{"id":48634,"date":"2023-12-13T02:14:10","date_gmt":"2023-12-13T07:14:10","guid":{"rendered":"https:\/\/www.escapeartist.com\/?page_id=48634"},"modified":"2023-12-13T02:14:10","modified_gmt":"2023-12-13T07:14:10","slug":"survey-eai-december-2023","status":"publish","type":"page","link":"https:\/\/www.escapeartist.com\/survey-eai-december-2023\/","title":{"rendered":"Survey EAI December 2023"},"content":{"rendered":"<p>[vc_row][vc_column][vc_column_text]<span style=\"font-weight: 400;\">Thank you for agreeing to take our survey and for being an active part of our <\/span><i><span style=\"font-weight: 400;\">Insiders<\/span><\/i><span style=\"font-weight: 400;\"> community!<\/span><\/p>\n<p><span style=\"font-weight: 400;\">By completing this survey, you\u2019ll receive a coupon code for 50% off at the Escape Artist store!<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Your feedback will help us get to know you better and serve you by providing the information you want in future editions of <\/span><i><span style=\"font-weight: 400;\">Escape Artist Insiders<\/span><\/i><span style=\"font-weight: 400;\"> magazine.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Let\u2019s get started\u2026<\/span>[\/vc_column_text]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return 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class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_242' id='gform_242'  action='\/wp-json\/wp\/v2\/pages\/48634\/#gf_242' >\n                        <div class='gform_body gform-body'><div id='gform_fields_242' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_242_9\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_9\"><label class='gfield_label' for='input_242_9' >Why did you subscribe to the magazine?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_242_9' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_242_23\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_23\"><label class='gfield_label' for='input_242_23' >What is the number one country you want to learn about?<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_242_23' class='large gfield_select'     aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select><\/div><\/div><div id=\"field_242_11\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_11\"><label class='gfield_label' for='input_242_11' >What is your favourite section in the magazine?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_242_11' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_242_12\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_12\"><label class='gfield_label' for='input_242_12' >What do you look forward to reading about in the magazine each month?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_242_12' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_242_24\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_24\"><label class='gfield_label' for='input_242_24' >How could we improve the magazine?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_242_24' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_242_13\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_13\"><legend class='gfield_label'  >How useful is the information in the magazine to you?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_13'>\n\t\t\t<div class='gchoice gchoice_242_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Never useful'  id='choice_242_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_13_0' id='label_242_13_0'>Never useful<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Almost never'  id='choice_242_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_13_1' id='label_242_13_1'>Almost never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Occasionally\/Sometimes'  id='choice_242_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_13_2' id='label_242_13_2'>Occasionally\/Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Almost every time'  id='choice_242_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_13_3' id='label_242_13_3'>Almost every time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Frequently useful'  id='choice_242_13_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_13_4' id='label_242_13_4'>Frequently useful<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_15\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_15\"><legend class='gfield_label'  >How will you rate the format of the magazine?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_15'>\n\t\t\t<div class='gchoice gchoice_242_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Not at all satisfied'  id='choice_242_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_15_0' id='label_242_15_0'>Not at all satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Slightly satisfied'  id='choice_242_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_15_1' id='label_242_15_1'>Slightly satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Moderately satisfied'  id='choice_242_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_15_2' id='label_242_15_2'>Moderately satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Very satisfied'  id='choice_242_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_15_3' id='label_242_15_3'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_15_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Completely satisfied'  id='choice_242_15_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_15_4' id='label_242_15_4'>Completely satisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_16\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_16\"><legend class='gfield_label'  >Would you prefer the magazine in print, digital, or both?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_16'>\n\t\t\t<div class='gchoice gchoice_242_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Print'  id='choice_242_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_16_0' id='label_242_16_0'>Print<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Digital'  id='choice_242_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_16_1' id='label_242_16_1'>Digital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Both'  id='choice_242_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_16_2' id='label_242_16_2'>Both<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_25\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_25\"><legend class='gfield_label'  >Would you be willing to pay more for a print magazine?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_25'>\n\t\t\t<div class='gchoice gchoice_242_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_242_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_25_0' id='label_242_25_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_242_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_25_1' id='label_242_25_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_242_26\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_26\"><label class='gfield_label' for='input_242_26' >What topic would you like to see us write about in future editions?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_242_26' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_242_27\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_27\"><label class='gfield_label' for='input_242_27' >What is the number one problem you are facing to put your Plan B Escape Route (international plan) in place?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_242_27' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_242_17\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_17\"><legend class='gfield_label'  >Which of the following best describes your age?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_17'>\n\t\t\t<div class='gchoice gchoice_242_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='18-29'  id='choice_242_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_0' id='label_242_17_0'>18-29<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='30-39'  id='choice_242_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_1' id='label_242_17_1'>30-39<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='40-49'  id='choice_242_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_2' id='label_242_17_2'>40-49<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='50-59'  id='choice_242_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_3' id='label_242_17_3'>50-59<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='60-64'  id='choice_242_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_4' id='label_242_17_4'>60-64<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_17_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='&gt;65'  id='choice_242_17_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_17_5' id='label_242_17_5'>>65<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_28\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_28\"><legend class='gfield_label'  >What is your gender?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_28'>\n\t\t\t<div class='gchoice gchoice_242_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Male'  id='choice_242_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_28_0' id='label_242_28_0'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Female'  id='choice_242_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_28_1' id='label_242_28_1'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Prefer not to answer'  id='choice_242_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_28_2' id='label_242_28_2'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_18\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_18\"><legend class='gfield_label'  >Which of the following best describes your total household annual income?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_18'>\n\t\t\t<div class='gchoice gchoice_242_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&lt;$20,000'  id='choice_242_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_0' id='label_242_18_0'><$20,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$20,000 - $40,000'  id='choice_242_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_1' id='label_242_18_1'>$20,000 - $40,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$40,000 - $60,000'  id='choice_242_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_2' id='label_242_18_2'>$40,000 - $60,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$60,000 - $80,000'  id='choice_242_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_3' id='label_242_18_3'>$60,000 - $80,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$80,000 - $100,000'  id='choice_242_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_4' id='label_242_18_4'>$80,000 - $100,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$100,000 - $150,000'  id='choice_242_18_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_5' id='label_242_18_5'>$100,000 - $150,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='$150,000 - $200,000'  id='choice_242_18_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_6' id='label_242_18_6'>$150,000 - $200,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='&gt;$200,000'  id='choice_242_18_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_7' id='label_242_18_7'>>$200,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_18_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Prefer not to answer'  id='choice_242_18_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_18_8' id='label_242_18_8'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_29\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_29\"><legend class='gfield_label'  >What is the highest level of education you have completed?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_29'>\n\t\t\t<div class='gchoice gchoice_242_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Some high school, no diploma'  id='choice_242_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_0' id='label_242_29_0'>Some high school, no diploma<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='High school'  id='choice_242_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_1' id='label_242_29_1'>High school<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Some college, no degree'  id='choice_242_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_2' id='label_242_29_2'>Some college, no degree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Associate (2-year) degree'  id='choice_242_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_3' id='label_242_29_3'>Associate (2-year) degree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Bachelor\u2019s (4-year) degree'  id='choice_242_29_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_4' id='label_242_29_4'>Bachelor\u2019s (4-year) degree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Masters'  id='choice_242_29_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_5' id='label_242_29_5'>Masters<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_29_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Doctorate'  id='choice_242_29_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_29_6' id='label_242_29_6'>Doctorate<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_242_30\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_30\"><label class='gfield_label' for='input_242_30' >What is your primary field of work or area of study?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_242_30' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_242_31\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_31\"><legend class='gfield_label'  >Which of the following best describes your employment status?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_31'>\n\t\t\t<div class='gchoice gchoice_242_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Student'  id='choice_242_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_0' id='label_242_31_0'>Student<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Unemployed'  id='choice_242_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_1' id='label_242_31_1'>Unemployed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Employed part-time'  id='choice_242_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_2' id='label_242_31_2'>Employed part-time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Employed full-time'  id='choice_242_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_3' id='label_242_31_3'>Employed full-time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Contract'  id='choice_242_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_4' id='label_242_31_4'>Contract<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Freelance'  id='choice_242_31_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_5' id='label_242_31_5'>Freelance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Digital nomad'  id='choice_242_31_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_6' id='label_242_31_6'>Digital nomad<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_31_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Retired'  id='choice_242_31_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_31_7' id='label_242_31_7'>Retired<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_32\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_32\"><legend class='gfield_label'  >Which of the following best describes your marital status?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_32'>\n\t\t\t<div class='gchoice gchoice_242_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Single'  id='choice_242_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_32_0' id='label_242_32_0'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Married'  id='choice_242_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_32_1' id='label_242_32_1'>Married<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Common-law'  id='choice_242_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_32_2' id='label_242_32_2'>Common-law<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_242_33\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_33\"><label class='gfield_label' for='input_242_33' >Including yourself, how many people live in your household?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_242_33' class='textarea small'   maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_242_34\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_34\"><legend class='gfield_label'  >What is your political affiliation?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_242_34'>\n\t\t\t<div class='gchoice gchoice_242_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Libertarian'  id='choice_242_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_34_0' id='label_242_34_0'>Libertarian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Republican'  id='choice_242_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_34_1' id='label_242_34_1'>Republican<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Democrat'  id='choice_242_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_34_2' id='label_242_34_2'>Democrat<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_34_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Other'  id='choice_242_34_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_34_3' id='label_242_34_3'>Other<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_242_34_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Prefer not to answer'  id='choice_242_34_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_242_34_4' id='label_242_34_4'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_242_1\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_1\"><legend class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_242_1'>\n                            \n                            <span id='input_242_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_242_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_242_1_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_242_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_242_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_242_1_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_242_2\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_2\"><label class='gfield_label' for='input_242_2' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_242_2' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_242_19\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_19\"><label class='gfield_label' for='input_242_19' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_242_19' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><span class='spf-phone valid-msg hide'>\u2713 Valid number<\/span><span class='spf-phone error-msg hide'> \u2715 Invalid number<\/span><\/div><div id=\"field_242_10\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_10\"><label class='gfield_label' for='input_242_10' >Country of Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_242_10' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select Country<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/div><div id=\"field_242_20\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_20\"><label class='gfield_label' for='input_242_20' >State of Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_242_20' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_242_35\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_35\"><label class='gfield_label' for='input_242_35' >City of Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_242_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_242_36\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_242_36\"><label class='gfield_label' for='input_242_36' >ZIP Code<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_242_36' type='text' value='' 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