{"id":63290,"date":"2023-01-09T10:35:11","date_gmt":"2023-01-09T16:35:11","guid":{"rendered":"https:\/\/trtaorg.wpengine.com\/?page_id=63290"},"modified":"2023-03-30T13:37:09","modified_gmt":"2023-03-30T18:37:09","slug":"online-membership","status":"publish","type":"page","link":"https:\/\/trta.org\/es\/online-membership\/","title":{"rendered":"Online Membership"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"63290\" class=\"elementor elementor-63290\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-828dbfa section-member-form-wrapper elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"828dbfa\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-02ab094\" data-id=\"02ab094\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a7f24bf elementor-widget elementor-widget-shortcode\" data-id=\"a7f24bf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style>\r\n\tspan.form-helper {  \r\n\t\tdisplay:block;\r\n\t\tcolor: #990000; \r\n\t\tfont-size: 26px; \r\n\t\tfont-weight: 700 !important;\r\n\t}\r\n\tlabel.required {\r\n\t\tposition: relative;\r\n\t\tcolor: #000000;\r\n\t}\r\n\tlabel.required::after {\r\n\t\tcolor: #000000;\r\n\t\tposition: absolute;\r\n\t\tfont-size: 14px;\r\n\t\ttop:-3px;\r\n\t\tleft:-6px;\r\n\t\tcontent:\"*\";\r\n\t}\r\n<\/style>\r\n\r\n<a name=\"join\" id=\"join\"><\/a>\r\n<form action=\"#!\" method=\"post\" name=\"form_membership\" id=\"form_membership\" role=\"form\">\r\n<input type=\"hidden\" name=\"action\" id=\"form-action\" value=\"mf_ajax_submission\">\r\n<input type=\"hidden\" name=\"data[membership_name]\" id=\"membership_name\" value=\"\">\r\n<input type=\"hidden\" name=\"data[product_type]\" id=\"product_type\" value=\"\">\r\n<input type=\"hidden\" name=\"data[product_price]\" id=\"product_price\" value=\"\">\r\n<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"74da53de68\" \/><div class=\"container\">\r\n\t<div class=\"row\">\r\n\t\t<div class=\"col-12\">\r\n\t\t\t<p class=\"form-helper\" style=\"color: #990000; font-weight: bold;\" data-error=\"\" id=\"helper_global\"><\/p>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t<div class=\"row\">\r\n        <div class=\"col-12\">\r\n            <h3 id=\"mform-step1-title\">First, choose a membership option:<\/h3>\r\n            \t\t\t<p><\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" data-product-type=\"Annual Membership\" data-product-price=\"$35.00\/YEAR\" onclick=\"selectProduct('0')\" name=\"data[payment_option]\" id=\"selector-product-0\" value=\"service|prod_Lijdb0N8ao6ewQ|price_1L1IA6J0KRZWvmQRIqHTvAKc\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"selector-product-0\" class=\"form-check-label\">Annual Membership With Auto-Renew - <strong>$35.00\/YEAR<\/strong><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<!-- <div class=\"col-10 col-md-11\">\r\n\t\t\t\t\t<label for=\"selector-product-0\" class=\"form-check-label\">Annual Membership With Auto-Renew - <strong>$35.00\/YEAR<\/strong><\/label>\r\n\t\t\t\t<\/div> -->\r\n\t\t\t<\/div>\r\n            \t\t\t<p><\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" data-product-type=\"Monthly Membership\" data-product-price=\"$2.92\/MONTH\" onclick=\"selectProduct('1')\" name=\"data[payment_option]\" id=\"selector-product-1\" value=\"service|prod_LijdF6Jzx0smm5|price_1L1I9oJ0KRZWvmQRiXruh8f8\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"selector-product-1\" class=\"form-check-label\">Monthly Membership With Auto-Renew - <strong>$2.92\/MONTH<\/strong><\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<!-- <div class=\"col-10 col-md-11\">\r\n\t\t\t\t\t<label for=\"selector-product-1\" class=\"form-check-label\">Monthly Membership With Auto-Renew - <strong>$2.92\/MONTH<\/strong><\/label>\r\n\t\t\t\t<\/div> -->\r\n\t\t\t<\/div>\r\n                        <span class=\"form-helper\" data-error=\"\" id=\"helper_payment_option\"><\/span>\r\n        <\/div>\r\n\t<\/div>\r\n<\/div>\r\n<div class=\"container membership-form\">\r\n\t<div class=\"row\">\r\n        <div class=\"col-md-12 center-content\">\r\n\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t<a id=\"epih-location\" href=\"#epih-location\"><\/a>\r\n\t\t\t\t\t<h3>Next, enter your personal information:<\/h3>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" name=\"data[renewal]\" id=\"renewal_0\" value=\"0\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"renewal_0\" class=\"form-check-label\">I am a new member enrolling for the first time.<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<p><\/p>\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" name=\"data[renewal]\" id=\"renewal_1\" value=\"1\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"renewal_1\" class=\"form-check-label\">I am an existing member renewing my membership.<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_renewal\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<h6 style=\"border-bottom: 2px solid #5C76A0; padding-bottom: 5px; margin-left: 10px; padding-left: 0;\">Legal Name<\/h6>\r\n\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"first_name\" class=\"required\">First Name<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[first_name]\" id=\"first_name\" maxlength=\"64\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_first_name\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-3\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"middle_name\">Middle Name<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[middle_name]\" id=\"middle_name\" maxlength=\"64\" value=\"\">\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-5\">\r\n\t\t\t\t\t<div class=\"md-form\">\t\t\t\t\t\r\n                        <label for=\"last_name\" class=\"required\">Last Name<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[last_name]\" id=\"last_name\" maxlength=\"64\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_last_name\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-5\">\r\n\t\t\t\t\t<div class=\"md-form\">\t\t\t\t\t\r\n                        <label for=\"preferred_name\" class=\"\">Preferred Name (optional)<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[preferred_name]\" id=\"preferred_name\" maxlength=\"100\" value=\"\" >\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_preferred_name\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"address1\" class=\"required\">Address<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[address1]\" id=\"address1\" maxlength=\"64\" value=\"\" style=\"margin-bottom: 5px;\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_address1\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[address2]\" id=\"address2\" maxlength=\"64\" value=\"\">\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_address2\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"city\" class=\"required\">City<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[city]\" id=\"city\" maxlength=\"40\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_city\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<div class=\"form-select\">\r\n                            <label for=\"state\" class=\"control-label required\">State<\/label>\r\n\t\t\t\t\t\t\t<select class=\"mdb-select\" name=\"data[state]\" id=\"state\" required>\r\n\t\t\t\t\t\t\t\t<option value=\"\" disabled selected>Choose A State<\/option>\r\n\t\t\t\t\t\t\t\t                                    <option value=\"AL\">ALABAMA<\/option>\r\n                                                                    <option value=\"AK\">ALASKA<\/option>\r\n                                                                    <option value=\"AZ\">ARIZONA<\/option>\r\n                                                                    <option value=\"AR\">ARKANSAS<\/option>\r\n                                                                    <option value=\"CA\">CALIFORNIA<\/option>\r\n                                                                    <option value=\"CO\">COLORADO<\/option>\r\n                                                                    <option value=\"CT\">CONNECTICUT<\/option>\r\n                                                                    <option value=\"DE\">DELAWARE<\/option>\r\n                                                                    <option value=\"DC\">DISTRICT OF COLUMBIA<\/option>\r\n                                                                    <option value=\"FL\">FLORIDA<\/option>\r\n                                                                    <option value=\"GA\">GEORGIA<\/option>\r\n                                                                    <option value=\"HI\">HAWAII<\/option>\r\n                                                                    <option value=\"ID\">IDAHO<\/option>\r\n                                                                    <option value=\"IL\">ILLINOIS<\/option>\r\n                                                                    <option value=\"IN\">INDIANA<\/option>\r\n                                                                    <option value=\"IA\">IOWA<\/option>\r\n                                                                    <option value=\"KS\">KANSAS<\/option>\r\n                                                                    <option value=\"KY\">KENTUCKY<\/option>\r\n                                                                    <option value=\"LA\">LOUISIANA<\/option>\r\n                                                                    <option value=\"ME\">MAINE<\/option>\r\n                                                                    <option value=\"MD\">MARYLAND<\/option>\r\n                                                                    <option value=\"MA\">MASSACHUSETTS<\/option>\r\n                                                                    <option value=\"MI\">MICHIGAN<\/option>\r\n                                                                    <option value=\"MN\">MINNESOTA<\/option>\r\n                                                                    <option value=\"MS\">MISSISSIPPI<\/option>\r\n                                                                    <option value=\"MO\">MISSOURI<\/option>\r\n                                                                    <option value=\"MT\">MONTANA<\/option>\r\n                                                                    <option value=\"NE\">NEBRASKA<\/option>\r\n                                                                    <option value=\"NV\">NEVADA<\/option>\r\n                                                                    <option value=\"NH\">NEW HAMPSHIRE<\/option>\r\n                                                                    <option value=\"NJ\">NEW JERSEY<\/option>\r\n                                                                    <option value=\"NM\">NEW MEXICO<\/option>\r\n                                                                    <option value=\"NY\">NEW YORK<\/option>\r\n                                                                    <option value=\"NC\">NORTH CAROLINA<\/option>\r\n                                                                    <option value=\"ND\">NORTH DAKOTA<\/option>\r\n                                                                    <option value=\"OH\">OHIO<\/option>\r\n                                                                    <option value=\"OK\">OKLAHOMA<\/option>\r\n                                                                    <option value=\"OR\">OREGON<\/option>\r\n                                                                    <option value=\"PA\">PENNSYLVANIA<\/option>\r\n                                                                    <option value=\"RI\">RHODE ISLAND<\/option>\r\n                                                                    <option value=\"SC\">SOUTH CAROLINA<\/option>\r\n                                                                    <option value=\"SD\">SOUTH DAKOTA<\/option>\r\n                                                                    <option value=\"TN\">TENNESSEE<\/option>\r\n                                                                    <option value=\"TX\">TEXAS<\/option>\r\n                                                                    <option value=\"UT\">UTAH<\/option>\r\n                                                                    <option value=\"VT\">VERMONT<\/option>\r\n                                                                    <option value=\"VI\">VIRGIN ISLANDS<\/option>\r\n                                                                    <option value=\"VA\">VIRGINIA<\/option>\r\n                                                                    <option value=\"WA\">WASHINGTON<\/option>\r\n                                                                    <option value=\"WV\">WEST VIRGINIA<\/option>\r\n                                                                    <option value=\"WI\">WISCONSIN<\/option>\r\n                                                                    <option value=\"WY\">WYOMING<\/option>\r\n                                \t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_state\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"zip\" class=\"required\">Zip<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[zip]\" id=\"zip\" maxlength=\"10\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_zip\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\t\t\r\n\t\t\t<\/div>\t\r\n\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-3\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"phone\" class=\"required\">Home Phone<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[phone]\" id=\"phone\" maxlength=\"25\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_phone\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-3\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"cell_phone\">Cell Phone<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cell_phone]\" id=\"cell_phone\" maxlength=\"25\" value=\"\">\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cell_phone\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"email\" class=\"required\">Personal Email<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[email]\" id=\"email\" maxlength=\"64\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_email\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-5\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label for=\"birthdate_month\" class=\"control-label required\">Date of Birth<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[birthdate_month]\" id=\"birthdate_month\">\r\n                                        <option value=\"\" disabled selected>Month<\/option>\r\n                                        \t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">January<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">February<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">March<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">April<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">May<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">June<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">July<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"8\">August<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"9\">September<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"10\">October<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"11\">November<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"12\">December<\/option>\r\n\t\t\t\t\t\t\t\t\t\t                                    <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label>&nbsp;<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[birthdate_day]\" id=\"birthdate_day\">\r\n                                        <option value=\"\" disabled selected>Day<\/option>\r\n                                                                                    <option value=\"1\">1<\/option>\r\n                                                                                    <option value=\"2\">2<\/option>\r\n                                                                                    <option value=\"3\">3<\/option>\r\n                                                                                    <option value=\"4\">4<\/option>\r\n                                                                                    <option value=\"5\">5<\/option>\r\n                                                                                    <option value=\"6\">6<\/option>\r\n                                                                                    <option value=\"7\">7<\/option>\r\n                                                                                    <option value=\"8\">8<\/option>\r\n                                                                                    <option value=\"9\">9<\/option>\r\n                                                                                    <option value=\"10\">10<\/option>\r\n                                                                                    <option value=\"11\">11<\/option>\r\n                                                                                    <option value=\"12\">12<\/option>\r\n                                                                                    <option value=\"13\">13<\/option>\r\n                                                                                    <option value=\"14\">14<\/option>\r\n                                                                                    <option value=\"15\">15<\/option>\r\n                                                                                    <option value=\"16\">16<\/option>\r\n                                                                                    <option value=\"17\">17<\/option>\r\n                                                                                    <option value=\"18\">18<\/option>\r\n                                                                                    <option value=\"19\">19<\/option>\r\n                                                                                    <option value=\"20\">20<\/option>\r\n                                                                                    <option value=\"21\">21<\/option>\r\n                                                                                    <option value=\"22\">22<\/option>\r\n                                                                                    <option value=\"23\">23<\/option>\r\n                                                                                    <option value=\"24\">24<\/option>\r\n                                                                                    <option value=\"25\">25<\/option>\r\n                                                                                    <option value=\"26\">26<\/option>\r\n                                                                                    <option value=\"27\">27<\/option>\r\n                                                                                    <option value=\"28\">28<\/option>\r\n                                                                                    <option value=\"29\">29<\/option>\r\n                                                                                    <option value=\"30\">30<\/option>\r\n                                                                                    <option value=\"31\">31<\/option>\r\n                                                                            <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-4\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label>&nbsp;<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[birthdate_year]\" id=\"birthdate_year\">\r\n                                        <option value=\"\" disabled selected>Year<\/option>\r\n                                                                                    <option value=\"2026\">2026<\/option>\r\n                                                                                    <option value=\"2025\">2025<\/option>\r\n                                                                                    <option value=\"2024\">2024<\/option>\r\n                                                                                    <option value=\"2023\">2023<\/option>\r\n                                                                                    <option value=\"2022\">2022<\/option>\r\n                                                                                    <option value=\"2021\">2021<\/option>\r\n                                                                                    <option value=\"2020\">2020<\/option>\r\n                                                                                    <option value=\"2019\">2019<\/option>\r\n                                                                                    <option value=\"2018\">2018<\/option>\r\n                                                                                    <option value=\"2017\">2017<\/option>\r\n                                                                                    <option value=\"2016\">2016<\/option>\r\n                                                                                    <option value=\"2015\">2015<\/option>\r\n                                                                                    <option value=\"2014\">2014<\/option>\r\n                                                                                    <option value=\"2013\">2013<\/option>\r\n                                                                                    <option value=\"2012\">2012<\/option>\r\n                                                                                    <option value=\"2011\">2011<\/option>\r\n                                                                                    <option value=\"2010\">2010<\/option>\r\n                                                                                    <option value=\"2009\">2009<\/option>\r\n                                                                                    <option value=\"2008\">2008<\/option>\r\n                                                                                    <option value=\"2007\">2007<\/option>\r\n                                                                                    <option value=\"2006\">2006<\/option>\r\n                                                                                    <option value=\"2005\">2005<\/option>\r\n                                                                                    <option value=\"2004\">2004<\/option>\r\n                                                                                    <option value=\"2003\">2003<\/option>\r\n                                                                                    <option value=\"2002\">2002<\/option>\r\n                                                                                    <option value=\"2001\">2001<\/option>\r\n                                                                                    <option value=\"2000\">2000<\/option>\r\n                                                                                    <option value=\"1999\">1999<\/option>\r\n                                                                                    <option value=\"1998\">1998<\/option>\r\n                                                                                    <option value=\"1997\">1997<\/option>\r\n                                                                                    <option value=\"1996\">1996<\/option>\r\n                                                                                    <option value=\"1995\">1995<\/option>\r\n                                                                                    <option value=\"1994\">1994<\/option>\r\n                                                                                    <option value=\"1993\">1993<\/option>\r\n                                                                                    <option value=\"1992\">1992<\/option>\r\n                                                                                    <option value=\"1991\">1991<\/option>\r\n                                                                                    <option value=\"1990\">1990<\/option>\r\n                                                                                    <option value=\"1989\">1989<\/option>\r\n                                                                                    <option value=\"1988\">1988<\/option>\r\n                                                                                    <option value=\"1987\">1987<\/option>\r\n                                                                                    <option value=\"1986\">1986<\/option>\r\n                                                                                    <option value=\"1985\">1985<\/option>\r\n                                                                                    <option value=\"1984\">1984<\/option>\r\n                                                                                    <option value=\"1983\">1983<\/option>\r\n                                                                                    <option value=\"1982\">1982<\/option>\r\n                                                                                    <option value=\"1981\">1981<\/option>\r\n                                                                                    <option value=\"1980\">1980<\/option>\r\n                                                                                    <option value=\"1979\">1979<\/option>\r\n                                                                                    <option value=\"1978\">1978<\/option>\r\n                                                                                    <option value=\"1977\">1977<\/option>\r\n                                                                                    <option value=\"1976\">1976<\/option>\r\n                                                                                    <option value=\"1975\">1975<\/option>\r\n                                                                                    <option value=\"1974\">1974<\/option>\r\n                                                                                    <option value=\"1973\">1973<\/option>\r\n                                                                                    <option value=\"1972\">1972<\/option>\r\n                                                                                    <option value=\"1971\">1971<\/option>\r\n                                                                                    <option value=\"1970\">1970<\/option>\r\n                                                                                    <option value=\"1969\">1969<\/option>\r\n                                                                                    <option value=\"1968\">1968<\/option>\r\n                                                                                    <option value=\"1967\">1967<\/option>\r\n                                                                                    <option value=\"1966\">1966<\/option>\r\n                                                                                    <option value=\"1965\">1965<\/option>\r\n                                                                                    <option value=\"1964\">1964<\/option>\r\n                                                                                    <option value=\"1963\">1963<\/option>\r\n                                                                                    <option value=\"1962\">1962<\/option>\r\n                                                                                    <option value=\"1961\">1961<\/option>\r\n                                                                                    <option value=\"1960\">1960<\/option>\r\n                                                                                    <option value=\"1959\">1959<\/option>\r\n                                                                                    <option value=\"1958\">1958<\/option>\r\n                                                                                    <option value=\"1957\">1957<\/option>\r\n                                                                                    <option value=\"1956\">1956<\/option>\r\n                                                                                    <option value=\"1955\">1955<\/option>\r\n                                                                                    <option value=\"1954\">1954<\/option>\r\n                                                                                    <option value=\"1953\">1953<\/option>\r\n                                                                                    <option value=\"1952\">1952<\/option>\r\n                                                                                    <option value=\"1951\">1951<\/option>\r\n                                                                                    <option value=\"1950\">1950<\/option>\r\n                                                                                    <option value=\"1949\">1949<\/option>\r\n                                                                                    <option value=\"1948\">1948<\/option>\r\n                                                                                    <option value=\"1947\">1947<\/option>\r\n                                                                                    <option value=\"1946\">1946<\/option>\r\n                                                                                    <option value=\"1945\">1945<\/option>\r\n                                                                                    <option value=\"1944\">1944<\/option>\r\n                                                                                    <option value=\"1943\">1943<\/option>\r\n                                                                                    <option value=\"1942\">1942<\/option>\r\n                                                                                    <option value=\"1941\">1941<\/option>\r\n                                                                                    <option value=\"1940\">1940<\/option>\r\n                                                                                    <option value=\"1939\">1939<\/option>\r\n                                                                                    <option value=\"1938\">1938<\/option>\r\n                                                                                    <option value=\"1937\">1937<\/option>\r\n                                                                                    <option value=\"1936\">1936<\/option>\r\n                                                                                    <option value=\"1935\">1935<\/option>\r\n                                                                                    <option value=\"1934\">1934<\/option>\r\n                                                                                    <option value=\"1933\">1933<\/option>\r\n                                                                                    <option value=\"1932\">1932<\/option>\r\n                                                                                    <option value=\"1931\">1931<\/option>\r\n                                                                                    <option value=\"1930\">1930<\/option>\r\n                                                                                    <option value=\"1929\">1929<\/option>\r\n                                                                                    <option value=\"1928\">1928<\/option>\r\n                                                                                    <option value=\"1927\">1927<\/option>\r\n                                                                            <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-12\">\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_birthdate\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"county\" class=\"required\">County Name<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[county]\" id=\"county\" maxlength=\"50\" value=\"\" required>\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_county\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"retired_from\" class=\"\">Employer Name (optional)<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[retired_from]\" id=\"retired_from\" maxlength=\"50\" value=\"\" >\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_retired_from\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-5\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label for=\"retirement_month\" class=\"control-label required\">Retirement Date<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[retirement_month]\" id=\"retirement_month\">\r\n                                        <option value=\"\" disabled selected>Month<\/option>\r\n                                        \t\t\t\t\t\t\t\t\t\t\t<option value=\"1\">January<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\">February<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\">March<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\">April<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\">May<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\">June<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\">July<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"8\">August<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"9\">September<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"10\">October<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"11\">November<\/option>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"12\">December<\/option>\r\n\t\t\t\t\t\t\t\t\t\t                                    <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-3\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label>&nbsp;<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[retirement_day]\" id=\"retirement_day\">\r\n                                        <option value=\"\" disabled selected>Day<\/option>\r\n                                                                                    <option value=\"1\">1<\/option>\r\n                                                                                    <option value=\"2\">2<\/option>\r\n                                                                                    <option value=\"3\">3<\/option>\r\n                                                                                    <option value=\"4\">4<\/option>\r\n                                                                                    <option value=\"5\">5<\/option>\r\n                                                                                    <option value=\"6\">6<\/option>\r\n                                                                                    <option value=\"7\">7<\/option>\r\n                                                                                    <option value=\"8\">8<\/option>\r\n                                                                                    <option value=\"9\">9<\/option>\r\n                                                                                    <option value=\"10\">10<\/option>\r\n                                                                                    <option value=\"11\">11<\/option>\r\n                                                                                    <option value=\"12\">12<\/option>\r\n                                                                                    <option value=\"13\">13<\/option>\r\n                                                                                    <option value=\"14\">14<\/option>\r\n                                                                                    <option value=\"15\">15<\/option>\r\n                                                                                    <option value=\"16\">16<\/option>\r\n                                                                                    <option value=\"17\">17<\/option>\r\n                                                                                    <option value=\"18\">18<\/option>\r\n                                                                                    <option value=\"19\">19<\/option>\r\n                                                                                    <option value=\"20\">20<\/option>\r\n                                                                                    <option value=\"21\">21<\/option>\r\n                                                                                    <option value=\"22\">22<\/option>\r\n                                                                                    <option value=\"23\">23<\/option>\r\n                                                                                    <option value=\"24\">24<\/option>\r\n                                                                                    <option value=\"25\">25<\/option>\r\n                                                                                    <option value=\"26\">26<\/option>\r\n                                                                                    <option value=\"27\">27<\/option>\r\n                                                                                    <option value=\"28\">28<\/option>\r\n                                                                                    <option value=\"29\">29<\/option>\r\n                                                                                    <option value=\"30\">30<\/option>\r\n                                                                                    <option value=\"31\">31<\/option>\r\n                                                                            <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-4\">\r\n                            <div class=\"md-form\">\r\n                                <div class=\"form-select\">\r\n                                    <label>&nbsp;<\/label>\r\n                                    <select class=\"mdb-select\" name=\"data[retirement_year]\" id=\"retirement_year\">\r\n                                        <option value=\"\" disabled selected>Year<\/option>\r\n                                                                                    <option value=\"2046\">2046<\/option>\r\n                                                                                    <option value=\"2045\">2045<\/option>\r\n                                                                                    <option value=\"2044\">2044<\/option>\r\n                                                                                    <option value=\"2043\">2043<\/option>\r\n                                                                                    <option value=\"2042\">2042<\/option>\r\n                                                                                    <option value=\"2041\">2041<\/option>\r\n                                                                                    <option value=\"2040\">2040<\/option>\r\n                                                                                    <option value=\"2039\">2039<\/option>\r\n                                                                                    <option value=\"2038\">2038<\/option>\r\n                                                                                    <option value=\"2037\">2037<\/option>\r\n                                                                                    <option value=\"2036\">2036<\/option>\r\n                                                                                    <option value=\"2035\">2035<\/option>\r\n                                                                                    <option value=\"2034\">2034<\/option>\r\n                                                                                    <option value=\"2033\">2033<\/option>\r\n                                                                                    <option value=\"2032\">2032<\/option>\r\n                                                                                    <option value=\"2031\">2031<\/option>\r\n                                                                                    <option value=\"2030\">2030<\/option>\r\n                                                                                    <option value=\"2029\">2029<\/option>\r\n                                                                                    <option value=\"2028\">2028<\/option>\r\n                                                                                    <option value=\"2027\">2027<\/option>\r\n                                                                                    <option value=\"2026\">2026<\/option>\r\n                                                                                    <option value=\"2025\">2025<\/option>\r\n                                                                                    <option value=\"2024\">2024<\/option>\r\n                                                                                    <option value=\"2023\">2023<\/option>\r\n                                                                                    <option value=\"2022\">2022<\/option>\r\n                                                                                    <option value=\"2021\">2021<\/option>\r\n                                                                                    <option value=\"2020\">2020<\/option>\r\n                                                                                    <option value=\"2019\">2019<\/option>\r\n                                                                                    <option value=\"2018\">2018<\/option>\r\n                                                                                    <option value=\"2017\">2017<\/option>\r\n                                                                                    <option value=\"2016\">2016<\/option>\r\n                                                                                    <option value=\"2015\">2015<\/option>\r\n                                                                                    <option value=\"2014\">2014<\/option>\r\n                                                                                    <option value=\"2013\">2013<\/option>\r\n                                                                                    <option value=\"2012\">2012<\/option>\r\n                                                                                    <option value=\"2011\">2011<\/option>\r\n                                                                                    <option value=\"2010\">2010<\/option>\r\n                                                                                    <option value=\"2009\">2009<\/option>\r\n                                                                                    <option value=\"2008\">2008<\/option>\r\n                                                                                    <option value=\"2007\">2007<\/option>\r\n                                                                                    <option value=\"2006\">2006<\/option>\r\n                                                                                    <option value=\"2005\">2005<\/option>\r\n                                                                                    <option value=\"2004\">2004<\/option>\r\n                                                                                    <option value=\"2003\">2003<\/option>\r\n                                                                                    <option value=\"2002\">2002<\/option>\r\n                                                                                    <option value=\"2001\">2001<\/option>\r\n                                                                                    <option value=\"2000\">2000<\/option>\r\n                                                                                    <option value=\"1999\">1999<\/option>\r\n                                                                                    <option value=\"1998\">1998<\/option>\r\n                                                                                    <option value=\"1997\">1997<\/option>\r\n                                                                                    <option value=\"1996\">1996<\/option>\r\n                                                                                    <option value=\"1995\">1995<\/option>\r\n                                                                                    <option value=\"1994\">1994<\/option>\r\n                                                                                    <option value=\"1993\">1993<\/option>\r\n                                                                                    <option value=\"1992\">1992<\/option>\r\n                                                                                    <option value=\"1991\">1991<\/option>\r\n                                                                                    <option value=\"1990\">1990<\/option>\r\n                                                                                    <option value=\"1989\">1989<\/option>\r\n                                                                                    <option value=\"1988\">1988<\/option>\r\n                                                                                    <option value=\"1987\">1987<\/option>\r\n                                                                                    <option value=\"1986\">1986<\/option>\r\n                                                                                    <option value=\"1985\">1985<\/option>\r\n                                                                                    <option value=\"1984\">1984<\/option>\r\n                                                                                    <option value=\"1983\">1983<\/option>\r\n                                                                                    <option value=\"1982\">1982<\/option>\r\n                                                                                    <option value=\"1981\">1981<\/option>\r\n                                                                                    <option value=\"1980\">1980<\/option>\r\n                                                                                    <option value=\"1979\">1979<\/option>\r\n                                                                                    <option value=\"1978\">1978<\/option>\r\n                                                                                    <option value=\"1977\">1977<\/option>\r\n                                                                                    <option value=\"1976\">1976<\/option>\r\n                                                                                    <option value=\"1975\">1975<\/option>\r\n                                                                                    <option value=\"1974\">1974<\/option>\r\n                                                                                    <option value=\"1973\">1973<\/option>\r\n                                                                                    <option value=\"1972\">1972<\/option>\r\n                                                                                    <option value=\"1971\">1971<\/option>\r\n                                                                                    <option value=\"1970\">1970<\/option>\r\n                                                                                    <option value=\"1969\">1969<\/option>\r\n                                                                                    <option value=\"1968\">1968<\/option>\r\n                                                                                    <option value=\"1967\">1967<\/option>\r\n                                                                                    <option value=\"1966\">1966<\/option>\r\n                                                                                    <option value=\"1965\">1965<\/option>\r\n                                                                                    <option value=\"1964\">1964<\/option>\r\n                                                                                    <option value=\"1963\">1963<\/option>\r\n                                                                                    <option value=\"1962\">1962<\/option>\r\n                                                                                    <option value=\"1961\">1961<\/option>\r\n                                                                                    <option value=\"1960\">1960<\/option>\r\n                                                                                    <option value=\"1959\">1959<\/option>\r\n                                                                                    <option value=\"1958\">1958<\/option>\r\n                                                                                    <option value=\"1957\">1957<\/option>\r\n                                                                                    <option value=\"1956\">1956<\/option>\r\n                                                                                    <option value=\"1955\">1955<\/option>\r\n                                                                                    <option value=\"1954\">1954<\/option>\r\n                                                                                    <option value=\"1953\">1953<\/option>\r\n                                                                                    <option value=\"1952\">1952<\/option>\r\n                                                                                    <option value=\"1951\">1951<\/option>\r\n                                                                                    <option value=\"1950\">1950<\/option>\r\n                                                                                    <option value=\"1949\">1949<\/option>\r\n                                                                                    <option value=\"1948\">1948<\/option>\r\n                                                                                    <option value=\"1947\">1947<\/option>\r\n                                                                            <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"col-12\">\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_retirement_date\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n            <\/div>\r\n\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<p class=\"required\" style=\"margin-bottom:0px;padding-bottom:0px;\"><strong>Are you currently a TRS annuitant?<\/strong><\/p>\r\n\t\t\t\t\t<div class=\"md-form form-inline\" style=\"margin-top: 20px;\">\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" class=\"form-check-input\" name=\"data[annuitant]\" id=\"annuity_1\" value=\"yes\">\r\n\t\t\t\t\t\t\t<label for=\"annuity_1\" class=\"form-check-label\">Yes<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" class=\"form-check-input\" name=\"data[annuitant]\" id=\"annuity_2\" value=\"no\">\r\n\t\t\t\t\t\t\t<label for=\"annuity_2\" class=\"form-check-label\">No<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<br>\r\n\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_annuitant\"><\/span>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-md-12\">\r\n\t\t\t\t\t<h3>And finally, how will you be paying?<\/h3>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"row\" id=\"how_pay\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" name=\"data[payment_method]\" id=\"payment_method_card\" value=\"card\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"payment_method_card\" class=\"form-check-label\">Credit or Debit Card<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t<input type=\"radio\" name=\"data[payment_method]\" id=\"payment_method_ach\" value=\"ach\" class=\"form-check-input\">\r\n\t\t\t\t\t\t\t<label for=\"payment_method_ach\" class=\"form-check-label\">Bank Draft (ACH)<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_payment_method\"><\/span>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t<\/div>\t\t\r\n\t\t\t<input type=\"hidden\" name=\"data[stripe_token]\" id=\"stripe_token\" value=\"\">\r\n\t\t\t<input type=\"hidden\" name=\"data[plaid_public_token]\" id=\"plaid_public_token\" value=\"\">\r\n\t\t\t<input type=\"hidden\" name=\"data[plaid_account_id]\" id=\"plaid_account_id\" value=\"\">\r\n\t\t\t<div id=\"payment-by-ach\" style=\"display: none;\">\t\t\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t<button type=\"button\" id=\"plaidlinkbutton\" class=\"btn btn-lg\" style=\"background-color: #9E0022;\">Link your bank account<\/span><\/button>\r\n\t\t\t\t\t\t<p id=\"account_linked\" style=\"font-size: 17px; font-weight: 700; color: #009900; display: none;\">Your bank account has been linked.<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-12\">\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_plaid\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"payment-by-annuity\"><\/div>\r\n\t\t\t<div id=\"payment-by-card\" style=\"display: none;\">\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t<h3>Billing Information<\/h3>\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t\t<div class=\"form-check\">\r\n\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"data[same-as]\" id=\"fb-same-as\" class=\"form-check-input\" value=\"yes\">\r\n\t\t\t\t\t\t\t\t<label for=\"fb-same-as\" class=\"form-check-label\">Same as Membership Information<\/label>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div id=\"billing-address\">\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n                            <label for=\"cc_address1\" class=\"required\">Address<\/label>\r\n\t\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cc_address1]\" id=\"cc_address1\" maxlength=\"64\" style=\"margin-bottom: 5px;\">\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_address1\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cc_address2]\" id=\"cc_address2\" maxlength=\"64\">\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_address2\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n                            <label for=\"cc_city\" class=\"required\">City<\/label>\r\n\t\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cc_city]\" id=\"cc_city\" maxlength=\"40\">\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_city\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n\t\t\t\t\t\t\t<div class=\"form-select\">\r\n                                <label for=\"cc_state\" class=\"required\">State<\/label>\r\n\t\t\t\t\t\t\t\t<select class=\"mdb-select\" name=\"data[cc_state]\" id=\"cc_state\">\r\n\t\t\t\t\t\t\t\t\t<option value=\"\" disabled selected>Choose A State<\/option>\r\n                                                                        <option value=\"AL\">ALABAMA<\/option>\r\n                                                                        <option value=\"AK\">ALASKA<\/option>\r\n                                                                        <option value=\"AZ\">ARIZONA<\/option>\r\n                                                                        <option value=\"AR\">ARKANSAS<\/option>\r\n                                                                        <option value=\"CA\">CALIFORNIA<\/option>\r\n                                                                        <option value=\"CO\">COLORADO<\/option>\r\n                                                                        <option value=\"CT\">CONNECTICUT<\/option>\r\n                                                                        <option value=\"DE\">DELAWARE<\/option>\r\n                                                                        <option value=\"DC\">DISTRICT OF COLUMBIA<\/option>\r\n                                                                        <option value=\"FL\">FLORIDA<\/option>\r\n                                                                        <option value=\"GA\">GEORGIA<\/option>\r\n                                                                        <option value=\"HI\">HAWAII<\/option>\r\n                                                                        <option value=\"ID\">IDAHO<\/option>\r\n                                                                        <option value=\"IL\">ILLINOIS<\/option>\r\n                                                                        <option value=\"IN\">INDIANA<\/option>\r\n                                                                        <option value=\"IA\">IOWA<\/option>\r\n                                                                        <option value=\"KS\">KANSAS<\/option>\r\n                                                                        <option value=\"KY\">KENTUCKY<\/option>\r\n                                                                        <option value=\"LA\">LOUISIANA<\/option>\r\n                                                                        <option value=\"ME\">MAINE<\/option>\r\n                                                                        <option value=\"MD\">MARYLAND<\/option>\r\n                                                                        <option value=\"MA\">MASSACHUSETTS<\/option>\r\n                                                                        <option value=\"MI\">MICHIGAN<\/option>\r\n                                                                        <option value=\"MN\">MINNESOTA<\/option>\r\n                                                                        <option value=\"MS\">MISSISSIPPI<\/option>\r\n                                                                        <option value=\"MO\">MISSOURI<\/option>\r\n                                                                        <option value=\"MT\">MONTANA<\/option>\r\n                                                                        <option value=\"NE\">NEBRASKA<\/option>\r\n                                                                        <option value=\"NV\">NEVADA<\/option>\r\n                                                                        <option value=\"NH\">NEW HAMPSHIRE<\/option>\r\n                                                                        <option value=\"NJ\">NEW JERSEY<\/option>\r\n                                                                        <option value=\"NM\">NEW MEXICO<\/option>\r\n                                                                        <option value=\"NY\">NEW YORK<\/option>\r\n                                                                        <option value=\"NC\">NORTH CAROLINA<\/option>\r\n                                                                        <option value=\"ND\">NORTH DAKOTA<\/option>\r\n                                                                        <option value=\"OH\">OHIO<\/option>\r\n                                                                        <option value=\"OK\">OKLAHOMA<\/option>\r\n                                                                        <option value=\"OR\">OREGON<\/option>\r\n                                                                        <option value=\"PA\">PENNSYLVANIA<\/option>\r\n                                                                        <option value=\"RI\">RHODE ISLAND<\/option>\r\n                                                                        <option value=\"SC\">SOUTH CAROLINA<\/option>\r\n                                                                        <option value=\"SD\">SOUTH DAKOTA<\/option>\r\n                                                                        <option value=\"TN\">TENNESSEE<\/option>\r\n                                                                        <option value=\"TX\">TEXAS<\/option>\r\n                                                                        <option value=\"UT\">UTAH<\/option>\r\n                                                                        <option value=\"VT\">VERMONT<\/option>\r\n                                                                        <option value=\"VI\">VIRGIN ISLANDS<\/option>\r\n                                                                        <option value=\"VA\">VIRGINIA<\/option>\r\n                                                                        <option value=\"WA\">WASHINGTON<\/option>\r\n                                                                        <option value=\"WV\">WEST VIRGINIA<\/option>\r\n                                                                        <option value=\"WI\">WISCONSIN<\/option>\r\n                                                                        <option value=\"WY\">WYOMING<\/option>\r\n                                    \t\t\t\t\t\t\t\t<\/select>\r\n\t\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_state\"><\/span>\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"col-sm-4\">\r\n\t\t\t\t\t\t<div class=\"md-form\">\r\n                            <label for=\"cc_zip\" class=\"required\">Zip<\/label>\r\n\t\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cc_zip]\" id=\"cc_zip\" maxlength=\"10\" value=\"\">\r\n\t\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_zip\"><\/span>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\t\t\r\n\t\t\t\t<\/div>\t\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<h3>Credit\/Debit Card Information<\/h3>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-sm-12\">\r\n\t\t\t\t\t<div class=\"md-form\">\r\n                        <label for=\"cc_name\" class=\"required\">Name On Card<\/label>\r\n\t\t\t\t\t\t<input class=\"form-control\" type=\"text\" name=\"data[cc_name]\" id=\"cc_name\" maxlength=\"64\" value=\"\">\r\n\t\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_cc_name\"><\/span>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n                <p>&nbsp;<\/p>\r\n\t\t\t\t<div class=\"col-sm-6\">\r\n\t\t\t\t\t<div class=\"form-row\">\r\n\t\t\t\t\t\t<div id=\"card-element\" style=\"width:100%;\"><\/div>\r\n\t\t\t\t\t\t<div id=\"card-errors\" role=\"alert\" style=\"font-size: 17px; font-weight: 700; color: #990000;\"><\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"col-12\">\r\n\t\t\t\t\t<span class=\"form-helper\" data-error=\"\" id=\"helper_stripe\"><\/span>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n            <div class=\"row\">\r\n                <div class=\"col-12\">\r\n                    <hr>\r\n                <\/div>\r\n            <\/div>\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-12\">\r\n\t\t\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t\t\t<button class=\"btn btn-lg\" type=\"submit\" name=\"submit\" id=\"submit\">Submit Membership &raquo;<\/button>\r\n\t\t\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t\t\t<p>&nbsp;<\/p>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t\r\n<\/div>\r\n<\/form>\r\n\t\t<div class=\"elementor-shortcode\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-63290","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This 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