document.write("<div class=\"fsBody fsEmbed\">"+"\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"//static.formstack.com/forms/css/3/reset_53bc1bb20a.css\" />"+"\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"//static.formstack.com/forms/css/3/slim_163181bdd6.css\" />"+"\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"//static.formstack.com/forms/../common/css/uil-static.css\" />"+"\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"//static.formstack.com/forms/css/common/dialogs_68abb2e62a.css\" />"+"\n");
document.write("<!--[if IE]>"+"\n");
document.write("    <link rel=\"stylesheet\" type=\"text/css\" media=\"all\" href=\"https://refusefascism.formstack.com/forms/css/3/ie.css?20140508\" />"+"\n");
document.write("<![endif]-->"+"\n");
document.write("<!--[if IE 7]><link rel=\"stylesheet\" type=\"text/css\" media=\"all\" href=\"https://refusefascism.formstack.com/forms/css/3/ie7.css\" /><![endif]-->"+"\n");
document.write("<!--[if IE 6]><link rel=\"stylesheet\" type=\"text/css\" media=\"all\" href=\"https://refusefascism.formstack.com/forms/css/3/ie6fixes.css\" /><![endif]-->"+"\n");
document.write("<form method=\"post\" accept-charset=\"UTF-8\" novalidate action=\"https://refusefascism.formstack.com/forms/index.php\" class=\"fsForm fsSingleColumn\" id=\"fsForm2810241\">"+"\n");
document.write("<input type=\"hidden\" name=\"form\" value=\"2810241\" />"+"\n");
document.write("<input type=\"hidden\" name=\"viewkey\" value=\"ajWIaBZHeZ\" />"+"\n");
document.write("<input type=\"hidden\" name=\"password\" value=\"\" />"+"\n");
document.write("<input type=\"hidden\" name=\"hidden_fields\" id=\"hidden_fields2810241\" value=\"\" />"+"\n");
document.write("<input type=\"hidden\" name=\"incomplete\" id=\"incomplete2810241\" value=\"\" />"+"\n");
document.write("<input type=\"hidden\" name=\"incomplete_password\" id=\"incomplete_password2810241\" />"+"\n");
document.write("<input type=\"hidden\" name=\"referrer\" id=\"referrer2810241\" value=\"https://refusefascism.org/2017/08/06/this-nightmare-must-end-the-trumppence-regime-must-go/\" />"+"\n");
document.write("<input type=\"hidden\" name=\"referrer_type\" id=\"referrer_type2810241\" value=\"js\" />"+"\n");
document.write("<input type=\"hidden\" name=\"_submit\" value=\"1\" />"+"\n");
document.write("<input type=\"hidden\" name=\"style_version\" value=\"3\" />"+"\n");
document.write("<input type=\"hidden\" id=\"viewparam\" name=\"viewparam\" value=\"699752\" />"+"\n");
document.write("<input type=\"hidden\" id=\"fsSaveResumePassword2810241\" value=\"1\" />"+"\n");
document.write("<div id=\"requiredFieldsError\" style=\"display:none;\">Please fill in a valid value for all required fields</div>"+"\n");
document.write("<div id=\"invalidFormatError\" style=\"display:none;\">Please ensure all values are in a proper format.</div>"+"\n");
document.write("<div id=\"resumeConfirm\" style=\"display:none;\">Are you sure you want to leave this form and resume later?</div>"+"\n");
document.write("<div id=\"resumeConfirmPassword\" style=\"display: none;\">Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.</div>"+"\n");
document.write("<div id=\"saveAndResume\" style=\"display: none;\">Save and Resume Later</div>"+"\n");
document.write("<div id=\"saveResumeProcess\" style=\"display: none;\">Save and get link</div>"+"\n");
document.write("<div id=\"fileTypeAlert\" style=\"display:none;\">You must upload one of the following file types for the selected field:</div>"+"\n");
document.write("<div id=\"embedError\" style=\"display:none;\">There was an error displaying the form. Please copy and paste the embed code again.</div>"+"\n");
document.write("<div id=\"applyDiscountButton\" style=\"display:none;\">Apply Discount</div>"+"\n");
document.write("<div id=\"dcmYouSaved\" style=\"display:none;\">You saved</div>"+"\n");
document.write("<div id=\"dcmWithCode\" style=\"display:none;\">with code</div>"+"\n");
document.write("<div id=\"submitButtonText\" style=\"display:none;\">Endorse</div>"+"\n");
document.write("<div id=\"submittingText\" style=\"display:none;\">Submitting</div>"+"\n");
document.write("<div id=\"validatingText\" style=\"display:none;\">Validating</div>"+"\n");
document.write("<div id=\"autocaptureDisabledText\" style=\"display:none;\"></div>"+"\n");
document.write("<div id=\"paymentInitError\" style=\"display:none;\">There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.</div>"+"\n");
document.write("<div id=\"checkFieldPrompt\" style=\"display:none;\">Please check the field: </div>"+"\n");
document.write("<div class=\"fsPage\" id=\"fsPage2810241-1\">"+"\n");
document.write("<div id=\"ReactContainer2810241\" style=\"display:none\" class=\"FsReactContainerInitApp\" data-fs-react-app-id=\"2810241\"></div>"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("                            <div class=\"fsSection fs1Col\">"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-1\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell56248991\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"First Name\">"+"\n");
document.write("                                                                                                        <label id=\"label56248991\" class=\"fsLabel fsRequiredLabel\" for=\"field56248991\">First Name<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56248991\""+"\n");
document.write("  name=\"field56248991\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"     />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-2\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell56248992\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Last Name\">"+"\n");
document.write("                                                                                                        <label id=\"label56248992\" class=\"fsLabel fsRequiredLabel\" for=\"field56248992\">Last Name<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56248992\""+"\n");
document.write("  name=\"field56248992\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"     />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-3\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell56248993\" lang=\"en\" fs-field-type=\"radio\" fs-field-validation-name=\"RF - Nov 4 Endorser\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56248993\" id=\"label56248993\">"+"\n");
document.write("                            <legend id=\"fsLegend56248993\" class=\"fsLabel fsRequiredLabel fsLabelVertical hidden\"><span>RF - Nov 4 Endorser<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field56248993_1\"><input type=\"radio\" id=\"field56248993_1\" name=\"field56248993\" value=\"I personally endorse the Call for November 4\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />I personally endorse the Call for November 4</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field56248993_2\"><input type=\"radio\" id=\"field56248993_2\" name=\"field56248993\" value=\"My organization endorses the Call to Action for November 4\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />My organization endorses the Call to Action for November 4</label>"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-4\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56248995\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Organization\">"+"\n");
document.write("                                                                                                        <label id=\"label56248995\" class=\"fsLabel\" for=\"field56248995\">Organization                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56248995\""+"\n");
document.write("  name=\"field56248995\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-5\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249062\" lang=\"en\" fs-field-type=\"radio\" fs-field-validation-name=\"RF - Organization Type\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249062\" id=\"label56249062\">"+"\n");
document.write("                            <legend id=\"fsLegend56249062\" class=\"fsLabel fsRequiredLabel fsLabelVertical hidden\"><span>RF - Organization Type<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field56249062_1\"><input type=\"radio\" id=\"field56249062_1\" name=\"field56249062\" value=\"Local Organization\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" disabled=\"disabled\" />Local Organization</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field56249062_2\"><input type=\"radio\" id=\"field56249062_2\" name=\"field56249062\" value=\"National Organization\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" disabled=\"disabled\" />National Organization</label>"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-6\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56248994\" lang=\"en\" fs-field-type=\"email\" fs-field-validation-name=\"Email\">"+"\n");
document.write("                                                                                                        <label id=\"label56248994\" class=\"fsLabel fsRequiredLabel\" for=\"field56248994\">Email<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input type=\"email\" id=\"field56248994\" name=\"field56248994\" size=\"50\" required=\"required\" value=\"\" class=\"fsField fsFormatEmail fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("    <p>"+"\n");
document.write("        <label for=\"field56248994_confirm\" class=\"fsLabel fsRequiredLabel\">Confirm Email<span>*</span></label>"+"\n");
document.write("                <input type=\"email\" id=\"field56248994_confirm\" name=\"field56248994_confirm\" size=\"50\" required=\"required\" class=\"fsField fsFieldConfirm fsFormatEmail fsRequired\" aria-required=\"true\" disabled=\"disabled\" /> "+"\n");
document.write("            </p>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-7\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell56248997\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Affiliation for ID purposes only\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56248997\" id=\"label56248997\">"+"\n");
document.write("                            <legend id=\"fsLegend56248997\" class=\"fsLabel fsLabelVertical hidden\"><span>Affiliation for ID purposes only</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content fsHiddenByFieldSetting\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56248997_1\"><input type=\"checkbox\" id=\"field56248997_1\" name=\"field56248997[]\" value=\"Affiliation for identification only\" class=\"fsField vertical\" />Affiliation for identification only</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-8\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56248998\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Publish my name\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56248998\" id=\"label56248998\">"+"\n");
document.write("                            <legend id=\"fsLegend56248998\" class=\"fsLabel fsLabelVertical hidden\"><span>Publish my name</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56248998_1\"><input type=\"checkbox\" id=\"field56248998_1\" name=\"field56248998[]\" value=\"You may publish my name\" class=\"fsField vertical\" disabled=\"disabled\" />You may publish my name</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-9\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56248999\" lang=\"en\" fs-field-type=\"textarea\" fs-field-validation-name=\"Description of yourself to be used in publication\">"+"\n");
document.write("                                                                                                        <label id=\"label56248999\" class=\"fsLabel\" for=\"field56248999\">Description of yourself to be used in publication                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    "+"\n");
document.write("<textarea id=\"field56248999\""+"\n");
document.write("          class=\"fsField \""+"\n");
document.write("          name=\"field56248999\""+"\n");
document.write("          rows=\"3\""+"\n");
document.write("          cols=\"50\""+"\n");
document.write("                                                            disabled=\"disabled\"          ></textarea>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-10\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249000\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"City\">"+"\n");
document.write("                                                                                                        <label id=\"label56249000\" class=\"fsLabel\" for=\"field56249000\">City                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249000\""+"\n");
document.write("  name=\"field56249000\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-11\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249001\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"State\">"+"\n");
document.write("                                                                                                        <label id=\"label56249001\" class=\"fsLabel\" for=\"field56249001\">State                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249001\""+"\n");
document.write("  name=\"field56249001\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText  fsAutocomplete  \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    <input type=\"hidden\" id=\"field56249001_options\" value=\"Fleet Post Office (U.S. Navy and U.S. Marine Corps)|Army Post Office (U.S. Army and U.S. Air Force)|Armed Forces Pacific|Armed Forces Europe|Armed Forces (the) Americas|Wyoming|Wisconsin|West Virginia|Washington|Virginia|Vermont|Utah|Texas|Tennessee|South Dakota|South Carolina|Rhode Island|Puerto Rico|Pennsylvania|Oregon|Oklahoma|Ohio|North Dakota|North Carolina|New York|New Mexico|New Jersey|New Hampshire|Nevada|Nebraska|Montana|Missouri|Mississippi|Minnesota|Michigan|Massachusetts|Maryland|Maine|Louisiana|Kentucky|Kansas|Iowa|Indiana|Illinois|Idaho|Hawaii|Georgia|Florida|District of Columbia|Delaware|Connecticut|Colorado|California|Arkansas|Arizona|Alaska|Alabama||\" />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-12\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249002\" lang=\"en\" fs-field-type=\"phone\" fs-field-validation-name=\"Phone\">"+"\n");
document.write("                                                                                                        <label id=\"label56249002\" class=\"fsLabel\" for=\"field56249002\">Phone                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input type=\"tel\" id=\"field56249002\" name=\"field56249002\" size=\"20\" value=\"\" class=\"fsField fsFormatPhoneUS \" disabled=\"disabled\" data-country=\"US\" data-format=\"national\" />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-13\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249003\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Website\">"+"\n");
document.write("                                                                                                        <label id=\"label56249003\" class=\"fsLabel\" for=\"field56249003\">Website                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249003\""+"\n");
document.write("  name=\"field56249003\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-14\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249142\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Twitter Handle\">"+"\n");
document.write("                                                                                                        <label id=\"label56249142\" class=\"fsLabel\" for=\"field56249142\">Twitter Handle                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249142\""+"\n");
document.write("  name=\"field56249142\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-15\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249144\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Facebook Handle\">"+"\n");
document.write("                                                                                                        <label id=\"label56249144\" class=\"fsLabel\" for=\"field56249144\">Facebook Handle                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249144\""+"\n");
document.write("  name=\"field56249144\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-16\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249147\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Instagram Handle\">"+"\n");
document.write("                                                                                                        <label id=\"label56249147\" class=\"fsLabel\" for=\"field56249147\">Instagram Handle                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field56249147\""+"\n");
document.write("  name=\"field56249147\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-17\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249156\" lang=\"en\" fs-field-type=\"textarea\" fs-field-validation-name=\"Our organization can assist in the following ways:\">"+"\n");
document.write("                                                                                                        <label id=\"label56249156\" class=\"fsLabel\" for=\"field56249156\">Our organization can assist in the following ways:                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    "+"\n");
document.write("<textarea id=\"field56249156\""+"\n");
document.write("          class=\"fsField \""+"\n");
document.write("          name=\"field56249156\""+"\n");
document.write("          rows=\"10\""+"\n");
document.write("          cols=\"50\""+"\n");
document.write("                                                            disabled=\"disabled\"          ></textarea>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-18\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249299\" lang=\"en\" fs-field-type=\"richtext\" fs-field-validation-name=\"\">"+"\n");
document.write("                                                        "+"\n");
document.write("                                        "+"\n");
document.write("                    <p>I am a:"+"\n");
document.write("</p>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-19\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249356\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Student\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249356\" id=\"label56249356\">"+"\n");
document.write("                            <legend id=\"fsLegend56249356\" class=\"fsLabel fsLabelVertical hidden\"><span>Student</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249356_1\"><input type=\"checkbox\" id=\"field56249356_1\" name=\"field56249356[]\" value=\"Student\" class=\"fsField vertical\" disabled=\"disabled\" />Student</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-20\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249360\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Teacher or Professor\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249360\" id=\"label56249360\">"+"\n");
document.write("                            <legend id=\"fsLegend56249360\" class=\"fsLabel fsLabelVertical hidden\"><span>Teacher or Professor</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249360_1\"><input type=\"checkbox\" id=\"field56249360_1\" name=\"field56249360[]\" value=\"Teacher or Professor\" class=\"fsField vertical\" disabled=\"disabled\" />Teacher or Professor</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-21\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249361\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Representative of a Religious Organization\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249361\" id=\"label56249361\">"+"\n");
document.write("                            <legend id=\"fsLegend56249361\" class=\"fsLabel fsLabelVertical hidden\"><span>Representative of a Religious Organization</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249361_1\"><input type=\"checkbox\" id=\"field56249361_1\" name=\"field56249361[]\" value=\"Representative of a Religious Organization\" class=\"fsField vertical\" disabled=\"disabled\" />Representative of a Religious Organization</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-22\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249362\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Legal Professional\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249362\" id=\"label56249362\">"+"\n");
document.write("                            <legend id=\"fsLegend56249362\" class=\"fsLabel fsLabelVertical hidden\"><span>Legal Professional</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249362_1\"><input type=\"checkbox\" id=\"field56249362_1\" name=\"field56249362[]\" value=\"Legal Professional\" class=\"fsField vertical\" disabled=\"disabled\" />Legal Professional</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-23\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249364\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Medical Professional\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249364\" id=\"label56249364\">"+"\n");
document.write("                            <legend id=\"fsLegend56249364\" class=\"fsLabel fsLabelVertical hidden\"><span>Medical Professional</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249364_1\"><input type=\"checkbox\" id=\"field56249364_1\" name=\"field56249364[]\" value=\"Medical Professional\" class=\"fsField vertical\" disabled=\"disabled\" />Medical Professional</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-24\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249303\" lang=\"en\" fs-field-type=\"richtext\" fs-field-validation-name=\"\">"+"\n");
document.write("                                                        "+"\n");
document.write("                                        "+"\n");
document.write("                    <p>I can help in the following ways:"+"\n");
document.write("</p>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-25\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249307\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Digital: Tech\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249307\" id=\"label56249307\">"+"\n");
document.write("                            <legend id=\"fsLegend56249307\" class=\"fsLabel fsLabelVertical hidden\"><span>Digital: Tech</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249307_1\"><input type=\"checkbox\" id=\"field56249307_1\" name=\"field56249307[]\" value=\"Digital: Tech\" class=\"fsField vertical\" disabled=\"disabled\" />Digital: Tech</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-26\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249341\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Digital: Design\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249341\" id=\"label56249341\">"+"\n");
document.write("                            <legend id=\"fsLegend56249341\" class=\"fsLabel fsLabelVertical hidden\"><span>Digital: Design</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249341_1\"><input type=\"checkbox\" id=\"field56249341_1\" name=\"field56249341[]\" value=\"Digital: Design\" class=\"fsField vertical\" disabled=\"disabled\" />Digital: Design</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-27\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249342\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Social Media\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249342\" id=\"label56249342\">"+"\n");
document.write("                            <legend id=\"fsLegend56249342\" class=\"fsLabel fsLabelVertical hidden\"><span>Social Media</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249342_1\"><input type=\"checkbox\" id=\"field56249342_1\" name=\"field56249342[]\" value=\"Social Media\" class=\"fsField vertical\" disabled=\"disabled\" />Social Media</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-28\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249343\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Strategy\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249343\" id=\"label56249343\">"+"\n");
document.write("                            <legend id=\"fsLegend56249343\" class=\"fsLabel fsLabelVertical hidden\"><span>Strategy</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249343_1\"><input type=\"checkbox\" id=\"field56249343_1\" name=\"field56249343[]\" value=\"Strategy\" class=\"fsField vertical\" disabled=\"disabled\" />Strategy</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-29\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249347\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Donating\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249347\" id=\"label56249347\">"+"\n");
document.write("                            <legend id=\"fsLegend56249347\" class=\"fsLabel fsLabelVertical hidden\"><span>Donating</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249347_1\"><input type=\"checkbox\" id=\"field56249347_1\" name=\"field56249347[]\" value=\"Donating\" class=\"fsField vertical\" disabled=\"disabled\" />Donating</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-30\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249348\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Office / General\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249348\" id=\"label56249348\">"+"\n");
document.write("                            <legend id=\"fsLegend56249348\" class=\"fsLabel fsLabelVertical hidden\"><span>Office / General</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field56249348_1\"><input type=\"checkbox\" id=\"field56249348_1\" name=\"field56249348[]\" value=\"Office / General\" class=\"fsField vertical\" disabled=\"disabled\" />Office / General</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2810241-31\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell56249353\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Other:\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend56249353\" id=\"label56249353\">"+"\n");
document.write("                            <legend id=\"fsLegend56249353\" class=\"fsLabel fsLabelVertical hidden\"><span>Other:</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("    "+"\n");
document.write("            <div class=\"vertical fs-clear\">"+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" style=\"margin-right: 5px;\" for=\"field56249353_other\"><input type=\"checkbox\" id=\"field56249353_other\" name=\"field56249353[]\" value=\"Other\" class=\"fsField\" disabled=\"disabled\" />Other:</label>"+"\n");
document.write("            <input type=\"text\" id=\"field56249353_othervalue\" name=\"field56249353_other\" size=\"15\" class=\"fsOtherField\"            /><label class=\"hidden\" for=\"field56249353_othervalue\">Other Value</label>"+"\n");
document.write("        </div>"+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("</div>"+"\n");
document.write("  "+"\n");
document.write("<div id=\"fsSubmit2810241\" class=\"fsSubmit fsPagination\">"+"\n");
document.write("    <button type=\"button\" id=\"fsPreviousButton2810241\" class=\"fsPreviousButton\" value=\"Previous Page\" style=\"display:none;\" aria-label=\"Previous\"><span class=\"fsFull\">Previous</span><span class=\"fsSlim\">&larr;</span></button>"+"\n");
document.write("    <button type=\"button\" id=\"fsNextButton2810241\" class=\"fsNextButton\" value=\"Next Page\" style=\"display:none;\" aria-label=\"Next\"><span class=\"fsFull\">Next</span><span class=\"fsSlim\">&rarr;</span></button>"+"\n");
document.write("    <input id=\"fsSubmitButton2810241\""+"\n");
document.write("           class=\"fsSubmitButton\""+"\n");
document.write("           style=\"display: block;\""+"\n");
document.write("           type=\"submit\""+"\n");
document.write("           value=\"Endorse\" />"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("  <div class=\"clear\"></div>"+"\n");
document.write("  <div class=\"\">"+"\n");
document.write("      </div>"+"\n");
document.write("</div>"+"\n");
document.write("    <script type=\"text/javascript\">"+"\n");
document.write("        window.FS_FIELD_DATA_2810241 = [];"+"\n");
document.write("    </script>"+"\n");
document.write("            <script type=\"text/javascript\" src=\"//static.formstack.com/forms/js/3/scripts_306235d70b.js\" ></script>"+"\n");
document.write("            <script type=\"text/javascript\" src=\"//static.formstack.com/forms/js/3/analytics_0e96c0d8a9.js\" ></script>"+"\n");
document.write("            <script type=\"text/javascript\" src=\"//static.formstack.com/forms/js/3/google-phone-lib_0ee0a62fb5.js\" ></script>"+"\n");
document.write("    "+"\n");
document.write("    <script type=\"text/javascript\">"+"\n");
document.write("                (function() {"+"\n");
document.write("          if (typeof sessionStorage !== \'undefined\' && sessionStorage.fsFonts) {"+"\n");
document.write("            document.documentElement.className = document.documentElement.className += \' wf-active\';"+"\n");
document.write("          }"+"\n");
document.write("          var pre = document.createElement(\'link\');"+"\n");
document.write("          pre.rel  = \'preconnect\';"+"\n");
document.write("          pre.href = \'https://fonts.googleapis.com/\';"+"\n");
document.write("          pre.setAttribute(\'crossorigin\', \'\');"+"\n");
document.write("          var s = document.getElementsByTagName(\'head\')[0];"+"\n");
document.write("          s.appendChild(pre);"+"\n");
document.write("          var fontConfig = {"+"\n");
document.write("            google: {"+"\n");
document.write("              families: ["+"\n");
document.write("                \'Lato:400,700\'"+"\n");
document.write("              ]"+"\n");
document.write("            },"+"\n");
document.write("            timeout: 2000,"+"\n");
document.write("            active: function() {"+"\n");
document.write("              if (typeof sessionStorage === \'undefined\') {"+"\n");
document.write("                return;"+"\n");
document.write("              }"+"\n");
document.write("              sessionStorage.fsFonts = true;"+"\n");
document.write("            }"+"\n");
document.write("          };"+"\n");
document.write("          if (typeof WebFont === \'undefined\') {"+"\n");
document.write("              window.WebFontConfig = fontConfig;"+"\n");
document.write("              var wf = document.createElement(\'script\');"+"\n");
document.write("              wf.type  = \'text/javascript\';"+"\n");
document.write("              wf.async = \'true\';"+"\n");
document.write("              wf.src   = (\'https:\' == document.location.protocol ? \'https\' : \'http\') +"+"\n");
document.write("                         \'://ajax.googleapis.com/ajax/libs/webfont/1/webfont.js\';"+"\n");
document.write("              s.appendChild(wf);"+"\n");
document.write("          } else {"+"\n");
document.write("            WebFont.load(fontConfig);"+"\n");
document.write("          }"+"\n");
document.write("        })();"+"\n");
document.write("        "+"\n");
document.write("        if(window.addEventListener) {"+"\n");
document.write("            window.addEventListener(\'load\', loadFormstack, false);"+"\n");
document.write("        } else if(window.attachEvent) {"+"\n");
document.write("            window.attachEvent(\'onload\', loadFormstack);"+"\n");
document.write("        } else {"+"\n");
document.write("            loadFormstack();"+"\n");
document.write("        }"+"\n");
document.write("        "+"\n");
document.write("        function loadFormstack() {"+"\n");
document.write("            var form2810241 = new Formstack.Form(2810241, \'https://refusefascism.formstack.com/forms/\');"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        form2810241.checks.push({target: \'56248995\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249062\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56248994\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56248997\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56248998\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56248999\', action: \'Show\', bool: \'AND\', fields: [\'56248998\'],checks: [{field: \'56248998\', condition: \'==\', option: \'You may publish my name\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249000\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56249062\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56249062\', condition: \'==\', option: \'Local Organization\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249001\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56249062\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56249062\', condition: \'==\', option: \'Local Organization\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249002\', action: \'Show\', bool: \'OR\', fields: [\'56248993\',\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'},{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249003\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249142\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249144\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249147\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249156\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'My organization endorses the Call to Action for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249299\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249356\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249360\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249361\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249362\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249364\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249303\', action: \'Show\', bool: \'AND\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249307\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249341\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249342\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249343\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249347\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249348\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("                        form2810241.checks.push({target: \'56249353\', action: \'Show\', bool: \'OR\', fields: [\'56248993\'],checks: [{field: \'56248993\', condition: \'==\', option: \'I personally endorse the Call for November 4\'}]});"+"\n");
document.write("            "+"\n");
document.write("            form2810241.logicFields = [\'56248993\',\'56249062\',\'56248998\'];"+"\n");
document.write("            "+"\n");
document.write("            form2810241.calcFields = [];"+"\n");
document.write("            "+"\n");
document.write("            form2810241.dateCalcFields = [];"+"\n");
document.write("            form2810241.init();"+"\n");
document.write("                        form2810241.plugins.analytics = new Formstack.Analytics(\'https://refusefascism.formstack.com\', 2810241, form2810241);"+"\n");
document.write("            form2810241.plugins.analytics.trackTouch();"+"\n");
document.write("            form2810241.plugins.analytics.trackBottleneck();"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            window.form2810241 = form2810241;"+"\n");
document.write("        };"+"\n");
document.write("    </script>"+"\n");
document.write("</form>"+"\n");
document.write("<div class=\"fs-ngdialog fs-modal-small fs-form-dialog fs-form-dialog--hidden\">"+"\n");
document.write("  <div class=\"fs-ngdialog-overlay\"></div>"+"\n");
document.write("  <div class=\"fs-ngdialog-content\">"+"\n");
document.write("    <div class=\"fs-modal__top fs-form-dialog__title\"></div>"+"\n");
document.write("    <div class=\"fs-modal__middle\">"+"\n");
document.write("      <div class=\"fs-form-dialog__message\"></div>"+"\n");
document.write("      <label class=\"hidden\""+"\n");
document.write("             for=\"fsSaveResumePassword\">Enter your save and resume password</label>"+"\n");
document.write("      <input type=\"password\""+"\n");
document.write("             id=\"fsSaveResumePassword\""+"\n");
document.write("             class=\"fs-form-input fs-form-dialog__password fs-form-dialog--hidden fs--mt20\" placeholder=\"Enter your save and resume password\">"+"\n");
document.write("       <textarea class=\"fs-form-dialog__textarea fs-form-dialog--hidden\" rows=\"3\" style=\"width: 100%; margin-top: 10px\"></textarea>"+"\n");
document.write("    </div>"+"\n");
document.write("    <div class=\"fs-modal__bottom\">"+"\n");
document.write("      <a class=\"fs-form-dialog__cancel fs-btn2 fs-btn2--size_medium fs-btn2--style_edit-dark\" title=\"Cancel\">"+"\n");
document.write("        <div class=\"fs-btn2__content\">"+"\n");
document.write("          <div class=\"fs-btn2__text\">"+"\n");
document.write("            <span class=\"fs-form-dialog__button-text\">Cancel</span>"+"\n");
document.write("          </div>"+"\n");
document.write("        </div>"+"\n");
document.write("      </a>"+"\n");
document.write("      <a class=\"fs-form-dialog__confirm fs-btn2 fs-btn2--size_medium fs-btn2--style_create fs--float-right\" title=\"Confirm\">"+"\n");
document.write("        <div class=\"fs-btn2__content\">"+"\n");
document.write("          <div class=\"fs-btn2__text\">"+"\n");
document.write("            <span class=\"fs-form-dialog__button-text\">Confirm</span>"+"\n");
document.write("          </div>"+"\n");
document.write("        </div>"+"\n");
document.write("      </a>"+"\n");
document.write("    </div>"+"\n");
document.write("  </div>"+"\n");
document.write("</div>"+"\n");
document.write("</div>"+"\n");
document.write(""+"\n");