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class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-coupon-response-div s2member-pro-authnet-checkout-form-coupon-response-div"> <!-- A Coupon response (w/Discounts) will be displayed here; based on the Coupon Code that was entered. --> </div> <div id="s2member-pro-authnet-checkout-form-coupon-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-coupon-div s2member-pro-authnet-checkout-form-coupon-div"> <label for="s2member-pro-authnet-checkout-coupon" id="s2member-pro-authnet-checkout-form-coupon-label" class="s2member-pro-authnet-form-coupon-label s2member-pro-authnet-checkout-form-coupon-label"> <span>Gift, Coupon, or Redemption Code?</span><br /> <input type="text" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[coupon]" id="s2member-pro-authnet-checkout-coupon" class="s2member-pro-authnet-coupon s2member-pro-authnet-checkout-coupon form-control" value="" tabindex="1" /> </label> <input type="button" id="s2member-pro-authnet-checkout-coupon-apply" class="s2member-pro-authnet-coupon-apply s2member-pro-authnet-checkout-coupon-apply btn btn-default" value="Apply" tabindex="-1" /> </div> <div style="clear:both;"></div> </div> <!-- Registration Details (Name, Email, Username, Password). --> <!-- Some of this information will be prefilled automatically when/if a User/Member is already logged-in. --> <!-- Name fields will NOT be hidden automatically here; even if your Registration/Profile Field options dictate this behavior. --> <div id="s2member-pro-authnet-checkout-form-registration-section" class="s2member-pro-authnet-form-section s2member-pro-authnet-checkout-form-section s2member-pro-authnet-form-registration-section s2member-pro-authnet-checkout-form-registration-section"> <div id="s2member-pro-authnet-checkout-form-registration-section-title" class="s2member-pro-authnet-form-section-title s2member-pro-authnet-checkout-form-section-title s2member-pro-authnet-form-registration-section-title s2member-pro-authnet-checkout-form-registration-section-title"> Create Profile </div> <div id="s2member-pro-authnet-checkout-form-first-name-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-first-name-div s2member-pro-authnet-checkout-form-first-name-div"> <label for="s2member-pro-authnet-checkout-first-name" id="s2member-pro-authnet-checkout-form-first-name-label" class="s2member-pro-authnet-form-first-name-label s2member-pro-authnet-checkout-form-first-name-label"> <span>First Name *</span><br /> <input type="text" aria-required="true" maxlength="50" autocomplete="off" name="s2member_pro_authnet_checkout[first_name]" id="s2member-pro-authnet-checkout-first-name" class="s2member-pro-authnet-first-name s2member-pro-authnet-checkout-first-name form-control" value="" tabindex="10" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-last-name-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-last-name-div s2member-pro-authnet-checkout-form-last-name-div"> <label for="s2member-pro-authnet-checkout-last-name" id="s2member-pro-authnet-checkout-form-last-name-label" class="s2member-pro-authnet-form-last-name-label s2member-pro-authnet-checkout-form-last-name-label"> <span>Last Name *</span><br /> <input type="text" aria-required="true" maxlength="50" autocomplete="off" name="s2member_pro_authnet_checkout[last_name]" id="s2member-pro-authnet-checkout-last-name" class="s2member-pro-authnet-last-name s2member-pro-authnet-checkout-last-name form-control" value="" tabindex="20" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-email-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-email-div s2member-pro-authnet-checkout-form-email-div"> <label for="s2member-pro-authnet-checkout-email" id="s2member-pro-authnet-checkout-form-email-label" class="s2member-pro-authnet-form-email-label s2member-pro-authnet-checkout-form-email-label"> <span>Email Address *</span><br /> <input type="email" aria-required="true" data-expected="email" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[email]" id="s2member-pro-authnet-checkout-email" class="s2member-pro-authnet-email s2member-pro-authnet-checkout-email form-control" value="" tabindex="30" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-username-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-username-div s2member-pro-authnet-checkout-form-username-div"> <label for="s2member-pro-authnet-checkout-username" id="s2member-pro-authnet-checkout-form-username-label" class="s2member-pro-authnet-form-username-label s2member-pro-authnet-checkout-form-username-label"> <span>Username (lowercase alphanumeric) *</span><br /> <input type="text" aria-required="true" maxlength="60" autocomplete="off" name="s2member_pro_authnet_checkout[username]" id="s2member-pro-authnet-checkout-username" class="s2member-pro-authnet-username s2member-pro-authnet-checkout-username form-control" value="" tabindex="40" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-password-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-password-div s2member-pro-authnet-checkout-form-password-div"> <label for="s2member-pro-authnet-checkout-password1" id="s2member-pro-authnet-checkout-form-password-label" class="s2member-pro-authnet-form-password-label s2member-pro-authnet-checkout-form-password-label"> <span>Password (type this twice please) *</span><br /> <input type="password" aria-required="true" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[password1]" id="s2member-pro-authnet-checkout-password1" class="s2member-pro-authnet-password1 s2member-pro-authnet-checkout-password1 form-control" value="" tabindex="50" /> </label> <input type="password" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[password2]" id="s2member-pro-authnet-checkout-password2" class="s2member-pro-authnet-password2 s2member-pro-authnet-checkout-password2 form-control" value="" tabindex="60" /> <div id="s2member-pro-authnet-checkout-form-password-strength" class="ws-plugin--s2member-password-strength s2member-pro-authnet-form-password-strength s2member-pro-authnet-checkout-form-password-strength"><em>password strength indicator</em></div> </div> <div style="clear:both;"></div> </div> <!-- Custom Fields (Custom Registration/Profile Fields will appear here, when/if they've been configured). --> <!-- Custom Fields will NOT be displayed to existing Users/Members that are already logged-in. s2Member assumes this information has already been collected in that case. --> <div id="s2member-pro-authnet-checkout-form-custom-fields-section" class="s2member-pro-authnet-form-section s2member-pro-authnet-checkout-form-section s2member-pro-authnet-form-custom-fields-section s2member-pro-authnet-checkout-form-custom-fields-section"> <div id="s2member-pro-authnet-checkout-form-custom-fields-section-title" class="s2member-pro-authnet-form-section-title s2member-pro-authnet-checkout-form-section-title s2member-pro-authnet-form-custom-fields-section-title s2member-pro-authnet-checkout-form-custom-fields-section-title"> Additional Info </div> <div id="s2member-pro-authnet-checkout-form-custom-reg-field-company-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-custom-reg-field-company-div s2member-pro-authnet-checkout-form-custom-reg-field-company-div"> <label for="s2member-pro-authnet-checkout-custom-reg-field-company" id="s2member-pro-authnet-checkout-form-custom-reg-field-company-label" class="s2member-pro-authnet-form-custom-reg-field-company-label s2member-pro-authnet-checkout-form-custom-reg-field-company-label"> <span>Company</span></label><br /> <input type="text" maxlength="100" autocomplete="off" value="" name="s2member_pro_authnet_checkout[custom_fields][company]" id="s2member-pro-authnet-checkout-custom-reg-field-company" tabindex="100" class="s2member-pro-authnet-custom-reg-field-company s2member-pro-authnet-checkout-custom-reg-field-company form-control" tabindex="1" /></div> <div id="s2member-pro-authnet-checkout-form-custom-reg-field-profession-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-custom-reg-field-profession-div s2member-pro-authnet-checkout-form-custom-reg-field-profession-div"> <label for="s2member-pro-authnet-checkout-custom-reg-field-profession" id="s2member-pro-authnet-checkout-form-custom-reg-field-profession-label" class="s2member-pro-authnet-form-custom-reg-field-profession-label s2member-pro-authnet-checkout-form-custom-reg-field-profession-label"> <span>Profession</span></label><br /> <select name="s2member_pro_authnet_checkout[custom_fields][profession]" id="s2member-pro-authnet-checkout-custom-reg-field-profession" tabindex="101" class="s2member-pro-authnet-custom-reg-field-profession s2member-pro-authnet-checkout-custom-reg-field-profession form-control"><option value="Please Select" selected="selected">Please Select</option><option value="Allied Healthcare Professional">Allied Healthcare Professional</option><option value="Consultant/Analyst">Consultant/Analyst</option><option value="Marketing/Sales">Marketing/Sales</option><option value="Medical Professional">Medical Professional</option><option value="Product/Business Development">Product/Business Development</option><option value="Residency/Fellowship">Residency/Fellowship</option><option value="Surgeon">Surgeon</option><option value="Other">Other</option></select></div> </div> <!-- Billing Method (Customers can use a Credit/Debit card only). --> <div id="s2member-pro-authnet-checkout-form-billing-method-section" class="s2member-pro-authnet-form-section s2member-pro-authnet-checkout-form-section s2member-pro-authnet-form-billing-method-section s2member-pro-authnet-checkout-form-billing-method-section"> <div id="s2member-pro-authnet-checkout-form-billing-method-section-title" class="s2member-pro-authnet-form-section-title s2member-pro-authnet-checkout-form-section-title s2member-pro-authnet-form-billing-method-section-title s2member-pro-authnet-checkout-form-billing-method-section-title"> Billing Method </div> <div id="s2member-pro-authnet-checkout-form-card-type-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-card-type-div s2member-pro-authnet-checkout-form-card-type-div"> <input type="radio" name="s2member_pro_authnet_checkout[card_type]" id="s2member-pro-authnet-checkout-card-type-free" class="s2member-pro-authnet-card-type-free s2member-pro-authnet-checkout-card-type-free" value="Free" tabindex="-1" style="display:none;" /> <label for="s2member-pro-authnet-checkout-card-type-visa" id="s2member-pro-authnet-checkout-form-card-type-visa-label" class="s2member-pro-authnet-form-card-type-label s2member-pro-authnet-checkout-form-card-type-label s2member-pro-authnet-form-card-type-visa-label s2member-pro-authnet-checkout-form-card-type-visa-label"> <input type="radio" aria-required="true" name="s2member_pro_authnet_checkout[card_type]" id="s2member-pro-authnet-checkout-card-type-visa" class="s2member-pro-authnet-card-type-visa s2member-pro-authnet-checkout-card-type-visa" value="Visa" tabindex="200" /> </label><label for="s2member-pro-authnet-checkout-card-type-mastercard" id="s2member-pro-authnet-checkout-form-card-type-mastercard-label" class="s2member-pro-authnet-form-card-type-label s2member-pro-authnet-checkout-form-card-type-label s2member-pro-authnet-form-card-type-mastercard-label s2member-pro-authnet-checkout-form-card-type-mastercard-label"> <input type="radio" aria-required="true" name="s2member_pro_authnet_checkout[card_type]" id="s2member-pro-authnet-checkout-card-type-mastercard" class="s2member-pro-authnet-card-type-mastercard s2member-pro-authnet-checkout-card-type-mastercard" value="MasterCard" tabindex="200" /> </label><label for="s2member-pro-authnet-checkout-card-type-discover" id="s2member-pro-authnet-checkout-form-card-type-discover-label" class="s2member-pro-authnet-form-card-type-label s2member-pro-authnet-checkout-form-card-type-label s2member-pro-authnet-form-card-type-discover-label s2member-pro-authnet-checkout-form-card-type-discover-label"> <input type="radio" aria-required="true" name="s2member_pro_authnet_checkout[card_type]" id="s2member-pro-authnet-checkout-card-type-discover" class="s2member-pro-authnet-card-type-discover s2member-pro-authnet-checkout-card-type-discover" value="Discover" tabindex="200" /> </label><label for="s2member-pro-authnet-checkout-card-type-amex" id="s2member-pro-authnet-checkout-form-card-type-amex-label" class="s2member-pro-authnet-form-card-type-label s2member-pro-authnet-checkout-form-card-type-label s2member-pro-authnet-form-card-type-amex-label s2member-pro-authnet-checkout-form-card-type-amex-label"> <input type="radio" aria-required="true" name="s2member_pro_authnet_checkout[card_type]" id="s2member-pro-authnet-checkout-card-type-amex" class="s2member-pro-authnet-card-type-amex s2member-pro-authnet-checkout-card-type-amex" value="Amex" tabindex="200" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-card-number-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-card-number-div s2member-pro-authnet-checkout-form-card-number-div"> <label for="s2member-pro-authnet-checkout-card-number" id="s2member-pro-authnet-checkout-form-card-number-label" class="s2member-pro-authnet-form-card-number-label s2member-pro-authnet-checkout-form-card-number-label"> <span>Card Number (no dashes or spaces) *</span><br /> <input type="text" aria-required="true" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[card_number]" id="s2member-pro-authnet-checkout-card-number" class="s2member-pro-authnet-card-number s2member-pro-authnet-checkout-card-number form-control" value="" tabindex="210" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-card-expiration-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-card-expiration-div s2member-pro-authnet-checkout-form-card-expiration-div"> <label for="s2member-pro-authnet-checkout-card-expiration" id="s2member-pro-authnet-checkout-form-card-expiration-label" class="s2member-pro-authnet-form-card-expiration-label s2member-pro-authnet-checkout-form-card-expiration-label"> <span>Card Expiration Date (mm/yyyy) *</span><br /> <select aria-required="true" autocomplete="off" name="s2member_pro_authnet_checkout[card_expiration_month]" id="s2member-pro-authnet-checkout-card-expiration-month" class="s2member-pro-authnet-card-expiration-month s2member-pro-authnet-checkout-card-expiration-month form-control" tabindex="220"> <option value=""></option><option value="01">01 January</option><option value="02">02 February</option><option value="03">03 March</option><option value="04">04 April</option><option value="05">05 May</option><option value="06">06 June</option><option value="07">07 July</option><option value="08">08 August</option><option value="09">09 September</option><option value="10">10 October</option><option value="11">11 November</option><option value="12">12 December</option> </select> <select aria-required="true" autocomplete="off" name="s2member_pro_authnet_checkout[card_expiration_year]" id="s2member-pro-authnet-checkout-card-expiration-year" class="s2member-pro-authnet-card-expiration-year s2member-pro-authnet-checkout-card-expiration-year form-control" tabindex="221"> <option value=""></option><option value="2024">2024</option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option><option value="2036">2036</option><option value="2037">2037</option><option value="2038">2038</option><option value="2039">2039</option><option value="2040">2040</option><option value="2041">2041</option><option value="2042">2042</option><option value="2043">2043</option><option value="2044">2044</option><option value="2045">2045</option><option value="2046">2046</option><option value="2047">2047</option><option value="2048">2048</option><option value="2049">2049</option><option value="2050">2050</option><option value="2051">2051</option><option value="2052">2052</option><option value="2053">2053</option><option value="2054">2054</option><option value="2055">2055</option><option value="2056">2056</option><option value="2057">2057</option><option value="2058">2058</option><option value="2059">2059</option><option value="2060">2060</option><option value="2061">2061</option><option value="2062">2062</option><option value="2063">2063</option><option value="2064">2064</option><option value="2065">2065</option><option value="2066">2066</option><option value="2067">2067</option><option value="2068">2068</option><option value="2069">2069</option><option value="2070">2070</option><option value="2071">2071</option><option value="2072">2072</option><option value="2073">2073</option> </select> </label> <div style="clear:both;"></div> </div> <div id="s2member-pro-authnet-checkout-form-card-verification-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-card-verification-div s2member-pro-authnet-checkout-form-card-verification-div"> <label for="s2member-pro-authnet-checkout-card-verification" id="s2member-pro-authnet-checkout-form-card-verification-label" class="s2member-pro-authnet-form-card-verification-label s2member-pro-authnet-checkout-form-card-verification-label"> <span>Card Verification Code * <a href="https://en.wikipedia.org/wiki/Card_security_code" target="_blank" tabindex="-1" rel="external nofollow">need help?</a></span><br /> <input type="text" aria-required="true" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[card_verification]" id="s2member-pro-authnet-checkout-card-verification" class="s2member-pro-authnet-card-verification s2member-pro-authnet-checkout-card-verification form-control" value="" tabindex="230" /> </label> </div> <!-- This is displayed only when Maestro/Solo cards are selected as the Payment Method. --> <div id="s2member-pro-authnet-checkout-form-card-start-date-issue-number-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-card-start-date-issue-number-div s2member-pro-authnet-checkout-form-card-start-date-issue-number-div"> <label for="s2member-pro-authnet-checkout-card-start-date-issue-number" id="s2member-pro-authnet-checkout-form-card-start-date-issue-number-label" class="s2member-pro-authnet-form-card-start-date-issue-number-label s2member-pro-authnet-checkout-form-card-start-date-issue-number-label"> <span>Card Start Date (mm/yyyy), or Issue Number *</span><br /> <input type="text" aria-required="true" maxlength="100" autocomplete="off" name="s2member_pro_authnet_checkout[card_start_date_issue_number]" id="s2member-pro-authnet-checkout-card-start-date-issue-number" class="s2member-pro-authnet-card-start-date-issue-number s2member-pro-authnet-checkout-card-start-date-issue-number form-control" value="" tabindex="240" /> </label> </div> <div style="clear:both;"></div> </div> <!-- Billing Address (hidden dynamically when/if no Payment Method is selected yet). --> <div id="s2member-pro-authnet-checkout-form-billing-address-section" class="s2member-pro-authnet-form-section s2member-pro-authnet-checkout-form-section s2member-pro-authnet-form-billing-address-section s2member-pro-authnet-checkout-form-billing-address-section"> <div id="s2member-pro-authnet-checkout-form-billing-address-section-title" class="s2member-pro-authnet-form-section-title s2member-pro-authnet-checkout-form-section-title s2member-pro-authnet-form-billing-address-section-title s2member-pro-authnet-checkout-form-billing-address-section-title"> Billing Address </div> <div id="s2member-pro-authnet-checkout-form-street-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-street-div s2member-pro-authnet-checkout-form-street-div"> <label for="s2member-pro-authnet-checkout-street" id="s2member-pro-authnet-checkout-form-street-label" class="s2member-pro-authnet-form-street-label s2member-pro-authnet-checkout-form-street-label"> <span>Street Address *</span><br /> <input type="text" aria-required="true" maxlength="60" autocomplete="off" name="s2member_pro_authnet_checkout[street]" id="s2member-pro-authnet-checkout-street" class="s2member-pro-authnet-street s2member-pro-authnet-checkout-street form-control" value="" tabindex="300" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-city-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-city-div s2member-pro-authnet-checkout-form-city-div"> <label for="s2member-pro-authnet-checkout-city" id="s2member-pro-authnet-checkout-form-city-label" class="s2member-pro-authnet-form-city-label s2member-pro-authnet-checkout-form-city-label"> <span>City / Town *</span><br /> <input type="text" aria-required="true" maxlength="40" autocomplete="off" name="s2member_pro_authnet_checkout[city]" id="s2member-pro-authnet-checkout-city" class="s2member-pro-authnet-city s2member-pro-authnet-checkout-city form-control" value="" tabindex="310" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-state-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-state-div s2member-pro-authnet-checkout-form-state-div"> <label for="s2member-pro-authnet-checkout-state" id="s2member-pro-authnet-checkout-form-state-label" class="s2member-pro-authnet-form-state-label s2member-pro-authnet-checkout-form-state-label"> <span>State / Province *</span><br /> <input type="text" aria-required="true" maxlength="40" autocomplete="off" name="s2member_pro_authnet_checkout[state]" id="s2member-pro-authnet-checkout-state" class="s2member-pro-authnet-state s2member-pro-authnet-checkout-state form-control" value="" tabindex="320" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-zip-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-zip-div s2member-pro-authnet-checkout-form-zip-div"> <label for="s2member-pro-authnet-checkout-zip" id="s2member-pro-authnet-checkout-form-zip-label" class="s2member-pro-authnet-form-zip-label s2member-pro-authnet-checkout-form-zip-label"> <span>Postal / Zip Code *</span><br /> <input type="text" aria-required="true" maxlength="20" autocomplete="off" name="s2member_pro_authnet_checkout[zip]" id="s2member-pro-authnet-checkout-zip" class="s2member-pro-authnet-zip s2member-pro-authnet-checkout-zip form-control" value="" tabindex="330" /> </label> </div> <div id="s2member-pro-authnet-checkout-form-country-div" class="s2member-pro-authnet-form-div s2member-pro-authnet-checkout-form-div s2member-pro-authnet-form-country-div s2member-pro-authnet-checkout-form-country-div"> <label 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