{"id":4663,"date":"2023-12-14T00:39:49","date_gmt":"2023-12-14T00:39:49","guid":{"rendered":"https:\/\/amieuvic.net\/?page_id=4663"},"modified":"2024-06-24T09:38:10","modified_gmt":"2024-06-23T23:38:10","slug":"join","status":"publish","type":"page","link":"https:\/\/amieuvic.net\/zh\/join\/","title":{"rendered":"Join"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h4><strong>Please fill in the below details to assist us with your membership application.<\/strong><\/h4>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><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_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_3' ><style>#gform_wrapper_3[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/zh\/wp-json\/wp\/v2\/pages\/4663' data-formid='3' novalidate data-trp-original-action=\"\/zh\/wp-json\/wp\/v2\/pages\/4663\">\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_3_26\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_3_26' class='gfield_label gform-field-label' for='input_3_26'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='ginput_container'><input name='input_26' id='input_3_26' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_3_26'>\u8fd9\u4e2a\u5b57\u6bb5\u662f\u7528\u4e8e\u9a8c\u8bc1\u76ee\u7684\uff0c\u5e94\u8be5\u4fdd\u6301\u4e0d\u53d8\u3002<\/div><\/div><fieldset id=\"field_3_7\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"9f4fa024\" data-field-span=\"12\"><legend id='gfield_label_3_7' 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_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_7'>\n                            \n                            <span id='input_3_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_3_7_3' value=''   aria-required='true'   placeholder='First Name'  aria-labelledby=\"input_3_7_3_label gfield_label_3_7\"\/>\n                                                    <label for='input_3_7_3' id='input_3_7_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u7b2c\u4e00\u9875<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_3_7_6' value=''   aria-required='true'   placeholder='Surname'  \/>\n                                                    <label for='input_3_7_6' id='input_3_7_6_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u540e\u4e00\u9875<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"e7b81d03\" data-field-span=\"6\"><label id='gfield_label_3_3' class='gfield_label gform-field-label' for='input_3_3'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_3_3' type='email' value='' class='large'   placeholder='Email' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_11\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"e7b81d03\" data-field-span=\"6\"><label id='gfield_label_3_11' class='gfield_label gform-field-label' for='input_3_11'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_3_11' type='tel' value='' class='large'  placeholder='Phone Number' aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><fieldset id=\"field_3_14\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"203c8e0f\" data-field-span=\"12\"><legend id='gfield_label_3_14' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_14' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_14_1_container' >\n                                        <input type='text' name='input_14.1' id='input_3_14_1' value=''   placeholder='Street Address' aria-required='true'    aria-labelledby=\"input_3_14_1_label gfield_label_3_14\"\/>\n                                        <label for='input_3_14_1' id='input_3_14_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u8857\u9053\u5730\u5740<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_14_3_container' >\n                                    <input type='text' name='input_14.3' id='input_3_14_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_3_14_3' id='input_3_14_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u5e02<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_14_4_container' >\n                                        <input type='text' name='input_14.4' id='input_3_14_4' value=''     placeholder='State' aria-required='true'    \/>\n                                        <label for='input_3_14_4' id='input_3_14_4_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u5dde\/\u7701\/\u5730\u533a<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_14_5_container' >\n                                    <input type='text' name='input_14.5' id='input_3_14_5' value=''   placeholder='Post Code' aria-required='true'    \/>\n                                    <label for='input_3_14_5' id='input_3_14_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u90ae\u7f16\/\u90ae\u653f\u7f16\u7801<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_14_6_container' >\n                                        <select name='input_14.6' id='input_3_14_6'   aria-required='true'    ><option value='' >Country<\/option><option value='MO' >* \u6fb3\u95e8<\/option><option value='AL' >\u963f\u5c14\u5df4\u5c3c\u4e9a<\/option><option value='DZ' >\u963f\u5c14\u53ca\u5229\u4e9a<\/option><option value='AF' >\u963f\u5bcc\u6c57<\/option><option value='AR' >\u963f\u6839\u5ef7<\/option><option value='AE' >\u963f\u8054\u914b<\/option><option value='OM' >\u963f\u66fc<\/option><option value='AZ' >\u963f\u585e\u62dc\u7586<\/option><option value='EG' >\u57c3\u53ca<\/option><option value='ET' >\u57c3\u585e\u4fc4\u6bd4\u4e9a<\/option><option value='IE' >\u7231\u5c14\u5170<\/option><option value='EE' >\u7231\u6c99\u5c3c\u4e9a<\/option><option value='AD' >\u5b89\u9053\u5c14<\/option><option value='AO' >\u5b89\u54e5\u62c9<\/option><option value='AI' >\u5b89\u572d\u62c9\u5c9b<\/option><option value='AG' >\u5b89\u63d0\u74dc\u5c9b\u548c\u5df4\u5e03\u8fbe<\/option><option value='AT' >\u5965\u5730\u5229<\/option><option value='AX' >\u5965\u5170\u7fa4\u5c9b<\/option><option value='AU' selected='selected'>\u6fb3\u6d32<\/option><option value='BB' >\u5df4\u5df4\u591a\u65af<\/option><option value='PG' >\u5df4\u5e03\u4e9a\u65b0\u51e0\u5185\u4e9a<\/option><option value='BS' >\u5df4\u54c8\u9a6c<\/option><option value='PK' >\u5df4\u57fa\u65af\u5766<\/option><option value='PY' >\u5df4\u62c9\u572d<\/option><option value='PS' >\u5df4\u52d2\u65af\u5766\u56fd<\/option><option value='BH' >\u5df4\u6797<\/option><option value='PA' >\u5df4\u62ff\u9a6c<\/option><option value='BR' >\u5df4\u897f<\/option><option value='BY' >\u767d\u4fc4\u7f57\u65af<\/option><option value='BM' >\u767e\u6155\u5927<\/option><option value='BG' >\u4fdd\u52a0\u5229\u4e9a<\/option><option value='MP' >\u5317\u9a6c\u91cc\u4e9a\u7eb3\u7fa4\u5c9b<\/option><option value='MK' >\u5317\u9a6c\u5176\u987f<\/option><option value='BJ' >\u8d1d\u5b81<\/option><option value='BE' >\u6bd4\u5229\u65f6<\/option><option value='IS' >\u51b0\u5c9b<\/option><option value='PR' >\u6ce2\u591a\u9ece\u5404<\/option><option value='PL' >\u6ce2\u5170<\/option><option value='BA' >\u6ce2\u65af\u5c3c\u4e9a\u548c\u9ed1\u585e\u54e5\u7ef4\u90a3<\/option><option value='BO' >\u73bb\u5229\u7ef4\u4e9a<\/option><option value='BZ' >\u4f2f\u5229\u5179<\/option><option value='BW' >\u535a\u8328\u74e6\u7eb3<\/option><option value='BT' >\u4e0d\u4e39<\/option><option value='BF' >\u5e03\u5409\u7eb3\u6cd5\u7d22<\/option><option value='BI' >\u5e03\u9686\u8fea<\/option><option value='BV' >\u5e03\u7ef4\u5c9b<\/option><option value='GQ' >\u8d64\u9053\u51e0\u5185\u4e9a<\/option><option value='DK' >\u4e39\u9ea6<\/option><option value='TL' >\u4e1c\u5e1d\u6c76<\/option><option value='TG' >\u591a\u54e5<\/option><option value='DO' >\u591a\u7c73\u5c3c\u52a0\u5171\u548c\u56fd<\/option><option value='DM' >\u591a\u7c73\u5c3c\u514b<\/option><option value='EC' >\u5384\u74dc\u591a\u5c14<\/option><option value='ER' >\u5384\u7acb\u7279\u91cc\u4e9a<\/option><option value='FR' >\u6cd5\u56fd<\/option><option value='FO' >\u6cd5\u7f57\u7fa4\u5c9b<\/option><option value='PF' >\u6cd5\u5c5e\u6ce2\u5229\u5c3c\u897f\u4e9a<\/option><option value='TF' >\u6cd5\u5c5e\u5357\u90e8\u9886\u571f<\/option><option value='PH' >\u83f2\u5f8b\u5bbe<\/option><option value='FJ' >\u6590\u6d4e<\/option><option value='FI' >\u82ac\u5170<\/option><option value='CV' >\u4f5b\u5f97\u89d2<\/option><option value='GM' >\u5188\u6bd4\u4e9a (\u897f\u975e\u7684\u72ec\u7acb\u56fd)<\/option><option value='CG' >\u521a\u679c<\/option><option value='CD' >\u521a\u679c\u6c11\u4e3b\u5171\u548c\u56fd\u7684<\/option><option value='CO' >\u54e5\u4f26\u6bd4\u4e9a<\/option><option value='CR' >\u54e5\u65af\u8fbe\u9ece\u52a0<\/option><option value='GD' >\u683c\u6797\u7eb3\u8fbe<\/option><option value='GL' >\u683c\u9675\u5170<\/option><option value='GG' >\u6839\u897f\u5c9b<\/option><option value='CU' >\u53e4\u5df4<\/option><option value='GU' >\u5173\u5c9b<\/option><option value='GY' >\u572d\u4e9a\u90a3<\/option><option value='KZ' >\u54c8\u8428\u514b\u65af\u5766<\/option><option value='HT' >\u6d77\u5730<\/option><option value='NL' >\u8377\u5170<\/option><option value='HM' >\u8d6b\u5fb7\u5c9b\u548c\u9ea6\u514b\u5510\u7eb3\u5c9b<\/option><option value='ME' >\u9ed1\u5c71\u5171\u548c\u56fd<\/option><option value='HN' >\u6d2a\u90fd\u62c9\u65af<\/option><option value='KI' >\u57fa\u91cc\u5df4\u65af<\/option><option value='DJ' >\u5409\u5e03\u63d0<\/option><option value='KG' >\u5409\u5c14\u5409\u65af\u65af\u5766<\/option><option value='GN' >\u51e0\u5185\u4e9a<\/option><option value='GW' >\u51e0\u5185\u4e9a\u6bd4\u7ecd<\/option><option value='CA' >\u52a0\u62ff\u5927<\/option><option value='GH' >\u52a0\u7eb3<\/option><option value='GA' >\u52a0\u84ec<\/option><option value='KH' >\u67ec\u57d4\u5be8<\/option><option value='ZW' >\u6d25\u5df4\u5e03\u97e6<\/option><option value='CM' >\u5580\u9ea6\u9686<\/option><option value='QA' >\u5361\u5854\u5c14<\/option><option value='KY' >\u5f00\u66fc\u7fa4\u5c9b<\/option><option value='KM' >\u79d1\u6469\u7f57<\/option><option value='CI' >\u79d1\u7279\u8fea\u74e6<\/option><option value='KW' >\u79d1\u5a01\u7279<\/option><option value='HR' >\u514b\u7f57\u5730\u4e9a<\/option><option value='KE' >\u80af\u5c3c\u4e9a<\/option><option value='CW' >\u5e93\u62c9\u7d22<\/option><option value='LV' >\u62c9\u8131\u7ef4\u4e9a<\/option><option value='LS' >\u83b1\u7d22\u6258<\/option><option value='LB' >\u9ece\u5df4\u5ae9<\/option><option value='LT' >\u7acb\u9676\u5b9b<\/option><option value='LR' >\u5229\u6bd4\u91cc\u4e9a<\/option><option value='LY' >\u5229\u6bd4\u4e9a<\/option><option value='LI' >\u5217\u652f\u6566\u58eb\u767b<\/option><option value='LU' >\u5362\u68ee\u5821<\/option><option value='RW' >\u5362\u65fa\u8fbe<\/option><option value='RO' >\u7f57\u9a6c\u5c3c\u4e9a<\/option><option value='MG' >\u9a6c\u8fbe\u52a0\u65af\u52a0<\/option><option value='IM' >\u9a6c\u6069\u5c9b<\/option><option value='MV' >\u9a6c\u5c14\u4ee3\u592b<\/option><option value='MT' >\u9a6c\u8033\u4ed6<\/option><option value='MW' >\u9a6c\u62c9\u7ef4<\/option><option value='MY' >\u9a6c\u6765\u897f\u4e9a<\/option><option value='ML' >\u9a6c\u91cc<\/option><option value='MH' >\u9a6c\u7ecd\u5c14\u7fa4\u5c9b<\/option><option value='MU' >\u6bdb\u91cc\u6c42\u65af<\/option><option value='MR' >\u6bdb\u91cc\u5854\u5c3c\u4e9a<\/option><option value='US' >\u7f8e\u56fd<\/option><option value='AS' >\u7f8e\u5c5e\u8428\u6469\u4e9a<\/option><option value='BD' >\u5b5f\u52a0\u62c9\u56fd<\/option><option value='PE' >\u79d8\u9c81<\/option><option value='FM' >\u5bc6\u514b\u7f57\u5c3c\u897f\u4e9a<\/option><option value='MD' >\u6469\u5c14\u591a\u74e6<\/option><option value='MA' >\u6469\u6d1b\u54e5<\/option><option value='MC' >\u6469\u7eb3\u54e5<\/option><option value='MZ' >\u83ab\u6851\u6bd4\u514b<\/option><option value='MX' >\u58a8\u897f\u54e5<\/option><option value='NA' >\u7eb3\u7c73\u6bd4\u4e9a<\/option><option value='ZA' >\u5357\u975e<\/option><option value='AQ' >\u5357\u6781\u6d32<\/option><option value='NR' >\u7459\u9c81<\/option><option value='NI' >\u5c3c\u52a0\u62c9\u74dc<\/option><option value='NP' >\u5c3c\u6cca\u5c14<\/option><option value='NE' >\u5c3c\u65e5\u5c14<\/option><option value='NG' >\u5c3c\u65e5\u5229\u4e9a<\/option><option value='NO' >\u632a\u5a01<\/option><option value='PW' >\u5e15\u52b3\u7fa4\u5c9b<\/option><option value='PT' >\u8461\u8404\u7259<\/option><option value='GE' >\u4e54\u6cbb\u4e9a\u5dde<\/option><option value='JP' >\u65e5\u672c<\/option><option value='SE' >\u745e\u5178<\/option><option value='CH' >\u745e\u58eb<\/option><option value='SV' >\u8428\u5c14\u74e6\u591a<\/option><option value='WS' >\u8428\u6469\u4e9a\u7fa4\u5c9b<\/option><option value='RS' >\u585e\u5c14\u7ef4\u4e9a<\/option><option value='SL' >\u585e\u62c9\u5229\u6602<\/option><option value='SN' >\u585e\u5185\u52a0\u5c14<\/option><option value='CY' >\u585e\u6d66\u8def\u65af<\/option><option value='SC' >\u585e\u820c\u5c14\u7fa4\u5c9b<\/option><option value='SA' >\u6c99\u7279\u963f\u62c9\u4f2f<\/option><option value='ST' >\u5723\u591a\u7f8e\u548c\u666e\u6797\u897f\u6bd4<\/option><option value='KN' >\u5723\u57fa\u8328\u548c\u5c3c\u7ef4\u65af<\/option><option value='LC' >\u5723\u5362\u897f\u4e9a\u5c9b<\/option><option value='SX' >\u5723\u9a6c\u4e01\u5c9b<\/option><option value='SM' >\u5723\u9a6c\u529b\u8bfa<\/option><option value='VC' >\u5723\u6587\u68ee\u7279\u548c\u683c\u6797\u7eb3\u4e01\u65af<\/option><option value='LK' >\u65af\u91cc\u5170\u5361<\/option><option value='SK' >\u65af\u6d1b\u4f10\u514b<\/option><option value='SI' >\u65af\u6d1b\u6587\u5c3c\u4e9a<\/option><option value='SJ' >\u65af\u74e6\u5c14\u5df4\u5c9b\u548c\u626c\u9a6c\u5ef6\u5c9b<\/option><option value='SD' >\u82cf\u4e39<\/option><option value='SR' >\u82cf\u91cc\u5357\u6cb3<\/option><option value='SB' >\u6240\u7f57\u95e8\u7fa4\u5c9b<\/option><option value='SO' >\u7d22\u9a6c\u91cc<\/option><option value='TJ' >\u5854\u5409\u514b\u65af\u5766<\/option><option value='TW' >\u53f0\u6e7e(\u4e2d\u56fd)<\/option><option value='TH' >\u6cf0\u56fd<\/option><option value='TO' >\u6c64\u52a0<\/option><option value='TT' >\u7279\u7acb\u5c3c\u8fbe\u548c\u591a\u5df4\u54e5<\/option><option value='TN' >\u7a81\u5c3c\u65af<\/option><option value='TV' >\u56fe\u74e6\u5362<\/option><option value='TM' >\u571f\u5e93\u66fc\u65af\u5766<\/option><option value='VU' >\u74e6\u52aa\u963f\u56fe<\/option><option value='GT' >\u5371\u5730\u9a6c\u62c9<\/option><option value='VI' >\u7ef4\u5c14\u4eac\u7fa4\u5c9b,\u7f8e\u56fd<\/option><option value='VG' >\u7ef4\u5c14\u4eac\u7fa4\u5c9b,\u82f1\u56fd<\/option><option value='VE' >\u59d4\u5185\u745e\u62c9<\/option><option value='UG' >\u4e4c\u5e72\u8fbe<\/option><option value='UA' >\u4e4c\u514b\u5170<\/option><option value='UY' >\u4e4c\u62c9\u572d<\/option><option value='UZ' >\u4e4c\u5179\u522b\u514b\u65af\u5766<\/option><option value='ES' >\u897f\u73ed\u7259<\/option><option value='GR' >\u5e0c\u814a<\/option><option value='HK' >\u9999\u6e2f\u8bc1\u5238\u4ea4\u6613\u6240<\/option><option value='SG' >\u65b0\u52a0\u5761<\/option><option value='NZ' >\u65b0\u897f\u5170<\/option><option value='HU' >\u5308\u7259\u5229<\/option><option value='JM' >\u7259\u4e70\u52a0<\/option><option value='AM' >\u4e9a\u7f8e\u5c3c\u4e9a<\/option><option value='YE' >\u4e5f\u95e8<\/option><option value='IQ' >\u4f0a\u62c9\u514b<\/option><option value='IR' >\u4f0a\u6717<\/option><option value='IL' >\u4ee5\u8272\u5217<\/option><option value='IT' >\u610f\u5927\u5229<\/option><option value='IN' >\u5370\u5ea6<\/option><option value='ID' >\u5370\u5ea6\u5c3c\u897f\u4e9a<\/option><option value='GB' >\u82f1\u56fd<\/option><option value='JO' >\u7ea6\u65e6<\/option><option value='ZM' >\u8d5e\u6bd4\u4e9a<\/option><option value='JE' >\u6cfd\u897f\u5c9b<\/option><option value='TD' >\u4e4d\u5f97<\/option><option value='CL' >\u667a\u5229<\/option><option value='CF' >\u4e2d\u975e\u5171\u548c\u56fd<\/option><option value='CN' >\u4e2d\u56fd<\/option><option value='AW' >Aruba<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CK' >Cook Islands<\/option><option value='CZ' >Czechia<\/option><option value='DE' >Deutschland (\u5fb7\u56fd)<\/option><option value='SZ' >Eswatini<\/option><option value='FK' >Falkland Islands<\/option><option value='GF' >French Guiana<\/option><option value='GI' >Gibraltar<\/option><option value='GP' >Guadeloupe<\/option><option value='VA' >Holy See<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='MQ' >Martinique<\/option><option value='YT' >Mayotte<\/option><option value='MS' >Montserrat<\/option><option value='NC' >New Caledonia<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='PN' >Pitcairn<\/option><option value='RE' >R\u00e9union<\/option><option value='RU' >Russian Federation<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TK' >Tokelau<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='VN' >Viet Nam<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='MN' >\u041c\u043e\u043d\u0433\u043e\u043b \u0443\u043b\u0441 (\u8499\u53e4)<\/option><option value='MM' >\u1019\u103c\u1014\u103a\u1019\u102c (\u7f05\u7538)<\/option><\/select>\n                                        <label for='input_3_14_6' id='input_3_14_6_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>\u56fd\u5bb6<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_3_23\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"28daf0ab\" data-field-span=\"6\"><legend id='gfield_label_3_23' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date of Birth<\/span><\/legend><div id='input_3_23' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_23_2_container'><label for='input_3_23_2' id='input_3_23_2_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_23[]' id='input_3_23_2'   aria-required='false'   aria-labelledby=\"input_3_23_2_label gfield_label_3_23\" ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_23_1_container'><label for='input_3_23_1' id='input_3_23_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_23[]' id='input_3_23_1'   aria-required='false'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_23_3_container'><label for='input_3_23_3' id='input_3_23_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_23[]' id='input_3_23_3'   aria-required='false'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_3_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"28daf0ab\" data-field-span=\"6\"><label id='gfield_label_3_24' class='gfield_label gform-field-label' for='input_3_24'><span class='gform-field-label__text'>Gender<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_3_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"896ca176\" data-field-span=\"12\"><label id='gfield_label_3_16' class='gfield_label gform-field-label' for='input_3_16'><span class='gform-field-label__text'>Preferred Language<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_3_16' type='text' value='' class='large'    placeholder='Preferred Language'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"47090e58\" data-field-span=\"12\"><label id='gfield_label_3_17' class='gfield_label gform-field-label' for='input_3_17'><span class='gform-field-label__text'>Employer<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_3_17' type='text' value='' class='large'    placeholder='Employer'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"cddbaf8d\" data-field-span=\"12\"><label id='gfield_label_3_18' class='gfield_label gform-field-label' for='input_3_18'><span class='gform-field-label__text'>Workplace Address<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_3_18' type='text' value='' class='large'    placeholder='Workplace Address'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"32c838cb\" data-field-span=\"12\"><label id='gfield_label_3_19' class='gfield_label gform-field-label' for='input_3_19'><span class='gform-field-label__text'>Type of Employment<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_3_19' type='text' value='' class='large'    placeholder='Type of Employment'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"5bce7ad0\" data-field-span=\"12\"><label id='gfield_label_3_20' class='gfield_label gform-field-label' for='input_3_20'><span class='gform-field-label__text'>Position<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_3_20' type='text' value='' class='large'    placeholder='Position'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_22\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"f4045b53\" data-field-span=\"12\"><label id='gfield_label_3_22' class='gfield_label gform-field-label' for='input_3_22'><span class='gform-field-label__text'>Pre-Existing Issue?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_3_22' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Pre-existing Issue?<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_3_13\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"da3d7670\" data-field-span=\"12\"><label id='gfield_label_3_13' class='gfield_label gform-field-label' for='input_3_13'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_3_13' class='textarea medium'    placeholder='Comment'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_10\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"bf5c1b9f\" data-field-span=\"12\"><legend id='gfield_label_3_10' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Privacy Policy<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_10.1' id='input_3_10_1' type='checkbox' value='1'   aria-labelledby=\"input_3_10_1_label gfield_label_3_10\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_3_10_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_10_1' ><span class='gform-field-label__text'>I agree to AMIEU's privacy policy.<\/span><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/label><input type='hidden' name='input_10.2' value='I agree to AMIEU&#039;s privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_10.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_3_25\" class=\"gfield gfield--type-captcha gfield--input-type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7db93cda\" data-field-span=\"12\"><label id='gfield_label_3_25' class='gfield_label gform-field-label screen-reader-text' for='input_3_25'><span class='gform-field-label__text'><\/span><\/label><div id='input_3_25' class='ginput_container ginput_recaptcha' data-sitekey='6LeSN1QqAAAAACuqwzhOzJapaT9Z5UBGq-SGqQxg'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='AUD' value='fusN1Bg6Hj7\/8WNpCe6vD+sEUdnSJsKCAirpezeQQIriKyIp1UtLNTJEeH0E+eon5NbjCn8TZMghL0tn4SS5zkzOmVevMP\/IKKZ57oxyZRC+Clw=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJ7XCIyMlwiOltcImQ1MzA4ZWMyOTEwNGVkMWIxMjcyYmU4NDkzOTcxZTk0XCIsXCI3Y2VlZTdlMzQwODZhOGRkNGJmZmFiYWQ3NTNkZmYxM1wiXSxcIjEwLjFcIjpcImMyNGJhOTAxNjA1ZTUzNjE5MjAxZDU1ZTVjZDYyM2YwXCIsXCIxMC4yXCI6XCIwMjNlMDQ4MzMwMDA2MmM4YmE5NWU1MWM3NjY2ZmQ3M1wiLFwiMTAuM1wiOlwiYzI0YmE5MDE2MDVlNTM2MTkyMDFkNTVlNWNkNjIzZjBcIixcImdmb3JtX3N1Ym1pc3Npb25fbWV0aG9kXCI6W1wiNjJkOWMwZDNmOTA3ODIwN2ZlMGI3ZjhiOGRhOTJmYWRcIixcIjE4ZTNjOTc1ZTNlODA1YzBhZjRlM2I3YWUzN2NkY2VjXCJdLFwiZ2Zvcm1fdGhlbWVcIjpcIjk5NzNlNjVjYzViNTJjZjFiOTgxMjlkNWE3MDJkYjEzXCIsXCJnZm9ybV9zdHlsZV9zZXR0aW5nc1wiOlwiMmU4N2Y3M2E1MjMwNWY1MGY0MGVkNTY2OWRmOWVkNDRcIixcImZvcm1faWRcIjpcImQ3ODUyNWY4NGU5NWYzY2EzZDc4ZmZmNjJmM2U5NzEzXCIsXCJ1cmxcIjpcIjMxNWJhYjNkNGNlYzVjN2M3Mjg1M2FiZjJhODNjZDYzXCIsXCJzdGF0ZV90aW1lc3RhbXBcIjpcImNhNWIyNmQ4Zjk2NDhkMGEzYWM1YjAwY2UzMmFjMmQ0XCJ9IiwiMDM4ZjdkZTM2NTMyNDMxYzNiNzE0ZjRhMTkzNzVjYTkiLDE3OTI2NTg1NTZd' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <input type=\"hidden\" name=\"trp-form-language\" value=\"zh\"\/><\/form>\n                        <\/div><\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Please fill in the below details to assist us with your membership application. 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