{"id":676,"date":"2017-05-11T07:07:24","date_gmt":"2017-05-11T07:07:24","guid":{"rendered":"https:\/\/www.crbc.org\/nextgen\/?page_id=676"},"modified":"2020-09-16T14:57:29","modified_gmt":"2020-09-16T14:57:29","slug":"baptism-request-form","status":"publish","type":"page","link":"https:\/\/www.crbc.org\/nextgen\/baptism-request-form\/","title":{"rendered":"BAPTISM REQUEST FORM"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"676\" class=\"elementor elementor-676\" data-elementor-post-type=\"page\">\r\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8e03e60 elementor-section-full_width elementor-section-height-min-height elementor-hidden-tablet elementor-hidden-phone elementor-section-height-default elementor-section-items-middle\" data-id=\"8e03e60\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\r\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\r\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1acb13d\" data-id=\"1acb13d\" data-element_type=\"column\" data-e-type=\"column\">\r\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\r\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a9b2f07 elementor-widget elementor-widget-spacer\" data-id=\"a9b2f07\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\r\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\r\n\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t<\/section>\r\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9aca956 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9aca956\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\r\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\r\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6b9057d\" data-id=\"6b9057d\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\r\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\r\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-03664fe elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"03664fe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"theme-post-title.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">BAPTISM REQUEST FORM<\/h1>\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"elementor-element elementor-element-7971902 elementor-widget elementor-widget-spacer\" data-id=\"7971902\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\r\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\r\n\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"elementor-element elementor-element-3523452 elementor-widget elementor-widget-shortcode\" data-id=\"3523452\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"frm_forms  with_frm_style frm_style_crbc-form-style\" id=\"frm_form_11_container\" >\r\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_ajax_submit \" id=\"form_contact2\" >\r\n<div class=\"frm_form_fields \">\r\n<fieldset>\r\n<legend class=\"frm_hidden\">Baptism Request Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\r\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\r\n<input type=\"hidden\" name=\"form_id\" value=\"11\" \/>\r\n<input type=\"hidden\" name=\"frm_hide_fields_11\" id=\"frm_hide_fields_11\" value=\"\" \/>\r\n<input type=\"hidden\" name=\"form_key\" value=\"contact2\" \/>\r\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\r\n<input type=\"hidden\" id=\"frm_submit_entry_11\" name=\"frm_submit_entry_11\" value=\"30cf8371f1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nextgen\/wp-json\/wp\/v2\/pages\/676\" \/><div id=\"frm_field_186_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy2\" class=\"frm_primary_label\">BAPTISM CANDIDATE'S NAME\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy2\" name=\"item_meta[186]\" value=\"\"  placeholder=\"First Name\" data-reqmsg=\"BAPTISM CANDIDATE&#039;S NAME cannot be blank.\" aria-required=\"true\" data-invmsg=\"BAPTISM CANDIDATE&#039;S NAME is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_187_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half\">\r\n    <label for=\"field_iridw\" class=\"frm_primary_label\">NAME\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_iridw\" name=\"item_meta[187]\" value=\"\"  placeholder=\"Last Name\" data-reqmsg=\"NAME cannot be blank.\" aria-required=\"true\" data-invmsg=\"NAME is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_188_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first\">\r\n    <label for=\"field_qqliz\" class=\"frm_primary_label\">WHAT DATE (MUST BE A SUNDAY) WOULD YOU LIKE THE BAPTISM TO TAKE PLACE? (MM\/DD\/YYYY)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qqliz\" name=\"item_meta[188]\" value=\"\"  style=\"width:50%\" maxlength=\"150\" data-reqmsg=\"WHAT DATE (MUST BE A SUNDAY) WOULD YOU LIKE THE BAPTISM TO TAKE PLACE? (MM\/DD\/YYYY) cannot be blank.\" aria-required=\"true\" data-invmsg=\"WHAT DATE (MUST BE A SUNDAY) WOULD YOU LIKE THE BAPTISM TO TAKE PLACE? (MM\/DD\/YYYY) * is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_189_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_189-0\">\t\t\t<label  for=\"field_r0a6x-0\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[189]\" id=\"field_r0a6x-0\" value=\"9:30 am\"\r\n\t\t data-reqmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? cannot be blank.\" data-invmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? is invalid\"   \/> 9:30 am<\/label><\/div>\r\n\t\t<div class=\"frm_radio\" id=\"frm_radio_189-1\">\t\t\t<label  for=\"field_r0a6x-1\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[189]\" id=\"field_r0a6x-1\" value=\"11:00 am\"\r\n\t\t data-reqmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? cannot be blank.\" data-invmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? is invalid\"   \/> 11:00 am<\/label><\/div>\r\n\t\t<div class=\"frm_radio\" id=\"frm_radio_189-2\">\t\t\t<label  for=\"field_r0a6x-2\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[189]\" id=\"field_r0a6x-2\" value=\"Either is fine\"\r\n\t\t data-reqmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? cannot be blank.\" data-invmsg=\"WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? is invalid\"   \/> Either is fine<\/label><\/div>\r\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_190_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_full\">\r\n    <label for=\"field_b2412\" class=\"frm_primary_label\">ENTER CANDIDATE'S NAME EXACTLY AS IT SHOULD APPEAR ON THE BAPTISM CERTIFICATE:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_b2412\" name=\"item_meta[190]\" value=\"\"  data-reqmsg=\"ENTER CANDIDATE&#039;S NAME EXACTLY AS IT SHOULD APPEAR ON THE BAPTISM CERTIFICATE: cannot be blank.\" aria-required=\"true\" data-invmsg=\"ENTER CANDIDATE&#039;S NAME EXACTLY AS IT SHOULD APPEAR ON THE BAPTISM CERTIFICATE: is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_191_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full frm_first vertical_radio\">\r\n    <label  class=\"frm_primary_label\">WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_191-0\">\t\t\t<label  for=\"field_jam2y-0\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[191]\" id=\"field_jam2y-0\" value=\"Kevin Corey (NextGen Pastor)\"\r\n\t\t data-reqmsg=\"WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY? cannot be blank.\" data-invmsg=\"WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY? is invalid\"   \/> Kevin Corey (NextGen Pastor)<\/label><\/div>\r\n\t\t<div class=\"frm_radio\" id=\"frm_radio_191-1\">\t\t\t<label  for=\"field_jam2y-1\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[191]\" id=\"field_jam2y-1\" value=\"Dave Rhodenhizer (Senior Pastor)\"\r\n\t\t data-reqmsg=\"WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY? cannot be blank.\" data-invmsg=\"WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY? is invalid\"   \/> Dave Rhodenhizer (Senior Pastor)<\/label><\/div>\r\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_244_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_43wo7\" class=\"frm_primary_label\">SCHOOL GRADE?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[244]\" id=\"field_43wo7\"  data-reqmsg=\"SCHOOL GRADE? cannot be blank.\" aria-required=\"true\" data-invmsg=\"SCHOOL GRADE? is invalid\" aria-invalid=\"false\"  >\r\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"1st Grade\">1st Grade<\/option><option  value=\"2nd Grade\">2nd Grade<\/option><option  value=\"3rd Grade\">3rd Grade<\/option><option  value=\"4th Grade\">4th Grade<\/option><option  value=\"5th Grade\">5th Grade<\/option><option  value=\"6th Grade\">6th Grade<\/option><option  value=\"7th Grade\">7th Grade<\/option><option  value=\"8th Grade\">8th Grade<\/option><option  value=\"9th Grade\">9th Grade<\/option><option  value=\"10th Grade\">10th Grade<\/option><option  value=\"11th Grade\">11th Grade<\/option><option  value=\"12th Grade\">12th Grade<\/option>\t<\/select>\r\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_193_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_193-0\">\t\t\t<label  for=\"field_shbwj-0\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[193]\" id=\"field_shbwj-0\" value=\"Yes (see next field)\"\r\n\t\t data-reqmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? cannot be blank.\" data-invmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? is invalid\"   \/> Yes (see next field)<\/label><\/div>\r\n\t\t<div class=\"frm_radio\" id=\"frm_radio_193-1\">\t\t\t<label  for=\"field_shbwj-1\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[193]\" id=\"field_shbwj-1\" value=\"No\"\r\n\t\t data-reqmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? cannot be blank.\" data-invmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? is invalid\"   \/> No<\/label><\/div>\r\n\t\t<div class=\"frm_radio\" id=\"frm_radio_193-2\">\t\t\t<label  for=\"field_shbwj-2\">\r\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[193]\" id=\"field_shbwj-2\" value=\"Unsure\"\r\n\t\t data-reqmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? cannot be blank.\" data-invmsg=\"HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? is invalid\"   \/> Unsure<\/label><\/div>\r\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_194_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_full\">\r\n    <label for=\"field_z7vpo\" class=\"frm_primary_label\">IF YOU ANSWERED \"YES\" ABOVE, PROVIDE THE DATE, AGE, OR ANY INFORMATION THAT PERTAINS TO THE CANDIDATE'S PROFESSION OF FAITH:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_z7vpo\" name=\"item_meta[194]\" value=\"\"  style=\"width:100%\" data-reqmsg=\"IF YOU ANSWERED &quot;YES&quot; ABOVE, PROVIDE THE DATE, AGE, OR ANY INFORMATION THAT PERTAINS TO THE CANDIDATE&#039;S PROFESSION OF FAITH: cannot be blank.\" aria-required=\"true\" data-invmsg=\"IF YOU ANSWERED &quot;YES&quot; ABOVE, PROVIDE THE DATE, AGE, OR ANY INFORMATION THAT PERTAINS TO THE CANDIDATE&#039;S PROFESSION OF FAITH: is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_195_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_t3483\" class=\"frm_primary_label\">PARENT\/GUARDIAN NAME\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t3483\" name=\"item_meta[195]\" value=\"\"  placeholder=\"Firstname\" data-reqmsg=\"PARENT\/GUARDIAN NAME cannot be blank.\" aria-required=\"true\" data-invmsg=\"PARENT\/GUARDIAN NAME is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_196_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half frm_half\">\r\n    <label for=\"field_t6r08\" class=\"frm_primary_label\">NAME\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t6r08\" name=\"item_meta[196]\" value=\"\"  placeholder=\"Lastname\" data-reqmsg=\"NAME cannot be blank.\" aria-required=\"true\" data-invmsg=\"NAME is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_197_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_4qo91\" class=\"frm_primary_label\">ADDRESS (WHERE YOU WOULD LIKE THE CERTIFICATE TO BE MAILED):\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4qo91\" name=\"item_meta[197]\" value=\"\"  placeholder=\"Line 1\" data-reqmsg=\"ADDRESS (WHERE YOU WOULD LIKE THE CERTIFICATE TO BE MAILED): cannot be blank.\" aria-required=\"true\" data-invmsg=\"ADDRESS (WHERE YOU WOULD LIKE THE CERTIFICATE TO BE MAILED): is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_198_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm_first frm_half\">\r\n    <label for=\"field_jmdpn\" class=\"frm_primary_label\">Single Line Text\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jmdpn\" name=\"item_meta[198]\" value=\"\"  placeholder=\"Line 2\" data-reqmsg=\"Single Line Text cannot be blank.\" aria-required=\"true\" data-invmsg=\"Single Line Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_199_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm_first frm_fourth\">\r\n    <label for=\"field_c180p\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c180p\" name=\"item_meta[199]\" value=\"\"  placeholder=\"City\" data-reqmsg=\"City cannot be blank.\" aria-required=\"true\" data-invmsg=\"City is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_none_container frm_fourth\">\r\n    <label for=\"field_jlws4\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_jlws4\" name=\"item_meta[200]\" value=\"\"  placeholder=\"State\" data-invmsg=\"State is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_201_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm_first frm_fourth\">\r\n    <label for=\"field_se6pg\" class=\"frm_primary_label\">Zipcode\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_se6pg\" name=\"item_meta[201]\" value=\"\"  placeholder=\"Zipcode\" data-reqmsg=\"Zipcode cannot be blank.\" aria-required=\"true\" data-invmsg=\"Zipcode is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm_fourth\">\r\n    <label for=\"field_e2s6u\" class=\"frm_primary_label\">Country\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e2s6u\" name=\"item_meta[202]\" value=\"\"  placeholder=\"Country\" data-reqmsg=\"Country cannot be blank.\" aria-required=\"true\" data-invmsg=\"Country is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_fte5s\" class=\"frm_primary_label\">EMAIL\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_fte5s\" name=\"item_meta[203]\" value=\"\"  style=\"width:380px\" data-reqmsg=\"EMAIL cannot be blank.\" aria-required=\"true\" data-invmsg=\"EMAIL * is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_9tyiw\" class=\"frm_primary_label\">PREFERRED PHONE\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_9tyiw\" name=\"item_meta[204]\" value=\"\"  style=\"width:190px\" data-reqmsg=\"PREFERRED PHONE cannot be blank.\" aria-required=\"true\" data-invmsg=\"PREFERRED PHONE * is invalid\" class=\"auto_width\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_full\">\r\n    <label for=\"field_m2my5\" class=\"frm_primary_label\">COMMENT\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[205]\" id=\"field_m2my5\" rows=\"5\"  data-reqmsg=\"COMMENT cannot be blank.\" aria-required=\"true\" data-invmsg=\"COMMENT is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\r\n\t\t\t<div id=\"frm_field_1500_container\">\r\n\t\t\t<label for=\"field_u8r4g\" >\r\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\r\n\t\t\t<input  id=\"field_u8r4g\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[1500]\" value=\"\"  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