{"id":12105,"date":"2024-04-05T05:40:47","date_gmt":"2024-04-05T05:40:47","guid":{"rendered":"https:\/\/worldwomanfoundation.com\/cannesagenda\/?page_id=12105"},"modified":"2024-04-17T04:49:20","modified_gmt":"2024-04-17T04:49:20","slug":"speakers-apply","status":"publish","type":"page","link":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/speakers-apply\/","title":{"rendered":"SPEAKERS APPLY"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"12105\" class=\"elementor elementor-12105\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9bfa13a wwf_post elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9bfa13a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ebe8ae0\" data-id=\"ebe8ae0\" 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-430f74c elementor-widget elementor-widget-heading\" data-id=\"430f74c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SPEAKERS APPLY<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-24a022a speaker-form elementor-widget elementor-widget-shortcode\" data-id=\"24a022a\" 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\t\t<div class=\"elementor-shortcode\"><div id=\"quform-718a61\" class=\"quform quform-12 quform-support-page-caching\"><form id=\"quform-form-718a61\" class=\"quform-form quform-form-12\" action=\"\/davosagenda2025\/wp-json\/wp\/v2\/pages\/12105#quform-718a61\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:12,&quot;uniqueId&quot;:&quot;718a61&quot;,&quot;theme&quot;:&quot;&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\"><\/button><div class=\"quform-form-inner quform-form-inner-12\"><input type=\"hidden\" name=\"quform_form_id\" value=\"12\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"718a61\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/pages\/12105\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"mU7e2ktVxqWZDbmOfqKdc3v2gyQvUgLdpJfveawH\" \/><div class=\"quform-elements quform-elements-12 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-12_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-12_10 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_11\"><div class=\"quform-element quform-element-html quform-element-12_9 quform-cf\"><div class=\"quform-spacer\">Part 1: About you (the nominator)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_4 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_5\"><div class=\"quform-element quform-element-text quform-element-12_7 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_7\"><div class=\"quform-input quform-input-text quform-input-12_7 quform-cf\"><input type=\"text\" id=\"quform_12_7_718a61\" name=\"quform_12_7\" class=\"quform-field quform-field-text quform-field-12_7\" placeholder=\"Frist name\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_8 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_8\"><div class=\"quform-input quform-input-text quform-input-12_8 quform-cf\"><input type=\"text\" id=\"quform_12_8_718a61\" name=\"quform_12_8\" class=\"quform-field quform-field-text quform-field-12_8\" placeholder=\"Phone Number\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-12_6\"><div class=\"quform-element quform-element-text quform-element-12_3 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_3\"><div class=\"quform-input quform-input-text quform-input-12_3 quform-cf\"><input type=\"text\" id=\"quform_12_3_718a61\" name=\"quform_12_3\" class=\"quform-field quform-field-text quform-field-12_3\" placeholder=\"Last name\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-email quform-element-12_13 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-email quform-inner-12_13\"><div class=\"quform-input quform-input-email quform-input-12_13 quform-cf\"><input type=\"email\" id=\"quform_12_13_718a61\" name=\"quform_12_13\" class=\"quform-field quform-field-email quform-field-12_13\" placeholder=\"Email address\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_14 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_15\"><div class=\"quform-element quform-element-html quform-element-12_16 quform-cf\"><div class=\"quform-spacer\">Part 2: About the nominee<\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-12_18 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-12_18\"><div class=\"quform-input quform-input-checkbox quform-input-12_18 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_18[]\" id=\"quform_12_18_718a61_1\" class=\"quform-field quform-field-checkbox quform-field-12_18 quform-field-12_18_1\" value=\" I am nominating myself\" \/><label for=\"quform_12_18_718a61_1\" class=\"quform-option-label quform-option-label-12_18_1\"><span class=\"quform-option-text\"> I am nominating myself<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_19 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_20\"><div class=\"quform-element quform-element-text quform-element-12_23 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_23\"><div class=\"quform-input quform-input-text quform-input-12_23 quform-cf\"><input type=\"text\" id=\"quform_12_23_718a61\" name=\"quform_12_23\" class=\"quform-field quform-field-text quform-field-12_23\" placeholder=\"Name of nominee\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-email quform-element-12_24 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-email quform-inner-12_24\"><div class=\"quform-input quform-input-email quform-input-12_24 quform-cf\"><input type=\"email\" id=\"quform_12_24_718a61\" name=\"quform_12_24\" class=\"quform-field quform-field-email quform-field-12_24\" placeholder=\"Email address\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-select quform-element-12_26 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-select quform-inner-12_26\"><div class=\"quform-input quform-input-select quform-input-12_26 quform-cf\"><select id=\"quform_12_26_718a61\" name=\"quform_12_26\" class=\"quform-field quform-field-select quform-field-12_26\"><option value=\"\">Please select<\/option><option value=\"Afghanistan\" selected=\"selected\">Afghanistan<\/option><option value=\"\u00c5land Islands\">\u00c5land Islands<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"American Samoa\">American Samoa<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Anguilla\">Anguilla<\/option><option value=\"Antarctica\">Antarctica<\/option><option value=\"Antigua And Barbuda\">Antigua And Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Aruba\">Aruba<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bermuda\">Bermuda<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia And Herzegovina\">Bosnia And Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Bouvet Island\">Bouvet Island<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"British Indian Ocean Territory\">British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\">Brunei Darussalam<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Cayman Islands\">Cayman Islands<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Christmas Island\">Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo\">Congo<\/option><option value=\"Congo, The Democratic Republic Of The\">Congo, The Democratic Republic Of The<\/option><option value=\"Cook Islands\">Cook Islands<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote D&#039;Ivoire\">Cote D&#039;Ivoire<\/option><option value=\"Croatia (Local Name: Hrvatska)\">Croatia (Local Name: Hrvatska)<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor\">East Timor<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\">Faroe Islands<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"France, Metropolitan\">France, Metropolitan<\/option><option value=\"French Guiana\">French Guiana<\/option><option value=\"French Polynesia\">French Polynesia<\/option><option value=\"French Southern Territories\">French Southern Territories<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia\">Gambia<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Gibraltar\">Gibraltar<\/option><option value=\"Greece\">Greece<\/option><option value=\"Greenland\">Greenland<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guadeloupe\">Guadeloupe<\/option><option value=\"Guam\">Guam<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Heard And Mc Donald Islands\">Heard And Mc Donald Islands<\/option><option value=\"Holy See (Vatican City State)\">Holy See (Vatican City State)<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hong Kong\">Hong Kong<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran (Islamic Republic Of)\">Iran (Islamic Republic Of)<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, Democratic People&#039;s Republic Of\">Korea, Democratic People&#039;s Republic Of<\/option><option value=\"Korea, Republic Of\">Korea, Republic Of<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Lao People&#039;s Democratic Republic\">Lao People&#039;s Democratic Republic<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libyan Arab Jamahiriya\">Libyan Arab Jamahiriya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macau\">Macau<\/option><option value=\"Macedonia, Former Yugoslav Republic Of\">Macedonia, Former Yugoslav Republic Of<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Martinique\">Martinique<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mayotte\">Mayotte<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia, Federated States Of\">Micronesia, Federated States Of<\/option><option value=\"Moldova, Republic Of\">Moldova, Republic Of<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montserrat\">Montserrat<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"Netherlands Antilles\">Netherlands Antilles<\/option><option value=\"New Caledonia\">New Caledonia<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Niue\">Niue<\/option><option value=\"Norfolk Island\">Norfolk Island<\/option><option value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Pitcairn\">Pitcairn<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Puerto Rico\">Puerto Rico<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Reunion\">Reunion<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russian Federation\">Russian Federation<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts And Nevis\">Saint Kitts And Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent And The Grenadines\">Saint Vincent And The Grenadines<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome And Principe\">Sao Tome And Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia (Slovak Republic)\">Slovakia (Slovak Republic)<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"South Georgia, South Sandwich Islands\">South Georgia, South Sandwich Islands<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"St. Helena\">St. Helena<\/option><option value=\"St. Pierre And Miquelon\">St. Pierre And Miquelon<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Svalbard And Jan Mayen Islands\">Svalbard And Jan Mayen Islands<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syrian Arab Republic\">Syrian Arab Republic<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania, United Republic Of\">Tanzania, United Republic Of<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tokelau\">Tokelau<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad And Tobago\">Trinidad And Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Turks And Caicos Islands\">Turks And Caicos Islands<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States\">United States<\/option><option value=\"United States Minor Outlying Islands\">United States Minor Outlying Islands<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Virgin Islands (British)\">Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\">Virgin Islands (U.S.)<\/option><option value=\"Wallis And Futuna Islands\">Wallis And Futuna Islands<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Yugoslavia\">Yugoslavia<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-12_21\"><div class=\"quform-element quform-element-text quform-element-12_22 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_22\"><div class=\"quform-input quform-input-text quform-input-12_22 quform-cf\"><input type=\"text\" id=\"quform_12_22_718a61\" name=\"quform_12_22\" class=\"quform-field quform-field-text quform-field-12_22\" placeholder=\"Your Phone\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_25 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_25\"><div class=\"quform-input quform-input-text quform-input-12_25 quform-cf\"><input type=\"text\" id=\"quform_12_25_718a61\" name=\"quform_12_25\" class=\"quform-field quform-field-text quform-field-12_25\" placeholder=\"City\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-12_27 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-12_27\"><label class=\"quform-label-text\" id=\"quform_12_27_718a61_label\">Gender<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-12_27\"><div class=\"quform-input quform-input-radio quform-input-12_27 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_12_27_718a61_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_12_27\" id=\"quform_12_27_718a61_1\" class=\"quform-field quform-field-radio quform-field-12_27 quform-field-12_27_1\" value=\"Male\" \/><label for=\"quform_12_27_718a61_1\" class=\"quform-option-label quform-option-label-12_27_1\"><span class=\"quform-option-text\">Male<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_12_27\" id=\"quform_12_27_718a61_2\" class=\"quform-field quform-field-radio quform-field-12_27 quform-field-12_27_2\" value=\"Female\" \/><label for=\"quform_12_27_718a61_2\" class=\"quform-option-label quform-option-label-12_27_2\"><span class=\"quform-option-text\">Female<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_12_27\" id=\"quform_12_27_718a61_3\" class=\"quform-field quform-field-radio quform-field-12_27 quform-field-12_27_3\" value=\"Other\" \/><label for=\"quform_12_27_718a61_3\" class=\"quform-option-label quform-option-label-12_27_3\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_32 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_33\"><div class=\"quform-element quform-element-html quform-element-12_36 quform-cf\"><div class=\"quform-spacer\">Under which of the following categories would this person fall?<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_28 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_29\"><div class=\"quform-element quform-element-checkbox quform-element-12_38 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-12_38\"><div class=\"quform-input quform-input-checkbox quform-input-12_38 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_1\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_1\" value=\"Adventure\/Exploration\" \/><label for=\"quform_12_38_718a61_1\" class=\"quform-option-label quform-option-label-12_38_1\"><span class=\"quform-option-text\">Adventure\/Exploration<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_2\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_2\" value=\"Architecture\" \/><label for=\"quform_12_38_718a61_2\" class=\"quform-option-label quform-option-label-12_38_2\"><span class=\"quform-option-text\">Architecture<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_3\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_3\" value=\"Art\/Design\/Literature\" \/><label for=\"quform_12_38_718a61_3\" class=\"quform-option-label quform-option-label-12_38_3\"><span class=\"quform-option-text\">Art\/Design\/Literature<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_8\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_8\" value=\"Business\/Economics\" \/><label for=\"quform_12_38_718a61_8\" class=\"quform-option-label quform-option-label-12_38_8\"><span class=\"quform-option-text\">Business\/Economics<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_7\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_7\" value=\"Education\" \/><label for=\"quform_12_38_718a61_7\" class=\"quform-option-label quform-option-label-12_38_7\"><span class=\"quform-option-text\">Education<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_38[]\" id=\"quform_12_38_718a61_6\" class=\"quform-field quform-field-checkbox quform-field-12_38 quform-field-12_38_6\" value=\"Environment\" \/><label for=\"quform_12_38_718a61_6\" class=\"quform-option-label quform-option-label-12_38_6\"><span class=\"quform-option-text\">Environment<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-12_30\"><div class=\"quform-element quform-element-checkbox quform-element-12_39 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-12_39\"><div class=\"quform-input quform-input-checkbox quform-input-12_39 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_39[]\" id=\"quform_12_39_718a61_1\" class=\"quform-field quform-field-checkbox quform-field-12_39 quform-field-12_39_1\" value=\"Food\/Agriculture\" \/><label for=\"quform_12_39_718a61_1\" class=\"quform-option-label quform-option-label-12_39_1\"><span class=\"quform-option-text\">Food\/Agriculture<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_39[]\" id=\"quform_12_39_718a61_2\" class=\"quform-field quform-field-checkbox quform-field-12_39 quform-field-12_39_2\" value=\"Law\/Human Rights\" \/><label for=\"quform_12_39_718a61_2\" class=\"quform-option-label quform-option-label-12_39_2\"><span class=\"quform-option-text\">Law\/Human Rights<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_39[]\" id=\"quform_12_39_718a61_3\" class=\"quform-field quform-field-checkbox quform-field-12_39 quform-field-12_39_3\" value=\"Media\/Entertainment\" \/><label for=\"quform_12_39_718a61_3\" class=\"quform-option-label quform-option-label-12_39_3\"><span class=\"quform-option-text\">Media\/Entertainment<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_39[]\" id=\"quform_12_39_718a61_8\" class=\"quform-field quform-field-checkbox quform-field-12_39 quform-field-12_39_8\" value=\"Music\" \/><label for=\"quform_12_39_718a61_8\" class=\"quform-option-label quform-option-label-12_39_8\"><span class=\"quform-option-text\">Music<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_39[]\" id=\"quform_12_39_718a61_7\" class=\"quform-field quform-field-checkbox quform-field-12_39 quform-field-12_39_7\" value=\"Religion\/Spirituality\" \/><label for=\"quform_12_39_718a61_7\" class=\"quform-option-label quform-option-label-12_39_7\"><span class=\"quform-option-text\">Religion\/Spirituality<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-12_31\"><div class=\"quform-element quform-element-checkbox quform-element-12_37 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-checkbox quform-inner-12_37\"><div class=\"quform-input quform-input-checkbox quform-input-12_37 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_37[]\" id=\"quform_12_37_718a61_1\" class=\"quform-field quform-field-checkbox quform-field-12_37 quform-field-12_37_1\" value=\"Science\/Medicine\" \/><label for=\"quform_12_37_718a61_1\" class=\"quform-option-label quform-option-label-12_37_1\"><span class=\"quform-option-text\">Science\/Medicine<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_37[]\" id=\"quform_12_37_718a61_2\" class=\"quform-field quform-field-checkbox quform-field-12_37 quform-field-12_37_2\" value=\"Social Sciences\" \/><label for=\"quform_12_37_718a61_2\" class=\"quform-option-label quform-option-label-12_37_2\"><span class=\"quform-option-text\">Social Sciences<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_37[]\" id=\"quform_12_37_718a61_3\" class=\"quform-field quform-field-checkbox quform-field-12_37 quform-field-12_37_3\" value=\"Sports\" \/><label for=\"quform_12_37_718a61_3\" class=\"quform-option-label quform-option-label-12_37_3\"><span class=\"quform-option-text\">Sports<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_37[]\" id=\"quform_12_37_718a61_8\" class=\"quform-field quform-field-checkbox quform-field-12_37 quform-field-12_37_8\" value=\"Technology\" \/><label for=\"quform_12_37_718a61_8\" class=\"quform-option-label quform-option-label-12_37_8\"><span class=\"quform-option-text\">Technology<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_12_37[]\" id=\"quform_12_37_718a61_7\" class=\"quform-field quform-field-checkbox quform-field-12_37 quform-field-12_37_7\" value=\"Other\" \/><label for=\"quform_12_37_718a61_7\" class=\"quform-option-label quform-option-label-12_37_7\"><span class=\"quform-option-text\">Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-12_40 quform-1-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-12_41\"><div class=\"quform-element quform-element-textarea quform-element-12_43 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-textarea quform-inner-12_43 quform-field-size-slim\"><div class=\"quform-input quform-input-textarea quform-input-12_43 quform-cf\"><textarea id=\"quform_12_43_718a61\" name=\"quform_12_43\" class=\"quform-field quform-field-textarea quform-field-12_43\" placeholder=\"Has this person spoken publicly before? If so, where?\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_44 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_44\"><div class=\"quform-input quform-input-text quform-input-12_44 quform-cf\"><input type=\"text\" id=\"quform_12_44_718a61\" name=\"quform_12_44\" class=\"quform-field quform-field-text quform-field-12_44\" placeholder=\"Please provide links to online video or audio featuring the proposed speaker.\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_45 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_45\"><div class=\"quform-input quform-input-text quform-input-12_45 quform-cf\"><input type=\"text\" id=\"quform_12_45_718a61\" name=\"quform_12_45\" class=\"quform-field quform-field-text quform-field-12_45\" placeholder=\"Please provide links to any articles or web pages about the speaker.\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_46 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_46\"><div class=\"quform-input quform-input-text quform-input-12_46 quform-cf\"><input type=\"text\" id=\"quform_12_46_718a61\" name=\"quform_12_46\" class=\"quform-field quform-field-text quform-field-12_46\" placeholder=\"Facebook Link\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-12_47 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-12_47\"><div class=\"quform-input quform-input-text quform-input-12_47 quform-cf\"><input type=\"text\" id=\"quform_12_47_718a61\" name=\"quform_12_47\" class=\"quform-field quform-field-text quform-field-12_47\" placeholder=\"Twitter Link\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-12_48 quform-cf\"><div class=\"quform-spacer\">Questions? Contact Us<br>\n<a href=\"+1(424)2488958\">+1 (424) 248 8958<\/a><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-12_2 quform-cf quform-button-style-theme quform-button-width-tiny\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-12_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Send<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_12_0_718a61\">This field should be left blank<\/label><input type=\"text\" id=\"quform_12_0_718a61\" name=\"quform_12_0\" class=\"quform-field quform-field-tree quform-field-12_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a403da4 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-widget elementor-widget-shortcode\" data-id=\"a403da4\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"speaker-nomination\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style>\n.formbox .form-title {\n    color: #fff;\n}\n.formbox label {\n    color: #fff;\n}\n.formbox .phoneblock {\n    color: #fff;\n}\n\t.formbox input.button.button-red {\n    background-color: #72CC51;\n    color: #ffffff;\n    border: 0px;\n}\n<\/style>\n\t<div class=\"formbox\">\n\t<form action=\"\" method=\"post\" class=\"form\">\n\t\t<div class=\"container\">\n\t\t\t<div class=\"form-block\">\n\t\t\t\t<div class=\"form-title\">Part 1: About you (the nominator)<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"custonname\" placeholder=\"First name\" class=\"input\" required \/><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"custonlname\" placeholder=\"Last name\" class=\"input\" required \/><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"custonphone\" placeholder=\"Your phone\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"email\" name=\"custonemail\" placeholder=\"Email address\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form-title\">Part 2: About the nominee<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<div class=\"checkbox-block checkbox-block-first\">\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Tours\"><span><\/span> I am nominating myself<\/label><\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><!-- checkbox-block -->\n\t\t\t\t\t\t<!-- checkbox-block -->\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"nominee\" placeholder=\"Name of nominee\" class=\"input\" required \/><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"phone2\" placeholder=\"Your phone\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"email\" name=\"email2\" placeholder=\"Email address\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"city\" placeholder=\"City\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<p>\n\t\t\t\t\t\t\t<select name=\"country\" class=\"input\" required>\n\t\t\t\t\t\t\t\t<option value=\"AFG\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ALA\">\u00c5land Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ALB\">Albania<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DZA\">Algeria<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ASM\">American Samoa<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AND\">Andorra<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AGO\">Angola<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AIA\">Anguilla<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ATA\">Antarctica<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ATG\">Antigua and Barbuda<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ARG\">Argentina<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ARM\">Armenia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ABW\">Aruba<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AUS\">Australia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AUT\">Austria<\/option>\n\t\t\t\t\t\t\t\t<option value=\"AZE\">Azerbaijan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BHS\">Bahamas<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BHR\">Bahrain<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BGD\">Bangladesh<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BRB\">Barbados<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BLR\">Belarus<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BEL\">Belgium<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BLZ\">Belize<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BEN\">Benin<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BMU\">Bermuda<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BTN\">Bhutan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BOL\">Bolivia, Plurinational State of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BES\">Bonaire, Sint Eustatius and Saba<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BIH\">Bosnia and Herzegovina<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BWA\">Botswana<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BVT\">Bouvet Island<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BRA\">Brazil<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IOT\">British Indian Ocean Territory<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BRN\">Brunei Darussalam<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BGR\">Bulgaria<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BFA\">Burkina Faso<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BDI\">Burundi<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KHM\">Cambodia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CMR\">Cameroon<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CAN\">Canada<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CPV\">Cape Verde<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CYM\">Cayman Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CAF\">Central African Republic<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TCD\">Chad<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CHL\">Chile<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CHN\">China<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CXR\">Christmas Island<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CCK\">Cocos (Keeling) Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"COL\">Colombia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"COM\">Comoros<\/option>\n\t\t\t\t\t\t\t\t<option value=\"COG\">Congo<\/option>\n\t\t\t\t\t\t\t\t<option value=\"COD\">Congo, the Democratic Republic of the<\/option>\n\t\t\t\t\t\t\t\t<option value=\"COK\">Cook Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CRI\">Costa Rica<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CIV\">C\u00f4te d'Ivoire<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HRV\">Croatia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CUB\">Cuba<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CUW\">Cura\u00e7ao<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CYP\">Cyprus<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CZE\">Czech Republic<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DNK\">Denmark<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DJI\">Djibouti<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DMA\">Dominica<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DOM\">Dominican Republic<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ECU\">Ecuador<\/option>\n\t\t\t\t\t\t\t\t<option value=\"EGY\">Egypt<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SLV\">El Salvador<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GNQ\">Equatorial Guinea<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ERI\">Eritrea<\/option>\n\t\t\t\t\t\t\t\t<option value=\"EST\">Estonia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ETH\">Ethiopia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FLK\">Falkland Islands (Malvinas)<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FRO\">Faroe Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FJI\">Fiji<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FIN\">Finland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FRA\">France<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GUF\">French Guiana<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PYF\">French Polynesia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ATF\">French Southern Territories<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GAB\">Gabon<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GMB\">Gambia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GEO\">Georgia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"DEU\">Germany<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GHA\">Ghana<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GIB\">Gibraltar<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GRC\">Greece<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GRL\">Greenland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GRD\">Grenada<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GLP\">Guadeloupe<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GUM\">Guam<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GTM\">Guatemala<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GGY\">Guernsey<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GIN\">Guinea<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GNB\">Guinea-Bissau<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GUY\">Guyana<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HTI\">Haiti<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HMD\">Heard Island and McDonald Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VAT\">Holy See (Vatican City State)<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HND\">Honduras<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HKG\">Hong Kong<\/option>\n\t\t\t\t\t\t\t\t<option value=\"HUN\">Hungary<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ISL\">Iceland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IND\">India<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IDN\">Indonesia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IRN\">Iran, Islamic Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IRQ\">Iraq<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IRL\">Ireland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"IMN\">Isle of Man<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ISR\">Israel<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ITA\">Italy<\/option>\n\t\t\t\t\t\t\t\t<option value=\"JAM\">Jamaica<\/option>\n\t\t\t\t\t\t\t\t<option value=\"JPN\">Japan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"JEY\">Jersey<\/option>\n\t\t\t\t\t\t\t\t<option value=\"JOR\">Jordan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KAZ\">Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KEN\">Kenya<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KIR\">Kiribati<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PRK\">Korea, Democratic People's Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KOR\">Korea, Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KWT\">Kuwait<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KGZ\">Kyrgyzstan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LAO\">Lao People's Democratic Republic<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LVA\">Latvia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LBN\">Lebanon<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LSO\">Lesotho<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LBR\">Liberia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LBY\">Libya<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LIE\">Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LTU\">Lithuania<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LUX\">Luxembourg<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MAC\">Macao<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MKD\">Macedonia, the former Yugoslav Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MDG\">Madagascar<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MWI\">Malawi<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MYS\">Malaysia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MDV\">Maldives<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MLI\">Mali<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MLT\">Malta<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MHL\">Marshall Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MTQ\">Martinique<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MRT\">Mauritania<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MUS\">Mauritius<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MYT\">Mayotte<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MEX\">Mexico<\/option>\n\t\t\t\t\t\t\t\t<option value=\"FSM\">Micronesia, Federated States of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MDA\">Moldova, Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MCO\">Monaco<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MNG\">Mongolia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MNE\">Montenegro<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MSR\">Montserrat<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MAR\">Morocco<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MOZ\">Mozambique<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MMR\">Myanmar<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NAM\">Namibia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NRU\">Nauru<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NPL\">Nepal<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NLD\">Netherlands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NCL\">New Caledonia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NZL\">New Zealand<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NIC\">Nicaragua<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NER\">Niger<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NGA\">Nigeria<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NIU\">Niue<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NFK\">Norfolk Island<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MNP\">Northern Mariana Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"NOR\">Norway<\/option>\n\t\t\t\t\t\t\t\t<option value=\"OMN\">Oman<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PAK\">Pakistan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PLW\">Palau<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PSE\">Palestinian Territory, Occupied<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PAN\">Panama<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PNG\">Papua New Guinea<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PRY\">Paraguay<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PER\">Peru<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PHL\">Philippines<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PCN\">Pitcairn<\/option>\n\t\t\t\t\t\t\t\t<option value=\"POL\">Poland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PRT\">Portugal<\/option>\n\t\t\t\t\t\t\t\t<option value=\"PRI\">Puerto Rico<\/option>\n\t\t\t\t\t\t\t\t<option value=\"QAT\">Qatar<\/option>\n\t\t\t\t\t\t\t\t<option value=\"REU\">R\u00e9union<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ROU\">Romania<\/option>\n\t\t\t\t\t\t\t\t<option value=\"RUS\">Russian Federation<\/option>\n\t\t\t\t\t\t\t\t<option value=\"RWA\">Rwanda<\/option>\n\t\t\t\t\t\t\t\t<option value=\"BLM\">Saint Barth\u00e9lemy<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SHN\">Saint Helena, Ascension and Tristan da Cunha<\/option>\n\t\t\t\t\t\t\t\t<option value=\"KNA\">Saint Kitts and Nevis<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LCA\">Saint Lucia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"MAF\">Saint Martin (French part)<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SPM\">Saint Pierre and Miquelon<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VCT\">Saint Vincent and the Grenadines<\/option>\n\t\t\t\t\t\t\t\t<option value=\"WSM\">Samoa<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SMR\">San Marino<\/option>\n\t\t\t\t\t\t\t\t<option value=\"STP\">Sao Tome and Principe<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SAU\">Saudi Arabia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SEN\">Senegal<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SRB\">Serbia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SYC\">Seychelles<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SLE\">Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SGP\">Singapore<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SXM\">Sint Maarten (Dutch part)<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SVK\">Slovakia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SVN\">Slovenia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SLB\">Solomon Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SOM\">Somalia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ZAF\">South Africa<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SGS\">South Georgia and the South Sandwich Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SSD\">South Sudan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ESP\">Spain<\/option>\n\t\t\t\t\t\t\t\t<option value=\"LKA\">Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SDN\">Sudan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SUR\">Suriname<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SJM\">Svalbard and Jan Mayen<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SWZ\">Swaziland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SWE\">Sweden<\/option>\n\t\t\t\t\t\t\t\t<option value=\"CHE\">Switzerland<\/option>\n\t\t\t\t\t\t\t\t<option value=\"SYR\">Syrian Arab Republic<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TWN\">Taiwan, Province of China<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TJK\">Tajikistan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TZA\">Tanzania, United Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"THA\">Thailand<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TLS\">Timor-Leste<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TGO\">Togo<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TKL\">Tokelau<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TON\">Tonga<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TTO\">Trinidad and Tobago<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TUN\">Tunisia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TUR\">Turkey<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TKM\">Turkmenistan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TCA\">Turks and Caicos Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"TUV\">Tuvalu<\/option>\n\t\t\t\t\t\t\t\t<option value=\"UGA\">Uganda<\/option>\n\t\t\t\t\t\t\t\t<option value=\"UKR\">Ukraine<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ARE\">United Arab Emirates<\/option>\n\t\t\t\t\t\t\t\t<option value=\"GBR\">United Kingdom<\/option>\n\t\t\t\t\t\t\t\t<option value=\"USA\">United States<\/option>\n\t\t\t\t\t\t\t\t<option value=\"UMI\">United States Minor Outlying Islands<\/option>\n\t\t\t\t\t\t\t\t<option value=\"URY\">Uruguay<\/option>\n\t\t\t\t\t\t\t\t<option value=\"UZB\">Uzbekistan<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VUT\">Vanuatu<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VEN\">Venezuela, Bolivarian Republic of<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VNM\">Viet Nam<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VGB\">Virgin Islands, British<\/option>\n\t\t\t\t\t\t\t\t<option value=\"VIR\">Virgin Islands, U.S.<\/option>\n\t\t\t\t\t\t\t\t<option value=\"WLF\">Wallis and Futuna<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ESH\">Western Sahara<\/option>\n\t\t\t\t\t\t\t\t<option value=\"YEM\">Yemen<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ZMB\">Zambia<\/option>\n\t\t\t\t\t\t\t\t<option value=\"ZWE\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-6 col-sm-6 col-xs-12\">\n\t\t\t\t\t\t<div class=\"checkbox-block\">\n\t\t\t\t\t\t\t<label>Gender<\/label>\n\t\t\t\t\t   \t\t<p><input type=\"radio\" name=\"radio\" value=\"Male\"><span><\/span> <label>Male<\/label> <input type=\"radio\" name=\"radio\" value=\"Female\"><span><\/span> <label>Female<\/label> <input type=\"radio\" name=\"radio\" value=\"Other\"><span><\/span> <label>Other<\/label> <\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t   <p><div class=\"checkbox-block\"><label>Under which of the following categories would this person fall?<\/label><\/div><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-4 col-sm-4 col-xs-12\">\n\t\t\t\t\t   <div class=\"checkbox-block checkbox-block-first\">\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Adventure\/Exploration\"><span><\/span> Adventure\/Exploration<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Architecture\"><span><\/span> Architecture<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Art\/Design\/Literature\"><span><\/span> Art\/Design\/Literature<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Business\/Economics\"><span><\/span> Business\/Economics<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Education\"><span><\/span> Education<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Environment\"><span><\/span> Environment<\/label><\/p>\n\t\t\t\t\t\t<\/div><!-- checkbox-block -->\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4 col-sm-4 col-xs-12\">\n\t\t\t\t\t\t<div class=\"checkbox-block\">\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Food\/Agriculture\"><span><\/span> Food\/Agriculture<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Law\/Human Rights\"><span><\/span> Law\/Human Rights<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Media\/Entertainment\"><span><\/span> Media\/Entertainment<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Music\"><span><\/span> Music<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Religion\/Spirituality\"><span><\/span> Religion\/Spirituality<\/label><\/p>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4 col-sm-4 col-xs-12\">\n\t\t\t\t\t\t<div class=\"checkbox-block\">\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Science\/Medicine\"><span><\/span> Science\/Medicine<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Social Sciences\"><span><\/span> Social Sciences<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Sports\"><span><\/span> Sports<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Technology\"><span><\/span> Technology<\/label><\/p>\n\t\t\t\t\t\t\t<p><label><input type=\"checkbox\" name=\"comments[Options]\" value=\"Other\"><span><\/span> Other<\/label><\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"row\">\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<p><textarea class=\"input\" rows=\"4\" name=\"spoken\" placeholder=\"Has this person spoken publicly before? If so, where?\"><\/textarea><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"video-links\" placeholder=\"Please provide links to online video or audio featuring the proposed speaker.\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"article-links\" placeholder=\"Please provide links to any articles or web pages about the speaker.\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"facebook-links\" placeholder=\"Facebook Link\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12 col-sm-12 col-xs-12\">\n\t\t\t\t\t\t<p><input type=\"text\" name=\"twitter-links\" placeholder=\"Twitter Link\" class=\"input\" required><\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clearfix\"><\/div>\n\t\t\t\t<div class=\"phoneblock\">Questions? Contact&nbsp;Us <br><span><a href=\"tel:+14242488958\">+1 (424) <b> 248 8958<\/b><\/a><\/span><\/div>\n\t\t\t\t<p class=\"submit\"><input type=\"submit\" name=\"submitformspeaker\" value=\"Submit\" class=\"button button-red\"><\/p>\n\t\t\t<\/div><!-- form-block -->\n\t\t<\/div>\n\t<\/form>\t\n<\/div>\n\t\n<\/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":"<p>SPEAKERS APPLY<\/p>\n","protected":false},"author":2448,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-12105","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/pages\/12105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/users\/2448"}],"replies":[{"embeddable":true,"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/comments?post=12105"}],"version-history":[{"count":44,"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/pages\/12105\/revisions"}],"predecessor-version":[{"id":12306,"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/pages\/12105\/revisions\/12306"}],"wp:attachment":[{"href":"https:\/\/worldwomanfoundation.com\/davosagenda2025\/wp-json\/wp\/v2\/media?parent=12105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}