This is a custom code placeholder.
Switch to Preview or publish the page
to see how your code works.
Double-click to edit
<script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.25576" type="text/javascript"></script>
<script src="https://js.jotform.com/vendor/postMessage.js?3.3.25576" type="text/javascript"></script>
<script src="https://js.jotform.com/WidgetsServer.js?v=1622044453412" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/js/vendor/math-processor.js?v=3.3.25576" type="text/javascript"></script>
<script type="text/javascript">
JotForm.setCalculations([{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"373","equation":"{373}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105268009","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105263605","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"374","equation":"{374}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105278917","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105267313","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"368","equation":"{368}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105277892","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105277892","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[135.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616636937265","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1614998193923","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[110.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616636902045","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1616636900480","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[65.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616278837061","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1616278837061","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"354","equation":"[{354}*2]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1614998024172","resultField":"356","decimalPlaces":"2","isError":false,"conditionId":"1614998007814","conditionTrue":false},{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"354","equation":"{354}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1614998023375","resultField":"356","decimalPlaces":"2","isError":false,"conditionId":"1614998023375","conditionTrue":false}]);
JotForm.setConditions([{"action":[{"id":"action_1619297275826","visibility":"Show","isError":false,"field":"379"}],"id":"1619297282531","index":"0","link":"Any","priority":"0","terms":[{"id":"term_1619297275826","field":"378","operator":"equals","value":"Some other race","isError":false}],"type":"field"},{"action":[{"id":"action_0_1616105476023","visibility":"Show","isError":false,"field":"374"}],"id":"1616105460658","index":"1","link":"Any","priority":"1","terms":[{"id":"term_0_1616105476023","field":"366","operator":"equals","value":"Wollongong","isError":false}],"type":"field"},{"action":[{"id":"action_0_1616105475237","visibility":"Show","isError":false,"field":"373"}],"id":"1616105475237","index":"2","link":"Any","priority":"2","terms":[{"id":"term_0_1616105475237","field":"366","operator":"equals","value":"Central Coast","isError":false}],"type":"field"},{"action":[{"id":"action_0_1616105464367","visibility":"Show","isError":false,"field":"368"}],"id":"1616105464367","index":"3","link":"Any","priority":"3","terms":[{"id":"term_0_1616105464367","field":"366","operator":"equals","value":"Bowral","isError":false},{"id":"term_1_1616105464367","field":"366","operator":"equals","value":"Blue Mountains","isError":false},{"id":"term_2_1616105464367","field":"366","operator":"equals","value":"Sydney","isError":false}],"type":"field"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"373","equation":"{373}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105268009","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105263605","conditionTrue":false}],"id":"1616105263605","index":"4","link":"Any","priority":"4","terms":[{"id":"term_0_1616105268009","field":"373","operator":"isFilled","value":"","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"374","equation":"{374}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105278917","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105267313","conditionTrue":false}],"id":"1616105267313","index":"5","link":"Any","priority":"5","terms":[{"id":"term_0_1616105278917","field":"374","operator":"isFilled","value":"","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"368","equation":"{368}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616105277892","resultField":"360","decimalPlaces":"2","isError":false,"conditionId":"1616105277892","conditionTrue":false}],"id":"1616105277892","index":"6","link":"Any","priority":"6","terms":[{"id":"term_0_1616105277892","field":"368","operator":"isFilled","value":"","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[135.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616636937265","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1614998193923","conditionTrue":false}],"id":"1614998193923","index":"10","link":"Any","priority":"10","terms":[{"id":"term_0_1616636937265","field":"348","operator":"equals","value":"10","isError":false},{"id":"term_1_1616636937265","field":"348","operator":"equals","value":"9","isError":false},{"id":"term_2_1616636937265","field":"348","operator":"equals","value":"8","isError":false},{"id":"term_3_1616636937265","field":"348","operator":"equals","value":"7","isError":false},{"id":"term_4_1616636937265","field":"348","operator":"equals","value":"6","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[110.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616636902045","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1616636900480","conditionTrue":false}],"id":"1616636900480","index":"11","link":"Any","priority":"11","terms":[{"id":"term_5_1616636902045","field":"348","operator":"equals","value":"5","isError":false},{"id":"term_6_1616636902045","field":"348","operator":"equals","value":"4","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"","equation":"[65.00]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1616278837061","resultField":"367","decimalPlaces":"2","isError":false,"conditionId":"1616278837061","conditionTrue":false}],"id":"1616278837061","index":"12","link":"Any","priority":"12","terms":[{"id":"term_0_1616278837061","field":"348","operator":"equals","value":"3","isError":false},{"id":"term_1_1616278837061","field":"348","operator":"equals","value":"2","isError":false},{"id":"term_2_1616278837061","field":"348","operator":"equals","value":"1","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"354","equation":"[{354}*2]","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1614998024172","resultField":"356","decimalPlaces":"2","isError":false,"conditionId":"1614998007814","conditionTrue":false}],"id":"1614998007814","index":"13","link":"Any","priority":"13","terms":[{"id":"term_0_1614998024172","field":"355","operator":"notEquals","value":"1","isError":false},{"id":"term_1_1614998024172","field":"355","operator":"notEquals","value":"2","isError":false},{"id":"term_2_1614998024172","field":"355","operator":"notEquals","value":"3","isError":false}],"type":"calculation"},{"action":[{"replaceText":"","readOnly":false,"newCalculationType":true,"useCommasForDecimals":false,"operands":"354","equation":"{354}","showBeforeInput":false,"showEmptyDecimals":false,"ignoreHiddenFields":false,"insertAsText":false,"id":"action_0_1614998023375","resultField":"356","decimalPlaces":"2","isError":false,"conditionId":"1614998023375","conditionTrue":false}],"id":"1614998023375","index":"14","link":"Any","priority":"14","terms":[{"id":"term_0_1614998023375","field":"355","operator":"equals","value":"3","isError":false},{"id":"term_1_1614998023375","field":"355","operator":"equals","value":"2","isError":false},{"id":"term_2_1614998023375","field":"355","operator":"equals","value":"1","isError":false}],"type":"calculation"}]);
JotForm.init(function(){
if (window.JotForm && JotForm.accessible) $('input_379').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_382').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_383').setAttribute('tabindex',0);
JotForm.newDefaultTheme = true;
JotForm.extendsNewTheme = false;
JotForm.newPaymentUIForNewCreatedForms = false;
JotForm.newPaymentUI = true;
JotForm.alterTexts({"couponApply":"Apply","couponBlank":"Please enter a coupon.","couponChange":"","couponEnter":"Enter coupon","couponExpired":"Coupon is expired. Please try another one.","couponInvalid":"Coupon is invalid.","couponValid":"Coupon is valid.","shippingShipping":"Shipping","taxTax":"Tax","totalSubtotal":"Subtotal","totalTotal":"Total"}, true);
/*INIT-END*/
});
JotForm.prepareCalculationsOnTheFly([null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"typeA","qid":"66","text":"ProgressBar","type":"control_widget"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"demographicSurvey","qid":"208","text":"Demographic survey ","type":"control_head"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"submit","qid":"329","text":"Submit","type":"control_button"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"description":"","name":"whichCategory","qid":"377","text":"Which category below includes your age?","type":"control_radio"},{"description":"","name":"areYou","qid":"378","text":"Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander, or some other race?","type":"control_radio"},{"description":"","name":"pleaseSpecify","qid":"379","subLabel":"","text":"Please Specify:","type":"control_textbox"},{"description":"","name":"whatIs","qid":"380","text":"What is your gender?","type":"control_radio"},null,{"description":"","name":"whatCity","qid":"382","subLabel":"","text":"What City Do You Reside In?","type":"control_textbox"},{"description":"","name":"zipCode","qid":"383","subLabel":"","text":"Zip Code:","type":"control_textbox"},{"description":"","name":"areYou384","qid":"384","text":"Are you now married, widowed, divorced, separated, or never married?","type":"control_radio"},{"description":"","name":"whatIs385","qid":"385","text":"What is the highest level of school you have completed or the highest degree you have received?","type":"control_radio"},{"description":"","name":"whichOf","qid":"386","text":"Which of the following categories best describes your employment status?","type":"control_radio"},{"description":"","name":"howMuch","qid":"387","text":"How much total combined money did all members of your household earn?","type":"control_radio"}]);
setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"typeA","qid":"66","text":"ProgressBar","type":"control_widget"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"demographicSurvey","qid":"208","text":"Demographic survey ","type":"control_head"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"name":"submit","qid":"329","text":"Submit","type":"control_button"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"description":"","name":"whichCategory","qid":"377","text":"Which category below includes your age?","type":"control_radio"},{"description":"","name":"areYou","qid":"378","text":"Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander, or some other race?","type":"control_radio"},{"description":"","name":"pleaseSpecify","qid":"379","subLabel":"","text":"Please Specify:","type":"control_textbox"},{"description":"","name":"whatIs","qid":"380","text":"What is your gender?","type":"control_radio"},null,{"description":"","name":"whatCity","qid":"382","subLabel":"","text":"What City Do You Reside In?","type":"control_textbox"},{"description":"","name":"zipCode","qid":"383","subLabel":"","text":"Zip Code:","type":"control_textbox"},{"description":"","name":"areYou384","qid":"384","text":"Are you now married, widowed, divorced, separated, or never married?","type":"control_radio"},{"description":"","name":"whatIs385","qid":"385","text":"What is the highest level of school you have completed or the highest degree you have received?","type":"control_radio"},{"description":"","name":"whichOf","qid":"386","text":"Which of the following categories best describes your employment status?","type":"control_radio"},{"description":"","name":"howMuch","qid":"387","text":"How much total combined money did all members of your household earn?","type":"control_radio"}]);}, 20);
</script>
<link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.25576" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/themes/CSS/5e6b428acc8c4e222d1beb91.css?themeRevisionID=5f7ed99c2c2c7240ba580251"/>
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/payment/payment_styles.css?3.3.25576" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/payment/payment_feature.css?3.3.25576" />
<style type="text/css" id="form-designer-style">
/* Injected CSS Code */
*,
*:after,
*:before {
box-sizing: border-box;
}
.form-all {
font-family: "Inter", sans-serif;
}
.main .jotform-form {
width: 100%;
padding: 0 3%;
}
.form-all {
display: flex;
flex-direction: column;
width: 100%;
max-width: 1000px;
}
.form-line-active {
background-color: rgba(0, 116, 200, 0.02);
}
.form-all {
font-size: 16px;
}
li.form-line {
margin-top: 12px;
margin-bottom: 12px;
}
.form-line {
padding: 4px 10px;
}
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
border-radius: 6px;
}
.form-all .form-sub-label {
margin-left: 3px;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
border-radius: 6px;
}
.form-all .form-sub-label {
margin-left: 3px;
}
.form-section {
padding: 0px 38px;
}
.form-textbox,
.form-textarea {
border-width: 0px;
width: 100% !important;
color: #00a68c;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: rgba(79, 60, 123, 0.05);
}
.form-label {
font-family: "Inter", sans-serif;
}
.form-line-column {
width: calc(50% - 8px);
}
.form-dropdown {
background-color: rgba(79, 60, 123, 0.06);
}
.form-checkbox-item label,
.form-checkbox-item span,
.form-radio-item label,
.form-radio-item span {
color: #434343;
}
.form-radio-item,
.form-checkbox-item {
padding-bottom: 0px !important;
}
.form-radio-item:last-child,
.form-checkbox-item:last-child {
padding-bottom: 0;
}
.form-single-column .form-checkbox-item,
.form-single-column .form-radio-item {
width: 100%;
}
.form-checkbox-item .editor-container div,
.form-radio-item .editor-container div {
position: relative;
}
.form-checkbox-item .editor-container div:before,
.form-radio-item .editor-container div:before {
display: inline-block;
vertical-align: middle;
left: 0;
width: 20px;
height: 20px;
}
.form-radio-item:not(#foo),
.form-checkbox-item:not(#foo) {
position: relative;
}
.form-radio-item:not(#foo) .form-radio + span:before,
.form-checkbox-item:not(#foo) .form-radio + span:before,
.form-radio-item:not(#foo) .form-radio + span:after,
.form-checkbox-item:not(#foo) .form-radio + span:after,
.form-radio-item:not(#foo) .form-radio:checked + span div:after,
.form-checkbox-item:not(#foo) .form-radio:checked + span div:after,
.form-radio-item:not(#foo) .form-checkbox + span:before,
.form-checkbox-item:not(#foo) .form-checkbox + span:before,
.form-radio-item:not(#foo) .form-checkbox + span:after,
.form-checkbox-item:not(#foo) .form-checkbox + span:after {
display: none;
}
.form-radio-item:not(#foo) label:before,
.form-checkbox-item:not(#foo) label:before {
background-color: transparent;
border: 2px solid #00a68c;
}
.form-radio-item:not(#foo) label:focus:before,
.form-checkbox-item:not(#foo) label:focus:before {
border-color: #588ee6;
}
.form-radio-item:not(#foo) .form-radio:checked + label:after,
.form-checkbox-item:not(#foo) .form-radio:checked + label:after,
.form-radio-item:not(#foo) .form-checkbox:checked + label:after,
.form-checkbox-item:not(#foo) .form-checkbox:checked + label:after {
background: none;
border-bottom: 3px solid #00a68c;
border-left: 3px solid #00a68c;
display: inline-block;
transform: rotate(-45deg) !important;
height: 9px;
width: 18px;
top: 0;
border-radius: 2px;
}
.form-radio-item:not(#foo) .form-radio-other,
.form-radio-item:not(#foo) .form-checkbox-other {
display: inline-block;
margin-right: 13px;
margin-top: 0px;
}
.form-radio-item:not(#foo) .form-radio-item label,
.form-radio-item:not(#foo) .form-radio-item label {
float: left;
margin-left: 0;
outline: none;
}
.form-radio-item:not(#foo) label:before {
content: '';
position: absolute;
display: inline-block;
vertical-align: baseline;
margin-right: 4px;
border-radius: 50%;
left: 4px;
width: 20px;
height: 20px;
cursor: pointer;
}
.form-radio-item:not(#foo) label:after {
content: '';
position: absolute;
z-index: 10;
display: inline-block;
top: 4px;
left: 8px;
width: 10px;
height: 10px;
}
.form-radio-item:not(#foo) input:checked + label:after {
opacity: 1;
}
.form-checkbox-item:not(#foo) .form-radio-other,
.form-checkbox-item:not(#foo) .form-checkbox-other {
display: inline-block;
margin-right: 13px;
margin-top: 0px;
}
.form-checkbox-item:not(#foo) .form-radio-item label,
.form-checkbox-item:not(#foo) .form-radio-item label {
float: left;
margin-left: 0;
outline: none;
}
.form-checkbox-item:not(#foo) label:before {
content: '';
position: absolute;
display: inline-block;
vertical-align: baseline;
margin-right: 4px;
border-radius: 2px;
left: 4px;
width: 20px;
height: 20px;
cursor: pointer;
}
.form-checkbox-item:not(#foo) label:after {
content: '';
position: absolute;
z-index: 10;
display: inline-block;
top: 6px;
left: 10px;
width: 4px;
height: 4px;
}
.form-checkbox-item:not(#foo) input:checked + label:after {
opacity: 1;
}
.form-all .form-submit-button,
.form-all .form-submit-print {
font-size: 16px;
font-weight: 600;
font-family: "Inter", sans-serif;
border: none;
border-width: 3px;
border-style: solid;
border-color: #00a68c;
}
.form-all .form-submit-button {
min-width: 180px;
}
.form-all .form-submit-button.js-new-sacl-button,
.form-all .form-submit-print {
min-width: 98px;
}
.form-all .form-submit-button {
color: #a94134;
background: #ffffff;
box-shadow: none;
text-shadow: none;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
font-family: "Inter", sans-serif;
font-size: 16px;
font-weight: normal;
border: none;
border-width: 3px;
border-style: solid;
border-color: #fa8c29;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
min-width: 128px;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
box-shadow: none;
text-shadow: none;
color: #ffffff;
background: #fa8c29;
}
li[data-type="control_image"] div {
text-align: left;
}
li[data-type="control_image"] img {
border: none;
border-width: 0px !important;
border-style: solid !important;
border-color: false !important;
}
.supernova {
height: 100%;
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
background-repeat: repeat;
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
/* | */
.form-all {
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
background-repeat: repeat;
}
.form-header-group {
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
}
.header-large h1.form-header {
font-size: 2em;
}
.header-large h2.form-header {
font-size: 1.5em;
}
.header-large h3.form-header {
font-size: 1.17em;
}
.header-large h1 + .form-subHeader {
font-size: 1em;
}
.header-large h2 + .form-subHeader {
font-size: .875em;
}
.header-large h3 + .form-subHeader {
font-size: .75em;
}
.header-default h1.form-header {
font-size: 2em;
}
.header-default h2.form-header {
font-size: 1.5em;
}
.header-default h3.form-header {
font-size: 1.17em;
}
.header-default h1 + .form-subHeader {
font-size: 1em;
}
.header-default h2 + .form-subHeader {
font-size: .875em;
}
.header-default h3 + .form-subHeader {
font-size: .75em;
}
.header-small h1.form-header {
font-size: 2em;
}
.header-small h2.form-header {
font-size: 1.5em;
}
.header-small h3.form-header {
font-size: 1.17em;
}
.header-small h1 + .form-subHeader {
font-size: 1em;
}
.header-small h2 + .form-subHeader {
font-size: .875em;
}
.header-small h3 + .form-subHeader {
font-size: .75em;
}
.form-header-group {
text-align: left;
}
.form-header-group {
font-family: "Inter", sans-serif;
}
div.form-header-group.header-large {
margin: 0px -38px;
}
div.form-header-group.header-large {
padding: 40px 52px;
}
.form-header-group .form-header,
.form-header-group .form-subHeader {
color: #00a68c;
}
.form-line-error {
overflow: hidden;
-webkit-transition-property: none;
-moz-transition-property: none;
-ms-transition-property: none;
-o-transition-property: none;
transition-property: none;
-webkit-transition-duration: 0.3s;
-moz-transition-duration: 0.3s;
-ms-transition-duration: 0.3s;
-o-transition-duration: 0.3s;
transition-duration: 0.3s;
-webkit-transition-timing-function: ease;
-moz-transition-timing-function: ease;
-ms-transition-timing-function: ease;
-o-transition-timing-function: ease;
transition-timing-function: ease;
background-color: #ffffff;
}
.form-line-error .form-error-message {
background-color: #0074c8;
clear: both;
float: none;
}
.form-line-error .form-error-message .form-error-arrow {
border-bottom-color: #0074c8;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
border: 1px solid #0074c8;
box-shadow: 0 0 3px #0074c8;
}
.supernova {
background-color: #f7f7f7;
}
.supernova body {
background-color: transparent;
}
.supernova .form-all,
.form-all {
background-color: #f7f7f7;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: rgba(79, 60, 123, 0.05);
}
.form-matrix-table tr {
border-color: #dedede;
}
.form-matrix-table tr:nth-child(2n) {
background-color: #eaeaea;
}
.form-all {
color: #292929;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html {
color: #292929;
}
.form-line-error {
overflow: hidden;
-webkit-transition-property: none;
-moz-transition-property: none;
-ms-transition-property: none;
-o-transition-property: none;
transition-property: none;
-webkit-transition-duration: 0.3s;
-moz-transition-duration: 0.3s;
-ms-transition-duration: 0.3s;
-o-transition-duration: 0.3s;
transition-duration: 0.3s;
-webkit-transition-timing-function: ease;
-moz-transition-timing-function: ease;
-ms-transition-timing-function: ease;
-o-transition-timing-function: ease;
transition-timing-function: ease;
background-color: #ffffff;
}
/*__INSPECT_SEPERATOR__*/
.formFooter {
display : none;
}
.form-textbox {
border-bottom : 2px solid #00a68c;
}
.progressBar-newDefaultTheme .progressjs-theme-newDefault {
border-radius : 10px;
height : 20px!important;
margin : 20px 0;
}
.progressBar-newDefaultTheme .progressjs-inner {
border-radius : 10px;
}
.form-all {
border : 3px solid #00a68c;
}
#footer {
text-align : left;
margin : -35px auto 0;
font-size : 14px;
width : 1000px;
display : none;
}
.form-header {
}
.form-buttons-wrapper.form-buttons-auto.jsTest-button-wrapperField {
}
/* Injected CSS Code */
</style>
<form class="jotform-form" action="https://submit.jotform.com/submit/211138165499461/" method="post" name="form_211138165499461" id="211138165499461" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="211138165499461" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_208" class="form-input-wide" data-type="control_head">
<div style="display:table;width:100%">
<div class="form-header-group hasImage header-small" data-imagealign="Top">
<div class="header-logo">
<img src="https://www.jotform.com/uploads/jotformexpert/form_files/DTKLG-Square-01%20(2)%20(1).6084865ecb7720.30098457.jpg" alt="" width="300" class="header-logo-top" />
</div>
<div class="header-text httac htvam">
<h3 id="header_208" class="form-header" data-component="header">
Demographic survey
</h3>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_widget" id="id_66">
<div id="cid_66" class="form-input" data-layout="full">
<div style="width:100%;text-align:Center" data-component="widget-directEmbed">
<div class="direct-embed-widgets progress-bar-widget " data-type="direct-embed" style="width:1px;min-height:1px">
<div class="direct-embed-66">
<script type="text/javascript">
var progressBarqid = "66";
var onlyCountReq = "No";
var fixedProgressBar = "No";
var deleteLabelProgressBar = "";
var fieldsProgressBar = "Fields Completed";
var submitProgressBar = "Please Submit the Form";
var requiredProgressBar = "Required Fields Complete";
var barColor = "#eb3c27";
var theme = "Island Blue";
</script>
<link href="//widgets.jotform.io/progressBar/min/styles.min.css" rel="stylesheet" media="screen" />
<script src="//widgets.jotform.io/progressBar/min/scripts.min.js"></script>
</div>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_377">
<label class="form-label form-label-top form-label-auto" id="label_377" for="input_377"> Which category below includes your age? </label>
<div id="cid_377" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_377" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_0" name="q377_whichCategory" value="17 or younger" />
<label id="label_input_377_0" for="input_377_0"> 17 or younger </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_1" name="q377_whichCategory" value="18-20" />
<label id="label_input_377_1" for="input_377_1"> 18-20 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_2" name="q377_whichCategory" value="21-29" />
<label id="label_input_377_2" for="input_377_2"> 21-29 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_3" name="q377_whichCategory" value="30-39" />
<label id="label_input_377_3" for="input_377_3"> 30-39 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_4" name="q377_whichCategory" value="40-49" />
<label id="label_input_377_4" for="input_377_4"> 40-49 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_5" name="q377_whichCategory" value="50-59" />
<label id="label_input_377_5" for="input_377_5"> 50-59 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_377_6" name="q377_whichCategory" value="60 or older" />
<label id="label_input_377_6" for="input_377_6"> 60 or older </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_378">
<label class="form-label form-label-top form-label-auto" id="label_378" for="input_378"> Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific Islander, or some other race? </label>
<div id="cid_378" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_378" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_0" name="q378_areYou" value="White" />
<label id="label_input_378_0" for="input_378_0"> White </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_1" name="q378_areYou" value="Black or African-American" />
<label id="label_input_378_1" for="input_378_1"> Black or African-American </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_2" name="q378_areYou" value="American Indian or Alaskan Native" />
<label id="label_input_378_2" for="input_378_2"> American Indian or Alaskan Native </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_3" name="q378_areYou" value="Asian" />
<label id="label_input_378_3" for="input_378_3"> Asian </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_4" name="q378_areYou" value="Native Hawaiian or other Pacific islander" />
<label id="label_input_378_4" for="input_378_4"> Native Hawaiian or other Pacific islander </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_5" name="q378_areYou" value="From multiple races" />
<label id="label_input_378_5" for="input_378_5"> From multiple races </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_378_6" name="q378_areYou" value="Some other race" />
<label id="label_input_378_6" for="input_378_6"> Some other race </label>
</span>
</div>
</div>
</li>
<li class="form-line always-hidden form-field-hidden" style="display:none;" data-type="control_textbox" id="id_379">
<label class="form-label form-label-top form-label-auto" id="label_379" for="input_379"> Please Specify: </label>
<div id="cid_379" class="form-input-wide always-hidden" data-layout="half">
<input type="text" id="input_379" name="q379_pleaseSpecify" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_379" />
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_380">
<label class="form-label form-label-top form-label-auto" id="label_380" for="input_380"> What is your gender? </label>
<div id="cid_380" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_380" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_380_0" name="q380_whatIs" value="Female" />
<label id="label_input_380_0" for="input_380_0"> Female </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_380_1" name="q380_whatIs" value="Male" />
<label id="label_input_380_1" for="input_380_1"> Male </label>
</span>
<span class="form-radio-item formRadioOther" style="clear:left">
<input type="radio" class="form-radio-other form-radio" name="q380_whatIs" id="other_380" value="other" aria-label="Other" />
<label id="label_other_380" style="text-indent:0" for="other_380"> Other </label>
<span id="other_380_input" class="other-input-container" style="display:none">
<input type="text" class="form-radio-other-input form-textbox" name="q380_whatIs[other]" data-otherhint="Other" size="15" id="input_380" data-placeholder="Please type another option here" placeholder="Please type another option here" />
</span>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1" data-type="control_textbox" id="id_382">
<label class="form-label form-label-top form-label-auto" id="label_382" for="input_382"> What City Do You Reside In? </label>
<div id="cid_382" class="form-input-wide" data-layout="half">
<input type="text" id="input_382" name="q382_whatCity" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_382" />
</div>
</li>
<li class="form-line form-line-column form-col-2" data-type="control_textbox" id="id_383">
<label class="form-label form-label-top form-label-auto" id="label_383" for="input_383"> Zip Code: </label>
<div id="cid_383" class="form-input-wide" data-layout="half">
<input type="text" id="input_383" name="q383_zipCode" data-type="input-textbox" class="form-textbox" style="width:310px" size="310" value="" data-component="textbox" aria-labelledby="label_383" />
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_384">
<label class="form-label form-label-top form-label-auto" id="label_384" for="input_384"> Are you now married, widowed, divorced, separated, or never married? </label>
<div id="cid_384" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_384" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_384_0" name="q384_areYou384" value="Married" />
<label id="label_input_384_0" for="input_384_0"> Married </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_384_1" name="q384_areYou384" value="Widowed" />
<label id="label_input_384_1" for="input_384_1"> Widowed </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_384_2" name="q384_areYou384" value="Divorced" />
<label id="label_input_384_2" for="input_384_2"> Divorced </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_384_3" name="q384_areYou384" value="Separated" />
<label id="label_input_384_3" for="input_384_3"> Separated </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_384_4" name="q384_areYou384" value="Never married" />
<label id="label_input_384_4" for="input_384_4"> Never married </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_385">
<label class="form-label form-label-top form-label-auto" id="label_385" for="input_385"> What is the highest level of school you have completed or the highest degree you have received? </label>
<div id="cid_385" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_385" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_0" name="q385_whatIs385" value="Less than high school degree" />
<label id="label_input_385_0" for="input_385_0"> Less than high school degree </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_1" name="q385_whatIs385" value="High school degree or equivalent (e.g., GED)" />
<label id="label_input_385_1" for="input_385_1"> High school degree or equivalent (e.g., GED) </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_2" name="q385_whatIs385" value="Some college but no degree" />
<label id="label_input_385_2" for="input_385_2"> Some college but no degree </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_3" name="q385_whatIs385" value="Associate degree" />
<label id="label_input_385_3" for="input_385_3"> Associate degree </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_4" name="q385_whatIs385" value="Bachelor degree" />
<label id="label_input_385_4" for="input_385_4"> Bachelor degree </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_385_5" name="q385_whatIs385" value="Graduate degree" />
<label id="label_input_385_5" for="input_385_5"> Graduate degree </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_386">
<label class="form-label form-label-top form-label-auto" id="label_386" for="input_386"> Which of the following categories best describes your employment status? </label>
<div id="cid_386" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_386" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_0" name="q386_whichOf" value="Employed, working 1-39 hours per week" />
<label id="label_input_386_0" for="input_386_0"> Employed, working 1-39 hours per week </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_1" name="q386_whichOf" value="Employed, working 40 or more hours per week" />
<label id="label_input_386_1" for="input_386_1"> Employed, working 40 or more hours per week </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_2" name="q386_whichOf" value="Not employed, looking for work" />
<label id="label_input_386_2" for="input_386_2"> Not employed, looking for work </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_3" name="q386_whichOf" value="Not employed, NOT looking for work" />
<label id="label_input_386_3" for="input_386_3"> Not employed, NOT looking for work </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_4" name="q386_whichOf" value="Retired" />
<label id="label_input_386_4" for="input_386_4"> Retired </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_386_5" name="q386_whichOf" value="Disabled, not able to work" />
<label id="label_input_386_5" for="input_386_5"> Disabled, not able to work </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_387">
<label class="form-label form-label-top form-label-auto" id="label_387" for="input_387"> How much total combined money did all members of your household earn? </label>
<div id="cid_387" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_387" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_0" name="q387_howMuch" value="$0 – $9,999" />
<label id="label_input_387_0" for="input_387_0"> $0 – $9,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_1" name="q387_howMuch" value="$10,000 – $19,999" />
<label id="label_input_387_1" for="input_387_1"> $10,000 – $19,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_2" name="q387_howMuch" value="$20,000 – $29,999" />
<label id="label_input_387_2" for="input_387_2"> $20,000 – $29,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_3" name="q387_howMuch" value="$30,000 – $39,999" />
<label id="label_input_387_3" for="input_387_3"> $30,000 – $39,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_4" name="q387_howMuch" value="$40,000 – $49,999" />
<label id="label_input_387_4" for="input_387_4"> $40,000 – $49,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_5" name="q387_howMuch" value="$50,000 – $59,999" />
<label id="label_input_387_5" for="input_387_5"> $50,000 – $59,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_6" name="q387_howMuch" value="$60,000 – $69,999" />
<label id="label_input_387_6" for="input_387_6"> $60,000 – $69,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_7" name="q387_howMuch" value="$70,000 – $79,999" />
<label id="label_input_387_7" for="input_387_7"> $70,000 – $79,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_8" name="q387_howMuch" value="$80,000 – $89,999" />
<label id="label_input_387_8" for="input_387_8"> $80,000 – $89,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_9" name="q387_howMuch" value="$90,000 – $99,999" />
<label id="label_input_387_9" for="input_387_9"> $90,000 – $99,999 </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_387_10" name="q387_howMuch" value="$100,000 or more" />
<label id="label_input_387_10" for="input_387_10"> $100,000 or more </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_329">
<div id="cid_329" class="form-input-wide" data-layout="full">
<div data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField">
<button id="input_329" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="">
Submit
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<script>
JotForm.showJotFormPowered = "new_footer";
</script>
<script>
JotForm.poweredByText = "Powered by JotForm";
</script>
<input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="211138165499461" />
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='211138165499461'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++)
{
all_spc[i].value = "211138165499461-211138165499461";
}
</script>
<div class="formFooter-heightMask">
</div>
<div class="formFooter f6">
<div class="formFooter-wrapper formFooter-leftSide">
<a href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=211138165499461&utm_content=jotform_logo&utm_campaign=powered_by_jotform_le" target="_blank" class="formFooter-logoLink"><img class="formFooter-logo" src="https://cdn.jotfor.ms/assets/img/logo/logo-new@1x.png" alt="Jotform Logo"></a>
</div>
<div class="formFooter-wrapper formFooter-rightSide">
<span class="formFooter-text">
Now create your own JotForm - It's free!
</span>
<a class="formFooter-button" href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=211138165499461&utm_content=jotform_button&utm_campaign=powered_by_jotform_le" target="_blank">Create your own JotForm</a>
</div>
</div>
</form>
<script src="https://cdn.jotfor.ms//js/vendor/smoothscroll.min.js?v=3.3.25576"></script>
<script src="https://cdn.jotfor.ms//js/errorNavigation.js?v=3.3.25576"></script>