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		<input type="hidden" id="num_questions" name="num_questions" value="24">
		<input type="hidden" name="form_id" value="449">
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	$(function () {
		// reset payment token in case user clicked Back button in browser
		$('#paymentToken').val('');
		
		//$('#business_radio').trigger('change');
		
		
			$('#formsPayment :input').each(function() {
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	}

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	var sent = 0;
	
	// Thibault 2/11/06 added init function called at page load, plus validation that required fields are completed before submit.  should help with problems with the back button and credit cards,  issue 30102
	function init() {
		frm = document.iform;

		
	}

	window.onload = new Function("init()"); //set init function to run at page load

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		return mystring.toLowerCase()
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			if(_TempListSplitArray[i]==value){
				FoundIdx= i+1;
				break
			}
		}
		return FoundIdx;
	}

	function startValidate() {
		// this will kick off validation, but since we need to validate the captcha
		// we have to wait for that to finish first...
		var iForm = document.getElementById('iform');
		var fld_ss_form_testid = document.getElementById('fld_ss_form_testid');
		var mainV = validateFrm();
		fld_ss_form_testid.value = 1;
		if (mainV) {
			
				
					iForm.submit();
				
			
		}
	}

	function validateFrm() {
		if(!sent) sent = 0;  //make sure we have this!
		if (!validForm) validForm = false;
		arrReqMissing = new Array();
		
			
			var jsDesc = "\n\n\r\n\r\n\r\n\r\n\n\nThursday, September 10th, 2026\r\nWagon Room, Aqua Turf Club\r\nDownload Flyer\r\n\r\n\n\n\r\n\r\n\r\n\r\nProgram Sponsors\r\n\r\n&nbsp;&nbsp;\r\n\r\n\r\n2026&nbsp;Safety Alliance Conference\r\nRegistration Form";
			
			
			var jsDesc = "Registration Contact";
			
			
			var jsDesc = "Contact Name";
			
				obj = document.iform.response_3;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Company Name";
			
				obj = document.iform.response_4;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Email";
			
				obj = document.iform.response_5;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Phone";
			
				obj = document.iform.response_6;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Total Attendees";
			
				obj = document.iform.response_7;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Who is Attending?\r\n\r\n\n\n(There is NO COST to attend this conference. Please include first name, last name, and email address for each attendee.)";
			
			
			var jsDesc = "First and Last Name";
			
			
			var jsDesc = "Email Address";
			
			
			var jsDesc = "First and Last Name";
			
			
			var jsDesc = "Email Address";
			
			
			var jsDesc = "First and Last Name";
			
			
			var jsDesc = "Email Address";
			
			
			var jsDesc = "First and Last Name";
			
			
			var jsDesc = "Email Address";
			
			
			var jsDesc = "First and Last Name";
			
			
			var jsDesc = "Email Address";
			
			
			var jsDesc = "Add a Sponsorship";
			
			
			var jsDesc = "Choose Your Sponsor Level";
			
			
			var jsDesc = "Upload your Logo";
			
			
			var jsDesc = "";
			
			
				docfilename = document.iform.response_22.value.toLowerCase();
				list = "doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png";
				if (docfilename != '') {
					x = docfilename.length;
					y = docfilename.lastIndexOf(".") + 1;
					ext = docfilename.substr(y, x);
					extfound = listfind(list, ext, ',');
					if (extfound == 0) {
						allowedUploadsList = 'doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png';
						allowedUploadsList = allowedUploadsList.replace(/,/g, ', ');

						swal({
				  			title: 'File types',
				  			html: true,
				  			text: 'Sorry, you can only upload files of the following types: ' + allowedUploadsList,
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						return false;
					}
				// Leaving this disabled since I am going to relax security checks a bit, but leaving here
				// in case we need to add specific strings to exlusion for file uploads.
				//if ( docfilename.toLowerCase().indexOf("sp_") > -1 ) {
				//	alert("Sorry, you cannot upload files that contain the string 'sp_', please rename your file before uploading it.");
				//	return false;
				//	}
				}
			
		
			var jsDesc = "Payment Information";
			
			
			var jsDesc = "Choose your payment method for Sponsorships";
			
			
		if(arrReqMissing.length > 0) {
			//errStr = "We're sorry, but the following fields are required before you can submit this form. Please click OK, then correct these entries.<br>";
			errStr = "";
			for(i=0; i<arrReqMissing.length; i++) {
				errStr += arrReqMissing[i] + "<br>";
			}
			swal({
	  			title: 'Missing required fields',
	  			html: true,
	  			text: errStr,
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			return false;
		}

		for(i=0; i<document.iform.elements.length; i++) {
		 	if (document.iform.elements[i].type == 'textarea' || document.iform.elements[i].type == 'text') {
		 		if (document.iform.elements[i].value.length > 2147483647) {
		 			swal({
			  			title: 'Maximum allowable length',
			  			html: true,
			  			text: "One or more field responses exceeds the maximum allowable length of 2147483647 characters. Please adjust your responses and re-submit.",
			  			animation: 'slide-from-top',
			  			type: 'info',
			  			confirmButtonText: 'Ok',
			  			confirmButtonColor: '#337ab7'
			  		});
		 			return false;
		 		}
		 	}
		}

		if (sent == 1) {
	          swal({
	  			title: 'Processing..',
	  			html: true,
	  			text: "Your request is processing. Please do not click Submit more than once.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		  });
	          return false;
	    }
		
			bOK = true;
		
		if (bOK) {
			var btn = $('#submitBtn');
			btn.button('loading');
			btn.prop('disabled', true);
			sent = 1;
			validForm = true;
			return true;
		}
		else {
			return false;
		}
	}

	function IsNumeric(sText) {
	   var ValidChars = "0123456789.";
	   var IsNumber=true;
	   var Char;

	   for (i = 0; i < sText.length && IsNumber == true; i++) {
	      Char = sText.charAt(i);
	      if (ValidChars.indexOf(Char) == -1) {
	         IsNumber = false;
	      }
	   }
	   return IsNumber;
	}

	function setButtonVal(el, itemID, price) {
		// first set the price attribute on the element
		el.price = price;
		// now set the value of a hidden field for the associated radio button
		document.getElementById(itemID).price = price;
		document.getElementById(itemID).value = 1;
		// now call the calcTotalFix function to recaculate the total amount due
		calcTotalFix();
	}

	function getRadioButtonValForTotal(radioName){
		var rads = document.getElementsByName(radioName);
		var selectedPrice = 0;
		for(i=0; i < rads.length; i++) {
		  if(rads[i].checked == true){
		    selectedPrice = rads[i].getAttribute('price');
		  }
		}

		selectedPrice = parseFloat(selectedPrice);
		return selectedPrice;
	}

	function calcTotalFix() {
		var priceFields = $(".calculateTotal");
		// console.log('priceFields length: ' + priceFields.length);
		var updateTotal = 0; // initialize total before looping over array
		var processedRadioButtons = [];	/// reset array every time this function is called
		for (var i=0; i < priceFields.length; i++) {
			myFieldObj = priceFields[i];
			if (myFieldObj.value == '') { myFieldObj.value = 0; }
			fieldName = myFieldObj.name;
			value = myFieldObj.value;
			fieldID = myFieldObj.getAttribute('id');
			price = myFieldObj.getAttribute('price');

			// check to see if this is a radioVal by the item id
			if(fieldID != undefined){
				var nRadioVal = fieldID.indexOf("radioVal");
				if(nRadioVal > -1){
					fieldtype = 'radioval';
				} else {
					fieldtype = 'notradioval';
				}
			} else {
				fieldtype = 'nofieldid';
			}

			// if this is just an open price field, there is no notion of quantity times price, so the price to the value of the field
			if(fieldtype === 'radioval'){
				// radio price field - use "price" attribute since we have funky stuff in the "value" attribute that we can't parse easily
				arrNum = $.inArray(fieldName, processedRadioButtons);
				if(arrNum > -1) {
					// set price and calcualted value to zero for the rest of the checkboxes in this array because don't want to keep adding to price
					price = 0;
					calculatedValue = parseFloat(0);
				} else {
					price = getRadioButtonValForTotal(fieldName);
					calculatedValue = parseFloat(price);
					// add radio button field name to array of radio fields processed so we don't check again
					processedRadioButtons.push(fieldName);
				}
				// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
			} else {
				if (price === undefined || price === null) {
				// check to see if it's a radio price field first
					// open price field - use "value" attribute
					if (!IsNumeric(value)) {
						//alert("Open Prices must be numbers only, no formatting is allowed.");
						swal({
				  			title: 'Numbers only',
				  			html: true,
				  			text: "Open Prices must be numbers only, no formatting is allowed.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					calculatedValue = parseFloat(value);
					// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
				} else {
					if (!IsNumeric(value)) {
						//alert("Price fields only allow numbers.");
						swal({
				  			title: 'Price fields',
				  			html: true,
				  			text: "Price fields only allow numbers.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					myVal = parseFloat(value);
					// console.log('in parseint with 10 - fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / myVal: ' + myVal);
					calculatedValue = myVal * parseFloat(price);

				}
			}


			// console.log('Field id: ' + fieldID + ' / Fieldtype: ' + fieldtype + ' / Field name: ' + fieldName + ' / value: ' + value + ' / Price: ' + price + ' / Calculated Field Total: ' + calculatedValue);
			updateTotal = updateTotal + calculatedValue;
		}

		// update hidden total amount
		if (document.iform.hiddentotal) { document.iform.hiddentotal.value = updateTotal; }
		// console.log('The updateTotal is now: ' + updateTotal);
		
		
		// update total value with formatted amount
		if (typeof(formatCurrency) == "function") { document.iform.total.value = formatCurrency(updateTotal); }
		
		if ($('#ordertotal_work').length > 0) {
            $('#ordertotal_work').val(updateTotal.toFixed(2));
        }
        
        if ($('#pmt_method').length > 0) {
        	$('#pmt_method').val('');
        }
        $('.paymentProfileRadio').prop('checked', false);
        $('.card').removeClass('active');
        
		// need to update the cc_info tag fields...
		if (typeof(checkTotal) == "function") { checkTotal(); }
	}

	/* remove after confirming ok without it - 8/8/13 CJV */
	function calcTotal(myField){
		thisVal = myField.value;
		// alert(thisVal);
		if (thisVal == '') {
			thisVal = 0;
			myField.value = 0;
			}
			if (!IsNumeric(myField.value)) {
				//alert('Please enter only numbers or decimal points in a price field');
				swal({
		  			title: 'Price field',
		  			html: true,
		  			text: "Please enter only numbers or decimal points in a price field.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				myField.value = 0;
				thisVal = 0;
				}
				// get the current total
				var origTotal = document.iform.hiddentotal.value;
				// now backout the prior value from the total
				var priorTotal = origTotal - myField.priorval;
				if(priorTotal == ''){
					priorTotal = 0;
					}
				// add the open price to the total
				updateTotal = parseFloat(eval(priorTotal)) + parseFloat(eval(thisVal));
				// update hidden total amount
				document.iform.hiddentotal.value = updateTotal;
				
					
				// update total value with formatted amount
				document.iform.total.value = formatCurrency(updateTotal);
		checkTotal(); // need to update the cc_info tag fields...
	}
	/* */

	function setOpenPriceInput(thisField,thisPrice){
		if(thisPrice == ''){
			thisField.priorval = 0;
		} else {
			thisField.priorval = thisPrice;
		}
	}

	
		var div_bottom_moved = false;

		function addLoadEvent(func) {
 			var oldonload = window.onload;
  			if (typeof window.onload != 'function') {
    			window.onload = func;
  			}
  			else {
    			window.onload = function() {
      				if (oldonload) {
        				oldonload();
      				}
      				func();
    			}
  			}
 		}

		addLoadEvent(calcTotalFix);
	
</script>

	
<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
</style>


<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
		iTemp = strFileName.indexOf(":");
		
		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
		}
		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				obj.value = '';
				return false;
			}
		}
	}
	function clearRadio(rd) {
		if (document.iform) {
			var v;
			var ln;
			var ev;
			submitted = 0;
			v = "document.iform." + rd + ".length";
			ln = eval(v);
			// This will ensure we uncheck if there is only 1 radio button..
			v = "document.iform." + rd + ".checked = false;";
			ev = eval(v);
			// Now loop through the list of radio buttons and uncheck them all
			for (i=0;i<ln;i++) {
				v = "document.iform." + rd + "[" + i + "].checked = false;";
				//console.log(v);
				ev = eval(v);
			}
			calcTotalFix();
		}
	}
</script>


<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13298" class="layout form item outer row-1 item-13298 row_num-20 row_pos-10240 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<p><img alt="" src="/images/header_one_line-_no_logo.png" style="width: 900px; height: 128px;" /><br />
<img alt="" src="/images/Alliance_Logo_Trio_updated.png" style="width: 450px; height: 79px;" /></p>

<div class="i4a_ck_left33">
<p>Thursday, September 10th, 2026<br />
Wagon Room, Aqua Turf Club<br />
<a href="/files/Flyer_Safety_Alliance_Conference_26.pdf"><strong>Download Flyer</strong></a></p>

<p></p>
</div>

<div class="i4a_ck_right67">
<h2>Program Sponsors:</h2>

<p style="text-align: right;">&nbsp;&nbsp;<img alt="" src="/images/Program_Sponsors.png" style="width: 400px; height: 64px;" /></p>
</div>

<div style="clear:both;"><span style="font-size:18px;"><strong>2026&nbsp;Safety Alliance Conference</strong></span><br />
<strong>Registration Form</strong></div>
					

				<input type="hidden" name="question_1" value="&lt;p&gt;&lt;img alt=&quot;&quot; src=&quot;/images/header_one_line-_no_logo.png&quot; style=&quot;width: 900px; height: 128px;&quot; /&gt;&lt;br /&gt;
&lt;img alt=&quot;&quot; src=&quot;/images/Alliance_Logo_Trio_updated.png&quot; style=&quot;width: 450px; height: 79px;&quot; /&gt;&lt;/p&gt;

&lt;div class=&quot;i4a_ck_left33&quot;&gt;
&lt;p&gt;Thursday, September 10th, 2026&lt;br /&gt;
Wagon Room, Aqua Turf Club&lt;br /&gt;
&lt;a href=&quot;/files/Flyer_Safety_Alliance_Conference_26.pdf&quot;&gt;&lt;strong&gt;Download Flyer&lt;/strong&gt;&lt;/a&gt;&lt;/p&gt;

&lt;p&gt;&lt;/p&gt;
&lt;/div&gt;

&lt;div class=&quot;i4a_ck_right67&quot;&gt;
&lt;h2&gt;Program Sponsors:&lt;/h2&gt;

&lt;p style=&quot;text-align: right;&quot;&gt;&amp;nbsp;&amp;nbsp;&lt;img alt=&quot;&quot; src=&quot;/images/Program_Sponsors.png&quot; style=&quot;width: 400px; height: 64px;&quot; /&gt;&lt;/p&gt;
&lt;/div&gt;

&lt;div style=&quot;clear:both;&quot;&gt;&lt;span style=&quot;font-size:18px;&quot;&gt;&lt;strong&gt;2026&amp;nbsp;Safety Alliance Conference&lt;/strong&gt;&lt;/span&gt;&lt;br /&gt;
&lt;strong&gt;Registration Form&lt;/strong&gt;&lt;/div&gt;">
				<INPUT TYPE="hidden" NAME="response_1_question_id" VALUE="13298">
				<INPUT TYPE="hidden" NAME="question_type_1" value="None">
				<INPUT TYPE="hidden" NAME="label_1" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13272" class="layout form item outer row-2 item-13272 row_num-40 row_pos-10240 rowlength-3 type-None" style="clear:both;max-width:33%;position:relative;">

			<div class="inner">

				
						<h3><span style="color:#000000;">Registration Contact:</span></h3>
					

				<input type="hidden" name="question_2" value="&lt;h3&gt;&lt;span style=&quot;color:#000000;&quot;&gt;Registration Contact:&lt;/span&gt;&lt;/h3&gt;">
				<INPUT TYPE="hidden" NAME="response_2_question_id" VALUE="13272">
				<INPUT TYPE="hidden" NAME="question_type_2" value="None">
				<INPUT TYPE="hidden" NAME="label_2" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13273" class="layout form item outer row-3 item-13273 row_num-40 row_pos-20480 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							Contact Name:<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-3 item-13273"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_3_required"
							VALUE="The field Contact Name: is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_3" value="Contact Name:">
				<INPUT TYPE="hidden" NAME="response_3_question_id" VALUE="13273">
				<INPUT TYPE="hidden" NAME="question_type_3" value="Text">
				<INPUT TYPE="hidden" NAME="label_3" value="Contact Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13274" class="layout form item outer row-4 item-13274 row_num-40 row_pos-30720 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							Company Name:<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-4 item-13274"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_4_required"
							VALUE="The field Company Name: is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_4" value="Company Name:">
				<INPUT TYPE="hidden" NAME="response_4_question_id" VALUE="13274">
				<INPUT TYPE="hidden" NAME="question_type_4" value="Text">
				<INPUT TYPE="hidden" NAME="label_4" value="Company Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13301" class="layout form item outer row-5 item-13301 row_num-60 row_pos-10240 rowlength-3 type-Email" style="clear:both;;position:relative;">

			<div class="inner">

				
							Email:<span class="text-danger"> *</span>
					

								<script type="text/javascript" src="/i4a/ams/include/checkemail.js"></script>
							

							<input type="text"
								
									id="response_5"
									name="response_5"
								
								
								 style="width:300px;"
								
									
										onchange="VerifyEmailAddress('iform', this.name,'Email:')" value=""
									
								
								class="form-control type-Email row-5 item-13301"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_5_required"
							VALUE="The field Email: is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_5" value="Email:">
				<INPUT TYPE="hidden" NAME="response_5_question_id" VALUE="13301">
				<INPUT TYPE="hidden" NAME="question_type_5" value="Email">
				<INPUT TYPE="hidden" NAME="label_5" value="Email:">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13276" class="layout form item outer row-6 item-13276 row_num-60 row_pos-20480 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							Phone:<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_6"
									name="response_6"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-6 item-13276"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_6_required"
							VALUE="The field Phone: is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_6" value="Phone:">
				<INPUT TYPE="hidden" NAME="response_6_question_id" VALUE="13276">
				<INPUT TYPE="hidden" NAME="question_type_6" value="Text">
				<INPUT TYPE="hidden" NAME="label_6" value="Phone">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13281" class="layout form item outer row-7 item-13281 row_num-60 row_pos-30720 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							Total Attendees<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_7"
									name="response_7"
								
								
								 style="width:100px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-7 item-13281"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_7_required"
							VALUE="The field Total Attendees is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_7" value="Total Attendees">
				<INPUT TYPE="hidden" NAME="response_7_question_id" VALUE="13281">
				<INPUT TYPE="hidden" NAME="question_type_7" value="Text">
				<INPUT TYPE="hidden" NAME="label_7" value="Total Attendees">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13280" class="layout form item outer row-8 item-13280 row_num-80 row_pos-10240 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<h3><span style="color:#000000;">Who is Attending?</span></h3>

<p><em>(There is NO COST to attend this conference. Please include first name, last name, and email address for each attendee.)</em></p>
					

				<input type="hidden" name="question_8" value="&lt;h3&gt;&lt;span style=&quot;color:#000000;&quot;&gt;Who is Attending?&lt;/span&gt;&lt;/h3&gt;

&lt;p&gt;&lt;em&gt;(There is NO COST to attend this conference. Please include first name, last name, and email address for each attendee.)&lt;/em&gt;&lt;/p&gt;">
				<INPUT TYPE="hidden" NAME="response_8_question_id" VALUE="13280">
				<INPUT TYPE="hidden" NAME="question_type_8" value="None">
				<INPUT TYPE="hidden" NAME="label_8" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13282" class="layout form item outer row-9 item-13282 row_num-100 row_pos-10240 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First and Last Name:
					

							<input type="text"
								
									id="response_9"
									name="response_9"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-9 item-13282"
							><!-- input -->

							
				<input type="hidden" name="question_9" value="First and Last Name:">
				<INPUT TYPE="hidden" NAME="response_9_question_id" VALUE="13282">
				<INPUT TYPE="hidden" NAME="question_type_9" value="Text">
				<INPUT TYPE="hidden" NAME="label_9" value="Reg1 Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13283" class="layout form item outer row-10 item-13283 row_num-100 row_pos-20480 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email Address:
					

							<input type="text"
								
									id="response_10"
									name="response_10"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-10 item-13283"
							><!-- input -->

							
				<input type="hidden" name="question_10" value="Email Address:">
				<INPUT TYPE="hidden" NAME="response_10_question_id" VALUE="13283">
				<INPUT TYPE="hidden" NAME="question_type_10" value="Text">
				<INPUT TYPE="hidden" NAME="label_10" value="Reg1 Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13284" class="layout form item outer row-11 item-13284 row_num-120 row_pos-10240 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First and Last Name:
					

							<input type="text"
								
									id="response_11"
									name="response_11"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-11 item-13284"
							><!-- input -->

							
				<input type="hidden" name="question_11" value="First and Last Name:">
				<INPUT TYPE="hidden" NAME="response_11_question_id" VALUE="13284">
				<INPUT TYPE="hidden" NAME="question_type_11" value="Text">
				<INPUT TYPE="hidden" NAME="label_11" value="Reg2 Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13285" class="layout form item outer row-12 item-13285 row_num-120 row_pos-20480 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email Address:
					

							<input type="text"
								
									id="response_12"
									name="response_12"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-12 item-13285"
							><!-- input -->

							
				<input type="hidden" name="question_12" value="Email Address:">
				<INPUT TYPE="hidden" NAME="response_12_question_id" VALUE="13285">
				<INPUT TYPE="hidden" NAME="question_type_12" value="Text">
				<INPUT TYPE="hidden" NAME="label_12" value="Reg2 Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13286" class="layout form item outer row-13 item-13286 row_num-140 row_pos-10240 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First and Last Name:
					

							<input type="text"
								
									id="response_13"
									name="response_13"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-13 item-13286"
							><!-- input -->

							
				<input type="hidden" name="question_13" value="First and Last Name:">
				<INPUT TYPE="hidden" NAME="response_13_question_id" VALUE="13286">
				<INPUT TYPE="hidden" NAME="question_type_13" value="Text">
				<INPUT TYPE="hidden" NAME="label_13" value="Reg3 Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13287" class="layout form item outer row-14 item-13287 row_num-140 row_pos-20480 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email Address:
					

							<input type="text"
								
									id="response_14"
									name="response_14"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-14 item-13287"
							><!-- input -->

							
				<input type="hidden" name="question_14" value="Email Address:">
				<INPUT TYPE="hidden" NAME="response_14_question_id" VALUE="13287">
				<INPUT TYPE="hidden" NAME="question_type_14" value="Text">
				<INPUT TYPE="hidden" NAME="label_14" value="Reg3 Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13288" class="layout form item outer row-15 item-13288 row_num-160 row_pos-10240 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First and Last Name:
					

							<input type="text"
								
									id="response_15"
									name="response_15"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-15 item-13288"
							><!-- input -->

							
				<input type="hidden" name="question_15" value="First and Last Name:">
				<INPUT TYPE="hidden" NAME="response_15_question_id" VALUE="13288">
				<INPUT TYPE="hidden" NAME="question_type_15" value="Text">
				<INPUT TYPE="hidden" NAME="label_15" value="Reg4 Name">

				
			</div> <!-- /inner -->

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		<div id="form-item-13289" class="layout form item outer row-16 item-13289 row_num-160 row_pos-20480 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email Address:
					

							<input type="text"
								
									id="response_16"
									name="response_16"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-16 item-13289"
							><!-- input -->

							
				<input type="hidden" name="question_16" value="Email Address:">
				<INPUT TYPE="hidden" NAME="response_16_question_id" VALUE="13289">
				<INPUT TYPE="hidden" NAME="question_type_16" value="Text">
				<INPUT TYPE="hidden" NAME="label_16" value="Reg4 Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13290" class="layout form item outer row-17 item-13290 row_num-180 row_pos-10240 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First and Last Name:
					

							<input type="text"
								
									id="response_17"
									name="response_17"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-17 item-13290"
							><!-- input -->

							
				<input type="hidden" name="question_17" value="First and Last Name:">
				<INPUT TYPE="hidden" NAME="response_17_question_id" VALUE="13290">
				<INPUT TYPE="hidden" NAME="question_type_17" value="Text">
				<INPUT TYPE="hidden" NAME="label_17" value="Reg5 Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13291" class="layout form item outer row-18 item-13291 row_num-180 row_pos-20480 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Email Address:
					

							<input type="text"
								
									id="response_18"
									name="response_18"
								
								
								 style="width:300px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-18 item-13291"
							><!-- input -->

							
				<input type="hidden" name="question_18" value="Email Address:">
				<INPUT TYPE="hidden" NAME="response_18_question_id" VALUE="13291">
				<INPUT TYPE="hidden" NAME="question_type_18" value="Text">
				<INPUT TYPE="hidden" NAME="label_18" value="Reg5 Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13292" class="layout form item outer row-19 item-13292 row_num-200 row_pos-10240 rowlength-2 type-None" style="clear:both;max-width:50%;position:relative;">

			<div class="inner">

				
						<h3><span style="color:#000000;">Add a Sponsorship:</span></h3>
					

				<input type="hidden" name="question_19" value="&lt;h3&gt;&lt;span style=&quot;color:#000000;&quot;&gt;Add a Sponsorship:&lt;/span&gt;&lt;/h3&gt;">
				<INPUT TYPE="hidden" NAME="response_19_question_id" VALUE="13292">
				<INPUT TYPE="hidden" NAME="question_type_19" value="None">
				<INPUT TYPE="hidden" NAME="label_19" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13271" class="layout form item outer row-20 item-13271 row_num-200 row_pos-10256 rowlength-2 type-Radio" style="max-width:50%;position:relative;">

			<div class="inner">

				
							Choose Your Sponsor Level:
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_20"
											id="radioVal_13271_1"
											fieldtype="radioprice"
											price="0"
											value="Program Sponsor $1,000:
Company logo on sign, event announcement, program, CCIA Highlights and website"

											
											class="item type-radio type-Radio row-20 item-13271 "
											>
											

													Program Sponsor $1,000:
Company logo on sign, event announcement, program, CCIA Highlights and website

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_20"
											id="radioVal_13271_2"
											fieldtype="radioprice"
											price="0"
											value="Gold Sponsor $500:
Company logo on sign and program"

											
											class="item type-radio type-Radio row-20 item-13271 "
											>
											

													Gold Sponsor $500:
Company logo on sign and program

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_20"
											id="radioVal_13271_3"
											fieldtype="radioprice"
											price="0"
											value="Silver Sponsor $250:
Company name on sign and program"

											
											class="item type-radio type-Radio row-20 item-13271 "
											>
											

													Silver Sponsor $250:
Company name on sign and program

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_20"
											id="radioVal_13271_4"
											fieldtype="radioprice"
											price="0"
											value="Bronze $100:
Company name in program."

											
											class="item type-radio type-Radio row-20 item-13271 "
											>
											

													Bronze $100:
Company name in program.

												
										</label>
									</div>
							
							
									<br /><a href="javascript:void(0);" onclick="clearRadio('response_20');">Clear Selection</a>
								
							
				<input type="hidden" name="question_20" value="Choose Your Sponsor Level:">
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				<INPUT TYPE="hidden" NAME="question_type_20" value="Radio">
				<INPUT TYPE="hidden" NAME="label_20" value="Sponsor Levels">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

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			<div class="inner">

				
						<h3><span style="color:#000000;"><strong>Upload your Logo:</strong></span></h3>
					

				<input type="hidden" name="question_21" value="&lt;h3&gt;&lt;span style=&quot;color:#000000;&quot;&gt;&lt;strong&gt;Upload your Logo:&lt;/strong&gt;&lt;/span&gt;&lt;/h3&gt;">
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				<INPUT TYPE="hidden" NAME="question_type_21" value="None">
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			<div class="inner">

				
							<input type="file" accept="*" 
								
									id="response_22"
									name="response_22"
								
								
									onchange="checkInvalidCharacter('response_22');"
								

                                            value=""
									    
										
								class="type-File row-22 item-13296"
							><!-- input -->

							
				<input type="hidden" name="question_22" value="">
				<INPUT TYPE="hidden" NAME="response_22_question_id" VALUE="13296">
				<INPUT TYPE="hidden" NAME="question_type_22" value="File">
				<INPUT TYPE="hidden" NAME="label_22" value="Upload your Logo:">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13277" class="layout form item outer row-23 item-13277 row_num-240 row_pos-10240 rowlength-2 type-None" style="clear:both;max-width:50%;position:relative;">

			<div class="inner">

				
						<h3><span style="color:#000000;">Payment Information:</span></h3>
					

				<input type="hidden" name="question_23" value="&lt;h3&gt;&lt;span style=&quot;color:#000000;&quot;&gt;Payment Information:&lt;/span&gt;&lt;/h3&gt;">
				<INPUT TYPE="hidden" NAME="response_23_question_id" VALUE="13277">
				<INPUT TYPE="hidden" NAME="question_type_23" value="None">
				<INPUT TYPE="hidden" NAME="label_23" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-13278" class="layout form item outer row-24 item-13278 row_num-240 row_pos-10304 rowlength-2 type-Radio" style="max-width:50%;position:relative;">

			<div class="inner">

				
							Choose your payment method for Sponsorships:
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_24"
											id="radioVal_13278_1"
											fieldtype="radioprice"
											price="0"
											value="Credit Card (button on next screen)"

											
											class="item type-radio type-Radio row-24 item-13278 "
											>
											

													Credit Card (button on next screen)

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_24"
											id="radioVal_13278_2"
											fieldtype="radioprice"
											price="0"
											value="Check (Invoice will be sent to email provided)"

											
											class="item type-radio type-Radio row-24 item-13278 "
											>
											

													Check (Invoice will be sent to email provided)

												
										</label>
									</div>
							
							
									<br /><a href="javascript:void(0);" onclick="clearRadio('response_24');">Clear Selection</a>
								
							
				<input type="hidden" name="question_24" value="Choose your payment method for Sponsorships:">
				<INPUT TYPE="hidden" NAME="response_24_question_id" VALUE="13278">
				<INPUT TYPE="hidden" NAME="question_type_24" value="Radio">
				<INPUT TYPE="hidden" NAME="label_24" value="Payment">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
</div><!-- /form_layout_wrapper -->


		<div id="_ssdiv2" style="display:none">
			<input type="hidden" id="fld_uploadfields" name="UploadFields" value="22">
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				<style>
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				<INPUT TYPE="hidden" NAME="send_mail_ind" VALUE="0">
				<INPUT TYPE="hidden" NAME="no_opt_out" VALUE="1">
			
	
			<div id="frm_submit_button">
				<br />
				<button class="btn btn-primary" type="button" data-loading-text="Please wait..." id="submitBtn"
					
						onclick="startValidate();"
					
				>Submit Form</button>
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	<!-- display verisign seal if SSL connection -->
	
		
		<img alt="void" src="/i4a/sysimages/blank.gif" width="98" height="102" border="0">
	

			</div>
			
	
				<div id="frm_required_copy_bottom">
					<p>Fields marked with <span class="text-danger">*</span> are required.</p>
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	</form>
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