{"id":19883,"date":"2021-01-12T14:32:32","date_gmt":"2021-01-12T19:32:32","guid":{"rendered":"https:\/\/www.bates.edu\/alumni\/?page_id=19883"},"modified":"2025-06-23T14:26:47","modified_gmt":"2025-06-23T18:26:47","slug":"submit-a-business","status":"publish","type":"page","link":"https:\/\/www.bates.edu\/alumni\/submit-a-business\/","title":{"rendered":"Submit an Alumni Owned Business"},"content":{"rendered":"\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Please take a moment to complete this form to participate in the Alumni Business Directory. Please provide us with information about the alumni-owned business and how best the ÀÖ²¥´«Ã½ community can support the business at this time. <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Submission Form:<\/h4>\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_323' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_323'  action='\/alumni\/wp-json\/wp\/v2\/pages\/19883' data-formid='323' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_323' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_323_34\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_34'><span class='gform-field-label__text'>URL<\/span><\/label><div class='ginput_container'><input name='input_34' id='input_323_34' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_323_34'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_323_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you a ÀÖ²¥´«Ã½ Alumni?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_323_20'>\n\t\t\t<li class='gchoice gchoice_323_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Yes'  id='choice_323_20_0'    \/>\n\t\t\t\t<label for='choice_323_20_0' id='label_323_20_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='No'  id='choice_323_20_1'    \/>\n\t\t\t\t<label for='choice_323_20_1' id='label_323_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_323_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Sorry, your business must be ÀÖ²¥´«Ã½ alumni owned.<\/h2><div class='gsection_description' id='gfield_description_323_4'>Unfortunately, while we\u2019d like to support all businesses, this directory is intended to give ÀÖ²¥´«Ã½ alumni the opportunity to promote their business with their fellow classmates.<\/div><\/li><li id=\"field_323_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Personal Information<\/h2><\/li><li id=\"field_323_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_323_2'>Please enter the alumni business owner name and class year<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name has_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_323_2'>\n                            \n                            <span id='input_323_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_323_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_323_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_323_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_323_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_323_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <span id='input_323_2_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.8' id='input_323_2_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_323_2_8' class='gform-field-label gform-field-label--type-sub '>Class Year<\/label>\n                                                <\/span>\n                        <\/div><\/li><li id=\"field_323_1\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_1'><span class='gform-field-label__text'>Email<\/span><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_1' id='input_323_1' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_323_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Business Information<\/h2><\/li><li id=\"field_323_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_5'><span class='gform-field-label__text'>Business Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_323_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_323_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you own the business?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_323_6'>\n\t\t\t<li class='gchoice gchoice_323_6_0'>\n\t\t\t\t<input name='input_6' type='radio' value='Yes'  id='choice_323_6_0'    \/>\n\t\t\t\t<label for='choice_323_6_0' id='label_323_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_6_1'>\n\t\t\t\t<input name='input_6' type='radio' value='No, I&#039;m nominating a ÀÖ²¥´«Ã½ friend&#039;s business'  id='choice_323_6_1'    \/>\n\t\t\t\t<label for='choice_323_6_1' id='label_323_6_1' class='gform-field-label gform-field-label--type-inline'>No, I&#8217;m nominating a ÀÖ²¥´«Ã½ friend&#8217;s business<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_323_7\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_7'><span class='gform-field-label__text'>If you do not own this business, please list who the alumni business owner is and their contact information:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_323_7' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_323_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Business Type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_323_27'>\n\t\t\t<li class='gchoice gchoice_323_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Arts, Media &amp; Design'  id='choice_323_27_0'    \/>\n\t\t\t\t<label for='choice_323_27_0' id='label_323_27_0' class='gform-field-label gform-field-label--type-inline'>Arts, Media &amp; Design<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Consulting &amp; Professional Services'  id='choice_323_27_1'    \/>\n\t\t\t\t<label for='choice_323_27_1' id='label_323_27_1' class='gform-field-label gform-field-label--type-inline'>Consulting &amp; Professional Services<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Consumer Goods &amp; Retail'  id='choice_323_27_2'    \/>\n\t\t\t\t<label for='choice_323_27_2' id='label_323_27_2' class='gform-field-label gform-field-label--type-inline'>Consumer Goods &amp; Retail<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Education &amp; Youth Programs'  id='choice_323_27_3'    \/>\n\t\t\t\t<label for='choice_323_27_3' id='label_323_27_3' class='gform-field-label gform-field-label--type-inline'>Education &amp; Youth Programs<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_4'>\n\t\t\t\t<input name='input_27' type='radio' value='Food &amp; Hospitality'  id='choice_323_27_4'    \/>\n\t\t\t\t<label for='choice_323_27_4' id='label_323_27_4' class='gform-field-label gform-field-label--type-inline'>Food &amp; Hospitality<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_5'>\n\t\t\t\t<input name='input_27' type='radio' value='Health &amp; Wellness'  id='choice_323_27_5'    \/>\n\t\t\t\t<label for='choice_323_27_5' id='label_323_27_5' class='gform-field-label gform-field-label--type-inline'>Health &amp; Wellness<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_6'>\n\t\t\t\t<input name='input_27' type='radio' value='Manufacturing, Construction &amp; Industrial'  id='choice_323_27_6'    \/>\n\t\t\t\t<label for='choice_323_27_6' id='label_323_27_6' class='gform-field-label gform-field-label--type-inline'>Manufacturing, Construction &amp; Industrial<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_27_7'>\n\t\t\t\t<input name='input_27' type='radio' value='Sports &amp; Recreation'  id='choice_323_27_7'    \/>\n\t\t\t\t<label for='choice_323_27_7' id='label_323_27_7' class='gform-field-label gform-field-label--type-inline'>Sports &amp; Recreation<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_323_27'>Please tell us what kind of business you operate.<\/div><\/li><li id=\"field_323_28\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_28'><span class='gform-field-label__text'>Business mission and\/or description<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea' data-text-counter-max='250' data-text-counter-template='{current} of {max} max characters'><textarea name='input_28' id='input_323_28' class='textarea medium'   maxlength='250'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_323_16\" class=\"gfield gfield--type-post_image gfield--input-type-post_image field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_16'><span class='gform-field-label__text'>Business Logo<\/span><\/label><div class='gfield_description' id='gfield_description_323_16'>Though not required, a logo is strongly recommended as we will display this with your business name. \n\nPlease submit either a jpg, jpeg, png, or gif that is no bigger than 15MB. <\/div><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_16' id='input_323_16' type='file' class='medium'   aria-invalid=\"false\" aria-describedby=\"gfield_upload_rules_323_16 gfield_description_323_16\" \/><span id='gfield_upload_rules_323_16' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><\/li><li id=\"field_323_10\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_10'><span class='gform-field-label__text'>How can the ÀÖ²¥´«Ã½ community support your business?<\/span><\/label><div class='gfield_description' id='gfield_description_323_10'>Examples: write a review online, purchase gift cards, or visit us online at&#8230;<\/div><div class='ginput_container ginput_container_textarea' data-text-counter-max='250' data-text-counter-template='{current} of {max} max characters'><textarea name='input_10' id='input_323_10' class='textarea medium'  aria-describedby=\"gfield_description_323_10\" maxlength='250'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_323_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like your business to be featured or highlighted on social media?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_323_32'>\n\t\t\t<li class='gchoice gchoice_323_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Yes'  id='choice_323_32_0'    \/>\n\t\t\t\t<label for='choice_323_32_0' id='label_323_32_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_323_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='No'  id='choice_323_32_1'    \/>\n\t\t\t\t<label for='choice_323_32_1' id='label_323_32_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_323_32'>(*By saying yes, it does not constitute that your business will be highlighted)<\/div><\/li><li id=\"field_323_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_33'><span class='gform-field-label__text'>Business Social Media Channels<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_323_33' type='text' value='' class='large'  aria-describedby=\"gfield_description_323_33\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_323_33'>Please link any social media channels of your business that you would like to be included in your listing.<\/div><\/li><li id=\"field_323_19\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_19'><span class='gform-field-label__text'>Please submit a recent photo of yourself.<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10240000' \/><input name='input_19' id='input_323_19' type='file' class='medium' aria-describedby=\"gfield_upload_rules_323_19\" onchange='javascript:gformValidateFileSize( this, 10240000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_323_19'>Max. file size: 10 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_323_19'><\/div> <\/div><\/li><li id=\"field_323_18\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_323_18'><span class='gform-field-label__text'>If you would like to include additional information about yourself and your business, please share below.<\/span><\/label><div class='gfield_description' id='gfield_description_323_18'>As part of our commitment to celebrating small business owners and the diverse ÀÖ²¥´«Ã½ alumni community, we are particularly interested in highlighting alumni business owners who identify as women, people of color and\/or LGBTQ+. If you would like to share that as part of your potential business feature, please tell us more here. \n<\/div><div class='ginput_container ginput_container_textarea' data-text-counter-max='250' data-text-counter-template='{current} of {max} max characters'><textarea name='input_18' id='input_323_18' class='textarea medium'  aria-describedby=\"gfield_description_323_18\" maxlength='250'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_323_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Business Contact Information<\/h2><\/li><li id=\"field_323_12\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Business Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_323_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_323_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_323_12_1' value=''    aria-required='true'    \/>\n                                        <label for='input_323_12_1' id='input_323_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_323_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_323_12_2' value=''     aria-required='false'   \/>\n                                        <label for='input_323_12_2' id='input_323_12_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_323_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_323_12_3' value=''    aria-required='true'    \/>\n                                    <label for='input_323_12_3' id='input_323_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_323_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_323_12_4' value=''      aria-required='true'    \/>\n                                        <label for='input_323_12_4' id='input_323_12_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_323_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_323_12_5' value=''    aria-required='true'    \/>\n                                    <label for='input_323_12_5' id='input_323_12_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_323_12_6_container' >\n                                        <select name='input_12.6' id='input_323_12_6'   aria-required='true'    ><option value='' selected='selected'><\/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='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>\n                                        <label for='input_323_12_6' id='input_323_12_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_323_13\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label 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