CINXE.COM

<!doctype html> <html dir="ltr" lang="en"> <head> <base href="https://com.us14.list-manage.com/profile?u=d29ddfd8fe8b89acdb7fbf59d&id=f0a9bdccda&e=%5BUNIQID%5D&c=f6f5bfd878"> <title>ABPLUS EVENTS SRL</title> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <meta name="description" content="ABPLUS EVENTS SRL Email Forms"> <meta name="keywords" content="ABPLUS EVENTS SRL"> <script src="//ajax.googleapis.com/ajax/libs/dojo/1.8/dojo/dojo.js"></script> <script type="text/javascript"> require([ "dojo/query", "dojo/dom", "dojo/dom-geometry", "dojo/dom-class", "dojo/dom-style", "dojo/dom-construct", "dijit/focus", "dojo/parser", "dijit/form/DateTextBox", "dojo/NodeList-traverse", "dojo/domReady!" ], function(query, dom, domGeom, domClass, domStyle, domConstruct, focusUtil, parser){ // Move the focused-field class to the field-group that contains the focused input. var handle = focusUtil.watch("curNode", function(name, oldValue, newValue){ var parent = query(newValue).closest('.field-group'); if(!domClass.contains(parent, "focused-field")) { query('.focused-field').removeClass('focused-field'); parent.addClass('focused-field'); } }); // Add error class to parent wrapper and only show error borders on empty fields in addresses query('.feedback.error').closest('.field-group').addClass('error'); query('.addressfield input:text[value=""]').addClass('empty'); // Focus first input of birthdayfield or phonefield-us when parent wrapper is clicked query('div.subfields').on("click", function(e){ var firstInput = query('input', e.target)[0]; focusUtil.focus(firstInput); }); // Use native checkboxes and radio buttons outside the app dojo.query(".radio input, .checkbox input").removeAttr("data-dojo-type"); // Render DateTextBoxes parser.parse(); query('form').on("submit",function(e){ var invalidDate = dojo.query('.dijitTextBoxError'); if(invalidDate.length){ query('.dijitDateTextBox ~ .feedback.error').forEach(domConstruct.destroy); invalidDate.forEach(function(node) { domConstruct.place('<div class="feedback error"><div class="errorText">Please enter a valid date</div></div>', node, 'after'); }); e.preventDefault(); } else if (window.bmak) { // Bot manager telemetry data window.bmak.form_submit(); } }); }); </script> <script src="https://www.google.com/recaptcha/api.js" async defer></script> <style type="text/css">/* Forms */ label { display:block; width:auto; margin-top:8px; font-weight:bold; } .mergeRow { padding:0 0 6px 0 !important; clear:both; } .field-group { position:relative; margin:3px 0 12px 0; overflow:hidden; background:transparent !important; } .mergeRow-radio .field-group, .mergeRow-interests-checkboxes .field-group {margin-bottom:6px;} input, textarea, select { display:block; margin:0; padding:10px; background:#fff; width:100%; border:2px solid #d0d0d0 !important; border-radius:3px; -webkit-appearance: none; } .field-group input, select, textarea, .dijitInputField { font-size: 14px; } .field-group.error > input, .field-group.error > select, .field-group.error .addressfield input.empty, .field-group.error .birthdayfield, .field-group.error .subfields, .field-group.error .datefield .dijitInputInner, .datefield .dijitTextBoxError .dijitInputInner, .field-group.error textarea { border-color:#e85c41 !important; } textarea { font:14px/18px 'Helvetica', Arial, sans-serif; width:100%; height:150px; overflow:auto; } select { background:#fff url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat right -295px; background:#fff url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat right -295px, -webkit-gradient(linear, left top, left bottom, from(#fff), to(#f1f1f1)); background:#fff url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat right -295px, -webkit-linear-gradient(top, #fff, #f1f1f1); background:#fff url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat right -295px, -ms-linear-gradient(top, #fff, #f1f1f1); background:#fff url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat right -295px, linear-gradient(to bottom, #fff, #f1f1f1); } html[dir="rtl"] select {background-position:14px -295px;} /* Firefox always displays native select arrow button, so hide the background image arrow. */ @-moz-document url-prefix() { select { padding: 8px; background-position: -99px 0 !important; -moz-appearance: none; } } input:focus, textarea:focus, select:focus, .focused-field .subfields { border-color:#5d5d5d !important; outline:none; } /* Prevent Chrome's autofill yellow box shadow */ input:-webkit-autofill { -webkit-box-shadow: 0 0 0 1000px white inset !important; } .field-help { display:block; font-weight:normal; position:static; float:none; clear:both; margin:0; padding:0; max-height:0; overflow:hidden; -webkit-transition: all .25s; -moz-transition: all .25s; -ms-transition: all .25s; transition: all .25s; } .focused-field .field-help, input:focus + .field-help { display:block; padding:10px 0; max-height:100px; } .field-help .help { min-height:16px; text-decoration: none; } /* Error container */ .feedback { padding:10px 0; line-height:16px; font-size:14px; } .feedback br {display:none;} .feedback div { font:14px/20px 'Helvetica', Arial, sans-serif !important; padding:0 !important; margin:0 !important; } .indicates-required {text-align:right;} .indicates-required span { font-size:150%; font-weight:bold; display:inline !important; } .formstatus { margin-bottom:12px; font-size:18px; } .alert { background:#e4f3d4; border:2px solid #5ca000; font-size:14px; color:#4e7e0e !important; margin:10px 0; padding:10px; } /* Groups, checkboxes, radio buttons */ ul.interestgroup_field, ul.interestgroup_field li, ul.unsub-options, ul.unsub-options li, .interestgroup_row { display:block; padding:0; margin:0; list-style:none; } label.checkbox, label.radio { font-weight:normal; position:relative; line-height:24px; } .checkbox input, .radio input { width:auto !important; display:inline-block; margin-right:5px; padding:0; border:none; background-color:transparent; } /* Address blocks */ .addressfield span {display:block; margin:3px 0 15px 0;} .addressfield label {display:none;} .cityfield {width:35%; float:left; padding-right:12px;} .statefield {width:30%; float:left; padding-right:12px;} .zipfield {width:35%; float:left;} .countryfield {clear:both;} /* Date picker */ .dijitCalendarPopup {position:absolute;} .dijitComboBox.dijitDateTextBox .dijitArrowButtonContainer { cursor:pointer; position:absolute; top:3px; right:2px; background:url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat 10px -235px; height:34px; width:42px; opacity:.5; padding:0 5px; } .dijitComboBox.dijitDateTextBox .dijitArrowButtonContainer input {visibility:hidden;} .dijitComboBox.dijitDateTextBox .dijitArrowButtonContainer:hover {opacity:1;} .dijitValidationContainer {display:none;} /* Input placeholder color */ .dijitPlaceHolder {position:absolute; top:10px; left:10px; color:#ababab !important; font-weight:normal;} ::-webkit-input-placeholder {color:#ababab;} :-moz-placeholder {color:#ababab; opacity:1;} ::-moz-placeholder {color:#ababab; opacity:1;} :-ms-input-placeholder {color:#ababab;} html[dir="rtl"] .dijitComboBox.dijitDateTextBox .dijitArrowButtonContainer {left:6px; right:auto;} html[dir="rtl"] .dijitPlaceHolder {left:auto; right:10px;} /* Birthday & US phone field */ .subfields { display:block; margin:0; padding:8px 10px; background:#fff; width:100%; border:2px solid #d0d0d0; border-radius:3px; color:#d0d0d0 } .subfields input { display:inline-block; margin:0; padding:0; width:2.5em; border:none !important; text-align:center; } .subfields label {display:none;} .phonedetail2 input {width:3.4em;} .birthdayfield input {width:1.7em;} /* Forward to friend */ .captcha { float:left; width:320px; margin-right:20px; min-height:150px; } .captcha input {display:inline;} /* Archive list */ #archive-list { display:block; margin:15px 0; padding:0; border-top:1px solid #eee; } #archive-list li { display:block; list-style:none; margin:0; padding:6px 10px; border-bottom:1px solid #eee; } .borderbox, .field-help, input, textarea, select { -moz-box-sizing: border-box; -webkit-box-sizing: border-box; box-sizing: border-box; } .field-shift { left: -9999px; position: absolute; } html[dir="rtl"] .field-shift { right: -9999px; left: auto; } /* Image replacement for checkbox and radio buttons. */ /* Placing in @media block forces browsers that don't support :checked to fall back to native inputs. */ @media only screen { .mergeRow-radio .field-group, .mergeRow-interests-checkboxes .field-group {margin:0 -6px 11px -6px;} .checkbox, .radio { margin:9px 0 0 0; padding:0; } /* Position and hide the real checkboxes and radio buttons */ .checkbox input, .radio input { position:absolute; width:24px; height:24px; overflow:hidden; margin:0; padding:0; outline:0; opacity:0; } .checkbox input + span, .radio input + span { display:block; border-radius:3px; padding:6px 6px 6px 38px; } .checkbox:hover span, .checkbox input:focus + span, .radio:hover span, .radio input:focus + span { background:rgba(0,0,0,.05); } /* Insert a pseudo element inside each label with a background sprite. */ .checkbox input + span:before, .radio input + span:before { display:block; position:absolute; top:6px; left:6px; width:24px; height:24px; background:url('https://cdn-images.mailchimp.com/product/icons/signup-sprite.png') no-repeat; content:" "; vertical-align:top; } /* Position the background sprite based on state of checkbox/radio. */ .radio input:focus + span:before { background-position:0 -30px; } .radio input:checked + span:before { background-position:0 -60px; } .radio input:checked:focus + span:before { background-position:-0 -90px; } .checkbox input + span:before { background-position:0 -120px; } .checkbox input:focus + span:before { background-position:0 -150px; } .checkbox input:checked + span:before { background-position:0 -180px; } .checkbox input:checked:focus + span:before { background-position:0 -210px; } /* Right-to-left checkbox/radio modifications */ html[dir="rtl"] .checkbox input + span:before, html[dir="rtl"] .radio input + span:before {left:auto; right:0;} html[dir="rtl"] .checkbox input + span, html[dir="rtl"] .radio input + span {padding:6px 38px 6px 6px;} } /* Use high-res sprite for retina displays */ @media (-webkit-min-device-pixel-ratio: 1.5),(min-resolution: 1.5dppx) { .checkbox input + span:before, .radio input + span:before, .calendar-icon { background-image:url('https://cdn-images.mailchimp.com/product/icons/signup-sprite-2x.png'); background-size: 24px; } } /* IE6 and 7 overrides */ .ie-lte7 .field-group input, .ie-lte7 .subfields {width:535px;} .ie-lte7 .cityfield input {width:170px;} .ie-lte7 .statefield input {width:121px;} .ie-lte7 .zipfield input {width:170px;} .ie-lte7 .subfields input {width:40px;} .ie-lte7 .hidden-from-view {display:none;} .ie-lte7 select { display:inline-block; width:560px; } /* IE doesn't support input placeholders until v10, show labels on addresses */ .ie-lte7 .addressfield label, .ie-lte9 .addressfield label {display:block; font-weight:normal; font-size:14px;} /* Dijit styles for date picker */ .dijitPopup .dijitReset{margin:0;border:0;padding:0;font:inherit;line-height:normal;color:inherit;font-family:"Helvetica Neue",Helvetica,Arial,Verdana,sans-serif} .dijitPopup .dj_a11y .dijitReset{-moz-appearance:none;} .dijitPopup .dijitInline{display:inline-block;border:0;padding:0;vertical-align:middle} .dijitPopup .dijitInline{display:inline-table;box-sizing:content-box;-moz-box-sizing:content-box} .dijitPopup .dijitHidden{display:none !important} .dijitPopup .dijitVisible{display:block !important;position:relative;} .dijitPopup .dijitInputContainer{overflow:hidden;float:none !important;position:relative} .dijitPopup .dj_ie .dijitSelect input, .dijitPopup .dj_ie input.dijitTextBox, .dijitPopup .dj_ie .dijitTextBox input{font-size:100%} .dijitPopup .dijitSelect .dijitButtonText{float:left;vertical-align:top} .dijitPopup .dijitSelect{padding:0 !important;} .dijitPopup .dijitTextBox .dijitSpinnerButtonContainer, .dijitPopup .dijitTextBox .dijitArrowButtonContainer, .dijitPopup .dijitValidationTextBox .dijitValidationContainer{float:right;text-align:center} .dijitPopup .dijitSelect input.dijitInputField, .dijitPopup .dijitTextBox input.dijitInputField{padding-left:0 !important;padding-right:0 !important} .dijitPopup .dijitValidationTextBox .dijitValidationContainer{display:none} .dijitPopup .dijitTeeny{font-size:1px;line-height:1px} .dijitPopup .dijitOffScreen{position:absolute !important;left:50% !important;top:-10000px !important} .dijitPopup .dijitPositionOnly{padding:0 !important;border:0 !important;background-color:transparent !important;background-image:none !important;height:auto !important;width:auto !important} .dijitPopup .dijitNonPositionOnly{float:none !important;position:static !important;margin:0 0 0 0 !important;vertical-align:middle !important} .dijitPopup .dijitBackgroundIframe{position:absolute;left:0;top:0;width:100%;height:100%;z-index:-1;border:0;padding:0;margin:0} .dijitPopup .dijitDisplayNone{display:none !important} .dijitPopup .dijitContainer{overflow:hidden;} .dijitPopup{position:absolute;background-color:transparent;margin:0;border:0;padding:0} .dijitPopup{-webkit-box-shadow:0 6px 6px 1px rgba(0, 0, 0, 0.1);box-shadow:0 6px 6px 1px rgba(0, 0, 0, 0.1);border-radius:6px} @media screen and (max-width:40em){ .dijitPopup{width:96% !important;left:50% !important;margin:0 auto 0 -48%} } .dijitPopup .dijitMenuTable{width:100% !important} .dijitMenu{border:1px solid #000;background-color:#fff} .dijitMenuTable{border-collapse:collapse;border-width:0;background-color:#fff} .dj_webkit .dijitMenuTable td[colspan="2"]{border-right:hidden} .dijitMenuItem{text-align:left;white-space:nowrap;padding:.1em .2em;cursor:pointer} .dijitMenuItem:focus{outline:none} .dijitMenuItemIcon, .dijitMenuExpand{background-repeat:no-repeat} .dijitMenuItemDisabled *{opacity:.5;cursor:default} .dj_ie .dj_a11y .dijitMenuItemDisabled, .dj_ie .dj_a11y .dijitMenuItemDisabled *, .dj_ie .dijitMenuItemDisabled *{color:#808080;filter:alpha(opacity=35)} .dijitMenuItemLabel{position:relative;vertical-align:middle} .dj_a11y .dijitMenuItemSelected{border:1px dotted #000 !important;} .dj_ff3 .dj_a11y .dijitMenuItem td{padding:0 !important;background:none !important} .dj_a11y .dijitMenuItemSelected .dijitMenuItemLabel{border-width:1px;border-style:solid} .dj_ie8 .dj_a11y .dijitMenuItemLabel{position:static} .dijitMenuExpandA11y{display:none} .dj_a11y .dijitMenuExpandA11y{display:inline} .dijitMenuSeparator td{border:0;padding:0} .dijitMenuSeparatorTop{height:50%;margin:0;margin-top:3px;font-size:1px} .dijitMenuSeparatorBottom{height:50%;margin:0;margin-bottom:3px;font-size:1px} .dijitCheckedMenuItemIconChar{vertical-align:middle;visibility:hidden} .dijitCheckedMenuItemChecked .dijitCheckedMenuItemIconChar{visibility:visible} .dj_a11y .dijitCheckedMenuItemIconChar{display:inline !important} .dj_a11y .dijitCheckedMenuItemIcon{display:none} .dj_ie .dj_a11y .dijitMenuBar .dijitMenuItem{margin:0} .dijitCalendarContainer{width:auto;} .dijitCalendarContainer th, .dijitCalendarContainer td{padding:0;vertical-align:middle} .dijitCalendarYearLabel{white-space:nowrap;} .dijitCalendarNextYear{margin:0 0 0 .55em} .dijitCalendarPreviousYear{margin:0 .55em 0 0} .dijitCalendarIncrementControl{vertical-align:middle} .dijitCalendarIncrementControl, .dijitCalendarDateTemplate, .dijitCalendarMonthLabel, .dijitCalendarPreviousYear, .dijitCalendarNextYear{cursor:pointer} .dijitCalendarDisabledDate{color:#808080;text-decoration:line-through;cursor:default} .dijitSpacer{position:relative;height:1px;overflow:hidden;visibility:hidden} .dijitCalendarMonthMenu .dijitCalendarMonthLabel{text-align:center} .dijitCalendar{border:solid 1px #cfcfcf;background-color:#fff;text-align:center;padding:18px;border-radius:6px;border-collapse:separate} .dijitCalendar img{border:none} .dijitCalendarMonthContainer th{text-align:center;vertical-align:middle} .dijitCalendarMonthLabel{color:#595959;font-size:.9375em;font-weight:bold;padding:6px 12px} .dijitA11ySideArrow{display:none} .dijitCalendarArrow{cursor:pointer;border:1px solid transparent;position:relative;} .dijitCalendarArrow img {display:none;} .dijitCalendarArrow:hover{background-color:#f2f2f2;border-color:#d0d0d0} .dijitCalendarArrow:after{content:" "; width:0; height:0; border:6px solid transparent; border-left:6px solid #333; display:block; position:absolute; top:25%; left:45%} .dijitCalendarArrow:first-child:before{content:" "; width:0; height:0; border:6px solid transparent; border-right:6px solid #333; display:block; position:absolute; top:25%; left:45%} .dijitCalendarArrow:first-child:after{border:none;} .dijitCalendarCurrentDate {background:#eee;} .dijitCalendarDayLabelTemplate{text-align:center;font-weight:bold;padding:8px 12px} .dijitCalendarDayLabel{font-weight:bold;font-size:.9375em;text-align:center;color:#595959} .dijitCalendarDateTemplate{border-bottom:0 none;font-size:.9375em;font-weight:500;letter-spacing:.05em;text-align:center;color:#595959} .dijitCalendarPreviousMonth, .dijitCalendarNextMonth{border-bottom:0 none} .dijitCalendarDateTemplate .dijitCalendarDateLabel{text-decoration:none;display:block;padding:6px 10px;border:1px solid transparent;-webkit-transition-property:background-color,border;-ms-transition-property:background-color,border;transition-property:background-color,border;-webkit-transition-duration:.35s;-ms-transition-duration:.35s;transition-duration:.35s} .dijitCalendarPreviousMonth .dijitCalendarDateLabel, .dijitCalendarNextMonth .dijitCalendarDateLabel{color:#ababab;border-color:#fff;} .dijitCalendarYearContainer{vertical-align:middle} .dijitCalendarYearControl{padding:1px 2px 2px 2px} .dijitCalendarYearLabel{padding:8px 0 0;margin:0;font-size:.9375em} .dijitCalendarYearLabel span{vertical-align:middle} .dijitCalendarSelectedYear{padding:0 6px;font-size:.9375em;color:#52bad5} .dijitCalendarNextYear, .dijitCalendarPreviousYear{font-size:.9375em;border:1px solid transparent;padding:6px 12px} .dijitCalendarHoveredDate .dijitCalendarDateLabel, .dijitCalendarEnabledDate:hover .dijitCalendarDateLabel{background-color:#b1e0ec;border:solid 1px #52bad5;color:#595959;-webkit-transition-duration:.2s;-ms-transition-duration:.2s;transition-duration:.2s} .dijitCalendarNextYearHover, .dijitCalendarNextYear:hover, .dijitCalendarPreviousYearHover, .dijitCalendarPreviousYear:hover{color:#595959;background-color:#f2f2f2;border-color:#d0d0d0} .dijitCalendarNextYearActive, .dijitCalendarNextYear:active .dijitCalendarPreviousYearActive, .dijitCalendarPreviousYear:active{background-color:#c7c7c7} .dijitCalendarActiveDate .dijitCalendarDateLabel, .dijitCalendarEnabledDate:active .dijitCalendarDateLabel{border:solid 1px #fff;-webkit-transition-duration:.1s;-ms-transition-duration:.1s;transition-duration:.1s} .dijitCalendarSelectedDate .dijitCalendarDateLabel{color:#595959;background-color:#b1e0ec;border:solid 1px #52bad5} .dijitCalendarDisabledDate .dijitCalendarDateLabel{color:#808080;text-decoration:line-through} .dijitCalendar .dijitDropDownButton{margin:0;background-color:transparent} .dijitCalendar .dijitDropDownButtonHover .dijitButtonNode, .dijitCalendar .dijitDropDownButton:hover .dijitButtonNode{background-color:transparent;border:0 none} .dijitCalendarMonthMenu{border-color:#ababab;background-color:#fff;text-align:center;background-image:none} .dijitCalendarMonthMenu .dijitCalendarMonthLabel{border-top:solid 1px transparent;border-bottom:solid 1px transparent} .dijitCalendarMonthMenu .dijitCalendarMonthLabelHover, .dijitCalendarMonthMenu .dijitCalendarMonthLabel:hover{background-color:#b1e0ec;border-color:#52bad5;border-width:1px 0} .dijitTooltip{display:none !important;} </style> <style type="text/css"> body{ font:14px/20px 'Helvetica', Arial, sans-serif; margin:0; padding:75px 0 0 0; text-align:center; -webkit-text-size-adjust:none; } p{ padding:0 0 10px 0; } h1 img{ max-width:100%; height:auto !important; vertical-align:bottom; } h2{ font-size:22px; line-height:28px; margin:0 0 12px 0; } h3{ margin:0 0 12px 0; } .headerBar{ background:none; padding:0; border:none; } .wrapper{ width:600px; margin:0 auto 10px auto; text-align:left; } input.formEmailButton{ border:none !important; } .formEmailButton{ display:inline-block; font-weight:500; font-size:16px; line-height:42px; font-family:'Helvetica', Arial, sans-serif; width:auto; white-space:nowrap; height:42px; margin:12px 5px 12px 0; padding:0 22px; text-decoration:none; text-align:center; cursor:pointer; border:0; border-radius:3px; vertical-align:top; } .formEmailButton span{ display:inline; font-family:'Helvetica', Arial, sans-serif; text-decoration:none; font-weight:500; font-style:normal; font-size:16px; line-height:42px; cursor:pointer; border:none; } .rounded6{ border-radius:6px; } .poweredWrapper{ padding:20px 0; width:560px; margin:0 auto; } .poweredBy{ display:block; } span.or{ display:inline-block; height:32px; line-height:32px; padding:0 5px; margin:5px 5px 0 0; } .clear{ clear:both; } .profile-list{ display:block; margin:15px 20px; padding:0; list-style:none; border-top:1px solid #eee; } .profile-list li{ display:block; margin:0; padding:5px 0; border-bottom:1px solid #eee; } html[dir=rtl] .wrapper,html[dir=rtl] .container,html[dir=rtl] label{ text-align:right !important; } html[dir=rtl] ul.interestgroup_field label{ padding:0; } html[dir=rtl] ul.interestgroup_field input{ margin-left:5px; } html[dir=rtl] .hidden-from-view{ right:-5000px; left:auto; } body,#bodyTable{ background-color:#eeeeee; } h1{ font-size:28px; line-height:110%; margin-bottom:30px; margin-top:0; padding:0; } #templateContainer{ background-color:none; } #templateBody{ background-color:#ffffff; box-shadow:0 6px 12px 0 #0d12161f; } .bodyContent{ line-height:150%; font-family:Helvetica; font-size:14px; color:#333333; padding:20px; } a:link,a:active,a:visited,a{ color:#336699; } .formEmailButton:link,.formEmailButton:active,.formEmailButton:visited,.formEmailButton,.formEmailButton span{ background-color:#5d5d5d !important; color:#ffffff !important; } .formEmailButton:hover{ background-color:#444444 !important; color:#ffffff 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member profiles cannot be updated from test campaigns or archive pages </div> <p></p> <h2>Change Your Preferences</h2> <div class="indicates-required"> <span class="asterisk">*</span> indicates required </div> <form action="https://COM.us14.list-manage.com/profile/post" method="POST" id="subprefs-form"><input type="hidden" name="u" value="d29ddfd8fe8b89acdb7fbf59d"> <input type="hidden" name="id" value="f0a9bdccda"> <input type="hidden" name="e" value="*|UNIQID|*"> <label for="MERGE0">Email Address <span class="req asterisk">*</span></label> <div class="field-group"><input type="email" autocapitalize="off" autocorrect="off" name="MERGE0" id="MERGE0" size="25" value=""> </div><label for="MERGE10">Title</label> <div class="field-group"><input type="text" name="MERGE10" id="MERGE10" size="25" value=""> </div><label for="MERGE1">FirstName <span class="req asterisk">*</span></label> <div class="field-group"><input type="text" name="MERGE1" id="MERGE1" size="25" value=""> </div><label for="MERGE2">LastName <span class="req asterisk">*</span></label> <div class="field-group"><input type="text" name="MERGE2" id="MERGE2" size="25" value=""> </div><label for="MERGE4">Job Title</label> <div class="field-group"><input type="text" name="MERGE4" id="MERGE4" size="25" value=""> </div><label for="MERGE9">Organisation Name</label> <div class="field-group"><input type="text" name="MERGE9" id="MERGE9" size="25" value=""> </div><label for="MERGE3">Address</label> <div class="field-group"> <div class="field-wrapper"> <div class="addressfield"><span class="subfield addr1field"> <label for="MERGE3-addr1">Street Address</label> <input type="text" id="MERGE3-addr1" name="MERGE3[addr1]" maxlength="70" value="" placeholder="Street Address" class="av-text"> </span> <span class="subfield addr2field"> <label for="MERGE3-addr2">Address Line 2</label> <input type="text" id="MERGE3-addr2" name="MERGE3[addr2]" maxlength="70" value="" placeholder="Address Line 2" class="av-text"> </span> <span class="subfield cityfield borderbox"> <label for="MERGE3-city">City</label> <input type="text" id="MERGE3-city" name="MERGE3[city]" maxlength="40" value="" placeholder="City" class="av-text"> </span> <span class="subfield statefield borderbox"> <label for="MERGE3-state">State/Prov/Region</label> <input type="text" id="MERGE3-state" name="MERGE3[state]" maxlength="20" value="" placeholder="State/Prov/Region" class="av-text"> </span> <span class="subfield zipfield borderbox"> <label for="MERGE3-zip">Postal/Zip</label> <input type="text" id="MERGE3-zip" name="MERGE3[zip]" maxlength="10" value="" placeholder="Postal/Zip" class="av-text"> </span> <span class="subfield countryfield"> <label for="MERGE3-country">Country</label> <select class="select-small" id="MERGE3-country" name="MERGE3[country]"> <option value="164" selected>USA</option><option value="286">Aaland Islands</option><option value="274">Afghanistan</option><option value="2">Albania</option><option value="3">Algeria</option><option value="178">American Samoa</option><option value="4">Andorra</option><option value="5">Angola</option><option value="176">Anguilla</option><option value="175">Antigua And Barbuda</option><option value="6">Argentina</option><option value="7">Armenia</option><option value="179">Aruba</option><option value="8">Australia</option><option value="9">Austria</option><option value="10">Azerbaijan</option><option value="11">Bahamas</option><option value="12">Bahrain</option><option value="13">Bangladesh</option><option value="14">Barbados</option><option value="15">Belarus</option><option value="16">Belgium</option><option value="17">Belize</option><option value="18">Benin</option><option value="19">Bermuda</option><option value="20">Bhutan</option><option value="21">Bolivia</option><option value="325">Bonaire, Saint Eustatius and Saba</option><option value="22">Bosnia and Herzegovina</option><option value="23">Botswana</option><option value="181">Bouvet Island</option><option value="24">Brazil</option><option value="180">Brunei Darussalam</option><option value="25">Bulgaria</option><option value="26">Burkina Faso</option><option value="27">Burundi</option><option value="28">Cambodia</option><option value="29">Cameroon</option><option value="30">Canada</option><option value="31">Cape Verde</option><option value="32">Cayman Islands</option><option value="33">Central African Republic</option><option value="34">Chad</option><option value="35">Chile</option><option value="36">China</option><option value="185">Christmas Island</option><option value="37">Colombia</option><option value="204">Comoros</option><option value="38">Congo</option><option value="318">Congo, Democratic Republic of the</option><option value="183">Cook Islands</option><option value="268">Costa Rica</option><option value="275">Cote D'Ivoire</option><option value="40">Croatia</option><option value="298">Curacao</option><option value="41">Cyprus</option><option value="42">Czech Republic</option><option value="43">Denmark</option><option value="44">Djibouti</option><option value="289">Dominica</option><option value="187">Dominican Republic</option><option value="45">Ecuador</option><option value="46">Egypt</option><option value="47">El Salvador</option><option value="48">Equatorial Guinea</option><option value="49">Eritrea</option><option value="50">Estonia</option><option value="51">Ethiopia</option><option value="189">Falkland Islands</option><option value="191">Faroe Islands</option><option value="52">Fiji</option><option value="53">Finland</option><option value="54">France</option><option value="193">French Guiana</option><option value="277">French Polynesia</option><option value="56">Gabon</option><option value="57">Gambia</option><option value="58">Georgia</option><option value="59">Germany</option><option value="60">Ghana</option><option value="194">Gibraltar</option><option value="61">Greece</option><option value="195">Greenland</option><option value="192">Grenada</option><option value="196">Guadeloupe</option><option value="62">Guam</option><option value="198">Guatemala</option><option value="270">Guernsey</option><option value="63">Guinea</option><option value="64">Guinea-Bissau</option><option value="65">Guyana</option><option value="200">Haiti</option><option value="66">Honduras</option><option value="67">Hong Kong</option><option value="68">Hungary</option><option value="69">Iceland</option><option value="70">India</option><option value="71">Indonesia</option><option value="279">Iraq</option><option value="74">Ireland</option><option value="323">Isle of Man</option><option value="75">Israel</option><option value="76">Italy</option><option value="202">Jamaica</option><option value="78">Japan</option><option value="288">Jersey (Channel Islands)</option><option value="79">Jordan</option><option value="80">Kazakhstan</option><option value="81">Kenya</option><option value="203">Kiribati</option><option value="82">Kuwait</option><option value="83">Kyrgyzstan</option><option value="84">Lao People's Democratic Republic</option><option value="85">Latvia</option><option value="86">Lebanon</option><option value="87">Lesotho</option><option value="88">Liberia</option><option value="281">Libya</option><option value="90">Liechtenstein</option><option value="91">Lithuania</option><option value="92">Luxembourg</option><option value="208">Macau</option><option value="93">Macedonia</option><option value="94">Madagascar</option><option value="95">Malawi</option><option value="96">Malaysia</option><option value="97">Maldives</option><option value="98">Mali</option><option value="99">Malta</option><option value="207">Marshall Islands</option><option value="210">Martinique</option><option value="100">Mauritania</option><option value="212">Mauritius</option><option value="241">Mayotte</option><option value="101">Mexico</option><option value="102">Moldova, Republic of</option><option value="103">Monaco</option><option value="104">Mongolia</option><option value="290">Montenegro</option><option value="294">Montserrat</option><option value="105">Morocco</option><option value="106">Mozambique</option><option value="242">Myanmar</option><option value="107">Namibia</option><option value="215">Nauru</option><option value="108">Nepal</option><option value="109">Netherlands</option><option value="110">Netherlands Antilles</option><option value="213">New Caledonia</option><option value="111">New Zealand</option><option value="112">Nicaragua</option><option value="113">Niger</option><option value="114">Nigeria</option><option value="217">Niue</option><option value="214">Norfolk Island</option><option value="116">Norway</option><option value="117">Oman</option><option value="118">Pakistan</option><option value="222">Palau</option><option value="282">Palestine</option><option value="119">Panama</option><option value="219">Papua New Guinea</option><option value="120">Paraguay</option><option value="121">Peru</option><option value="122">Philippines</option><option value="221">Pitcairn</option><option value="123">Poland</option><option value="124">Portugal</option><option value="126">Qatar</option><option value="315">Republic of Kosovo</option><option value="127">Reunion</option><option value="128">Romania</option><option value="130">Rwanda</option><option value="205">Saint Kitts and Nevis</option><option value="206">Saint Lucia</option><option value="324">Saint Martin</option><option value="237">Saint Vincent and the Grenadines</option><option value="132">Samoa (Independent)</option><option value="227">San Marino</option><option value="255">Sao Tome and Principe</option><option value="133">Saudi Arabia</option><option value="134">Senegal</option><option value="326">Serbia</option><option value="135">Seychelles</option><option value="136">Sierra Leone</option><option value="137">Singapore</option><option value="302">Sint Maarten</option><option value="138">Slovakia</option><option value="139">Slovenia</option><option value="223">Solomon Islands</option><option value="140">Somalia</option><option value="141">South Africa</option><option value="257">South Georgia and the South Sandwich Islands</option><option value="142">South Korea</option><option value="311">South Sudan</option><option value="143">Spain</option><option value="144">Sri Lanka</option><option value="293">Sudan</option><option value="146">Suriname</option><option value="225">Svalbard and Jan Mayen Islands</option><option value="147">Swaziland</option><option value="148">Sweden</option><option value="149">Switzerland</option><option value="152">Taiwan</option><option value="260">Tajikistan</option><option value="153">Tanzania</option><option value="154">Thailand</option><option value="233">Timor-Leste</option><option value="155">Togo</option><option value="232">Tonga</option><option value="234">Trinidad and Tobago</option><option value="156">Tunisia</option><option value="157">Turkiye</option><option value="158">Turkmenistan</option><option value="287">Turks & Caicos Islands</option><option value="235">Tuvalu</option><option value="159">Uganda</option><option value="161">Ukraine</option><option value="162">United Arab Emirates</option><option value="262">United Kingdom</option><option value="163">Uruguay</option><option value="165">Uzbekistan</option><option value="239">Vanuatu</option><option value="166">Vatican City State (Holy See)</option><option value="167">Venezuela</option><option value="168">Vietnam</option><option value="169">Virgin Islands (British)</option><option value="238">Virgin Islands (U.S.)</option><option value="188">Western Sahara</option><option value="170">Yemen</option><option value="173">Zambia</option><option value="174">Zimbabwe</option> </select> </span> </div> </div> </div><label for="MERGE12">ID SHARE Community Member</label> <div class="field-group"><input type="text" 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