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-</option> <option value="I think I might be a victim">I think I might be a victim</option> <option value="I think I have witnessed examples of modern slavery or human trafficking">I think I have witnessed examples of modern slavery or human trafficking</option> <option value="I would like more information on modern slavery">I would like more information on modern slavery</option> <option value="I have a question about a potential case of modern slavery and I would like some guidance on what to do next">I have a question about a potential case of modern slavery, and I would like some guidance on what to do next</option> <option value="I am a business and I would like some information or support">I am a business and I would like some information or support</option> </select> </div> </div> <div class="row"> <div class="title">Please provide a description of what you have seen or experienced or your question.</div> <div class="inputwrapper"><textarea class="required savepartial" name="description" placeholder="Please describe what type of abuse or exploitation you are reporting or think you have seen. If known, please state: what work or actions people are being asked to undertake? Who are the potential victims - please include gender, age or other relevant factors? Who are the potential exploiters? What do you know about them? In what type of setting is this taking place? What are the living or working conditions?"></textarea></div> </div> <div class="row"> <div class="title">Location<span>(optional)</span></div> <div class="inputwrapper"><input type="text" class="savepartial" name="location" placeholder="Where suspected exploitation occurs: description, city, address, street, building name. "></div> </div> <div class="row"> <div class="title">Name<span>(optional)</span></div> <div class="inputwrapper"><input type="text" class="half savepartial" name="firstname" placeholder="First name or pseudonym"> <input type="text" class="half savepartial" name="surname" placeholder="Surname"></div> </div> <div class="row"> <div class="title">Can we contact you? We will only contact you if we need more information about the situation you are reporting.</div> <div class="inputwrapper"> <select id="can_contact" name="can_contact" class="required savepartial"> <option value="yes">Yes</option> <option value="no" selected="selected">No</option> </select> </div> </div> <div class="row contact-row"> <div class="title">Can we share your contact details? You can report a concern in confidence and we won't tell anyone else unless you consent, there are no children involved and no-one is at risk of immediate harm. We will only share your details with other organisations who may be able to assist in the situation you are reporting.</div> <div class="inputwrapper"> <select id="can_share_contact" name="can_share_contact" class="required savepartial"> <option value="yes">Yes</option> <option value="no">No</option> </select> </div> </div> <div class="row contact-row contact-email"> <div class="title">Email Address</div> <div class="inputwrapper"><input type="email" id="input_email" class="savepartial" data-validation-type="email" name="email"></div> </div> <div class="row contact-row contact-phone"> <div class="title">Telephone</div> <div class="inputwrapper"><input type="text" id="input_phone" class="savepartial" name="phone"></div> </div> <input type="hidden" name="fingerprint" id="fingerprint"/> <input type="hidden" name="widget" class="savepartial" value=""/> <input type="hidden" name="referrer" id="referrer_input" class="" value=""/> <span class="button blue fullwidth" id="sendmessage">Send Message</span> <input type="text" class="captcha" name="captcha"> <input type="hidden" name="action" value="sendform"> </form> <script> function checkInputs() { if (jQuery('#can_contact').val()=='yes') jQuery('.row.contact-row').show(); 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