\/em><\/span><\/p>\n            <p style=\"text-align:center;\"><em><span style=\"font-size:medium;\"> Thank you!<\/span><br \/><\/em><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column form-col-1\" data-type=\"control_button\" id=\"id_9\">\n        <div id=\"cid_9\" class=\"form-input-wide\">\n          <div style=\"text-align:center\" data-align=\"center\" class=\"form-buttons-wrapper form-buttons-center   jsTest-button-wrapperField\">\n            <button id=\"input_9\" type=\"submit\" class=\"form-submit-button form-submit-button-img form-submit-button-none submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">\n              <img src=\"https:\/\/www.jotform.com\/uploads\/chiwo.luzolo\/form_files\/paypal-pill%20(2).5e8b8905d8e4c8.80253032.png\" alt=\"Submit\" \/>\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  <script>\n  JotForm.showJotFormPowered = \"new_footer\";\n  <\/script>\n  <script>\n  JotForm.poweredByText = \"Powered by JotForm\";\n  <\/script>\n  <input type=\"hidden\" class=\"simple_spc\" id=\"simple_spc\" name=\"simple_spc\" value=\"200965777821162\" \/>\n  <script type=\"text\/javascript\">\n  var all_spc = document.querySelectorAll(\"form[id='200965777821162'] .si\" + \"mple\" + \"_spc\");\nfor (var i = 0; i < all_spc.length; i++)\n{\n  all_spc[i].value = \"200965777821162-200965777821162\";\n}\n  <\/script>\n  <div class=\"formFooter-heightMask\">\n  <\/div>\n  <div class=\"formFooter f6\">\n    <div class=\"formFooter-wrapper formFooter-leftSide\">\n      <a href=\"https:\/\/www.jotform.com\/?utm_source=formfooter&utm_medium=banner&utm_term=200965777821162&utm_content=jotform_logo&utm_campaign=powered_by_jotform_le\" target=\"_blank\" class=\"formFooter-logoLink\"><img class=\"formFooter-logo\" src=\"https:\/\/cdn.jotfor.ms\/assets\/img\/logo\/logo-new@1x.png\" alt=\"Jotform Logo\"><\/a>\n    <\/div>\n    <div class=\"formFooter-wrapper formFooter-rightSide\">\n      <span class=\"formFooter-text\">\n        Now create your own JotForm - It's free!\n      <\/span>\n      <a class=\"formFooter-button\" href=\"https:\/\/www.jotform.com\/?utm_source=formfooter&utm_medium=banner&utm_term=200965777821162&utm_content=jotform_button&utm_campaign=powered_by_jotform_le\" target=\"_blank\">Create your own JotForm<\/a>\n    <\/div>\n  <\/div>\n<\/form><\/body>\n<\/html>\n","Membership Registration Form - PayPal",Array);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");if(args[2]!="200965777821162"){return;}
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