{"id":911,"date":"2024-07-29T09:48:32","date_gmt":"2024-07-29T09:48:32","guid":{"rendered":"https:\/\/demo.iccbrossardmosque.com\/?page_id=911"},"modified":"2024-10-02T03:14:00","modified_gmt":"2024-10-02T03:14:00","slug":"membership-form-3","status":"publish","type":"page","link":"https:\/\/www.cdsbalimaya.org\/en\/membership-form-3\/","title":{"rendered":"Registration form for CDS Balimaya activities 3"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"911\" class=\"elementor elementor-911\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3c03617 elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"3c03617\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-01b9f73\" data-id=\"01b9f73\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b5244d1 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"b5244d1\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;,&quot;_animation_delay&quot;:300}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Registration form for CDS Balimaya solidarity fund<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f02bcc1 envato-kit-174-form-btn-style elementor-button-align-start elementor-invisible elementor-widget elementor-widget-form\" data-id=\"f02bcc1\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;,&quot;_animation_delay&quot;:400,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Solidarity Fund\u200b\" aria-label=\"Solidarity Fund\u200b\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"911\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"f02bcc1\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Registration form for CDS Balimaya activities 3\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"911\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-title elementor-col-20 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-title\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\t         Title\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[title]\" id=\"form-field-title\" class=\"elementor-field-textual elementor-size-lg\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Mr.\">Mr.<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mrs.\">Mrs.<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-fname elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fname\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[fname]\" id=\"form-field-fname\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"First Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-lname elementor-col-40 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-lname\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[lname]\" id=\"form-field-lname\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Last Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-gender elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gender\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tman\/ woman\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Man\" id=\"form-field-gender-0\" name=\"form_fields[gender][]\"> <label for=\"form-field-gender-0\">Man<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Woman\" id=\"form-field-gender-1\" name=\"form_fields[gender][]\"> <label for=\"form-field-gender-1\">Woman<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Email Address\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-age elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-age\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[age]\" id=\"form-field-age\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Age\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-people elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-people\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tNumber of people \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[people]\" id=\"form-field-people\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Number of people \" min=\"0\" max=\"6\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-pcare elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-pcare\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tNumber of people \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[pcare]\" id=\"form-field-pcare\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"The number of people in your care.\" min=\"0\" max=\"6\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-address elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-address\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[address]\" id=\"form-field-address\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Address\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-province elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-province\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tProvince\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[province]\" id=\"form-field-province\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Province\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-city elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-city\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[city]\" id=\"form-field-city\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"City\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-zip elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-zip\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[zip]\" id=\"form-field-zip\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Zip Code\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-homePhone elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-homePhone\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tHome Phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[homePhone]\" id=\"form-field-homePhone\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Home Phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-CellPhone elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-CellPhone\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCell Phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[CellPhone]\" id=\"form-field-CellPhone\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Cell Phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-declaration elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-declaration\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tI declare that I wish to become a member of the CDS Balimya community fund\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"I declare that I wish to become a member of the CDS Balimya community fund\" id=\"form-field-declaration-0\" name=\"form_fields[declaration][]\"> <label for=\"form-field-declaration-0\">I declare that I wish to become a member of the CDS Balimya community fund<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"As such, I acknowledge having read the membership conditions and pay the annual fee of $200.00.\" id=\"form-field-declaration-1\" name=\"form_fields[declaration][]\"> <label for=\"form-field-declaration-1\">As such, I acknowledge having read the membership conditions and pay the annual fee of $200.00.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tMessage\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-lg\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"7\" placeholder=\"Message\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha elementor-field-group elementor-column elementor-field-group-field_2ec81a3 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_2ec81a3\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LeNU-IoAAAAAAKBDlbkZbL1_V5J68Jku2Y5wkFi\" data-type=\"v2_checkbox\" data-theme=\"light\" data-size=\"normal\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-lg elementor-animation-bob\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<i class=\"fa fa-long-arrow-right\" aria-hidden=\"true\"><\/i>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">submitt Your Membership<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Registration form for CDS Balimaya solidarity fund<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-911","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/pages\/911"}],"collection":[{"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/comments?post=911"}],"version-history":[{"count":37,"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/pages\/911\/revisions"}],"predecessor-version":[{"id":4600,"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/pages\/911\/revisions\/4600"}],"wp:attachment":[{"href":"https:\/\/www.cdsbalimaya.org\/en\/wp-json\/wp\/v2\/media?parent=911"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}