{"id":209300,"date":"2021-07-28T13:27:26","date_gmt":"2021-07-28T18:27:26","guid":{"rendered":"https:\/\/\/?page_id=209300"},"modified":"2024-07-26T11:08:51","modified_gmt":"2024-07-26T16:08:51","slug":"pledge-form","status":"publish","type":"page","link":"https:\/\/\/pledge-form\/","title":{"rendered":"Pledge Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"209300\" class=\"elementor elementor-209300\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-443eaf7b e-flex e-con-boxed e-con e-parent\" data-id=\"443eaf7b\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-1248c2f7 e-con-full e-flex e-con e-child\" data-id=\"1248c2f7\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4a3f2cbc elementor-widget elementor-widget-text-editor\" data-id=\"4a3f2cbc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 05-08-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Thank you for partnering with an empowerment group of orphaned and vulnerable children!<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d8ad1d9 elementor-widget elementor-widget-text-editor\" data-id=\"d8ad1d9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>By completing the following form you are pledging your financial support to Zoe Empowers so that the children can receive the training and resources necessary to transform their lives in a three year period. If you have any questions while completing the form below, please feel free to contact Laura Nemecek at\u00a0<a href=\"mailto:laura.nemecek@\">laura.nemecek@<\/a>\u00a0(919-357-2074).<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-56dadf26 e-flex e-con-boxed e-con e-parent\" data-id=\"56dadf26\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-6b253772 e-con-full e-flex e-con e-child\" data-id=\"6b253772\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-646d29f1 e-flex e-con-boxed e-con e-child\" data-id=\"646d29f1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-eecc763 elementor-position-left elementor-vertical-align-middle elementor-view-default elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"eecc763\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/\/wp-content\/uploads\/elementor\/css\/custom-widget-icon-box.min.css?ver=1723841739\">\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon elementor-animation-\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"Layer_2\" viewBox=\"0 0 128 128\"><defs><style>.cls-1{stroke-linecap:square;}.cls-1,.cls-2{fill:none;stroke:#82ba59;stroke-miterlimit:40;stroke-width:8px;}<\/style><\/defs><g id=\"Layer_1-2\"><path class=\"cls-2\" d=\"m42.85,54.88c-1.92-4.06-6.06-6.88-10.85-6.88h-16c-6.63,0-12,5.37-12,12v20h8v28h24\"><\/path><circle class=\"cls-1\" cx=\"24\" cy=\"24\" r=\"12\"><\/circle><path class=\"cls-2\" d=\"m85.15,54.88c1.92-4.06,6.06-6.88,10.85-6.88h16c6.63,0,12,5.37,12,12v20h-8v28h-24\"><\/path><circle class=\"cls-1\" cx=\"104\" cy=\"24\" r=\"12\"><\/circle><path class=\"cls-1\" d=\"m76,124h-24v-32h-12v-28c0-8.84,7.16-16,16-16h16c8.84,0,16,7.16,16,16v28h-12v32Z\"><\/path><circle class=\"cls-1\" cx=\"64\" cy=\"20\" r=\"16\"><\/circle><\/g><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tCreate Your Partnership Pledge\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tTo ensure a seamless experience, your information is saved automatically as you enter it.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_33' style='display:none'><div id='gf_33' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_33'  action='\/wp-json\/wp\/v2\/pages\/209300#gf_33' data-formid='33' novalidate><input id=\"gpnf_session_hash_33\" type=\"hidden\" name=\"gpnf_session_hash\" value=\"443fae4507a2\"><input id=partial_entry_id_33 class=\"partial_entry_id\" type=hidden name=\"partial_entry_id\" value=\"pending\" data-form_id=\"33\"\/><input id=\"gw_page_progression\" name=\"gw_page_progression\" value=\"1\" type=\"hidden\" \/><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lf2GM0ZAAAAAI7oaAyCzodJ2ZS7QVm5KoyrJVSl' data-tabindex='0'><input id=\"input_49cec81e138c95c8714cdd3313d76949\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_49cec81e138c95c8714cdd3313d76949\" value=\"\"\/><\/div><div id='gf_page_steps_33' class='gf_page_steps'><div id='gf_step_33_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Partnership Details<\/span><\/div><div id='gf_step_33_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Contact Information<\/span><\/div><div id='gf_step_33_3' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Payment Options<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_33_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_33' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_33_98\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_98\" ><h3 class=\"gsection_title\">Partnership Details<\/h3><\/div><div id=\"field_33_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_65\" ><label class='gfield_label gform-field-label' for='input_33_65'>Name of individual(s), family, church, or organization entering into this three-year partnership:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_33_65' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_33_68\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_68\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Primary Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_33_68'>\n                            \n                            <span id='input_33_68_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_68.3' id='input_33_68_3' value=''   aria-required='true'   placeholder='First Name' autocomplete=\"given-name\" \/>\n                                                    <label for='input_33_68_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_33_68_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_68.6' id='input_33_68_6' value=''   aria-required='true'   placeholder='Last Name' autocomplete=\"family-name\" \/>\n                                                    <label for='input_33_68_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_33_70\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_70\" ><label class='gfield_label gform-field-label' for='input_33_70'>Primary Contact Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_70' id='input_33_70' type='email' value='' class='large'   placeholder='email@domain.com' aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_33_69\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_69\" ><label class='gfield_label gform-field-label' for='input_33_69'>Primary Contact Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_69' id='input_33_69' type='tel' value='' class='large'  placeholder='(123) 456-7890' aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><div id=\"field_33_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_71\" ><label class='gfield_label gform-field-label' for='input_33_71'>Church Affiliation for Individuals (Optional)<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_33_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_33_95\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_95\" ><label class='gfield_label gform-field-label' for='input_33_95'>I\/We would like our partnership to begin in:<\/label><div class='ginput_container ginput_container_select'><select name='input_95' id='input_33_95' class='large gfield_select'     aria-invalid=\"false\" ><option value='2024' >2024<\/option><option value='2025' >2025<\/option><\/select><\/div><\/div><fieldset id=\"field_33_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_74\" ><legend class='gfield_label gform-field-label' >My\/our partnership level will be:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_33_74'>\n\t\t\t<div class='gchoice gchoice_33_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Multiple Group Partnership: $9,000 per group per year for 3 years'  id='choice_33_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_74_0' id='label_33_74_0' class='gform-field-label gform-field-label--type-inline'>Multiple Group Partnership: $9,000 per group per year for 3 years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_33_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Full Partnership: $9,000 per year for 3 years'  id='choice_33_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_74_1' id='label_33_74_1' class='gform-field-label gform-field-label--type-inline'>Full Partnership: $9,000 per year for 3 years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_33_74_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Half Partnership: $4,500 per year for 3 years'  id='choice_33_74_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_74_2' id='label_33_74_2' class='gform-field-label gform-field-label--type-inline'>Half Partnership: $4,500 per year for 3 years<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_33_75\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_75\" ><label class='gfield_label gform-field-label' for='input_33_75'>How many groups would you like to partner with?<\/label><div class='ginput_container ginput_container_number'><input name='input_75' id='input_33_75' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_33_97\" class=\"gfield gfield--type-multiselect gfield--input-type-multiselect gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_97\" ><label class='gfield_label gform-field-label' for='input_33_97'>Which countries would you like to partner with groups from?<\/label><div class='gfield_description' id='gfield_description_33_97'>Zoe Empowers has groups available in Kenya, Rwanda, Zimbabwe, Malawi, Liberia, India, Tanzania, Mozambique, South Sudan, and Uganda. You may also specify \"countries with greatest need,\" to partner with groups in countries with the highest need.<\/div><div class='ginput_container ginput_container_multiselect'><select multiple='multiple' data-placeholder='Click to select...' size='7' name='input_97[]' id='input_33_97' class='large gfield_select'   aria-invalid=\"false\"  aria-describedby=\"gfield_description_33_97\"><option value='Country with Greatest Need' >Country with Greatest Need<\/option><option value='Kenya' >Kenya<\/option><option value='Rwanda' >Rwanda<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Malawi' >Malawi<\/option><option value='Liberia' >Liberia<\/option><option value='Chennai, India' >Chennai, India<\/option><option value='Vizag, India' >Vizag, India<\/option><option value='Tanzania' >Tanzania<\/option><option value='Mozambique' >Mozambique<\/option><option value='South Sudan' >South Sudan<\/option><option value='Uganda' >Uganda<\/option><option value='To Be Determined' >To Be Determined<\/option><\/select><\/div><\/div><div id=\"field_33_77\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_77\" ><label class='gfield_label gform-field-label' for='input_33_77'>I\/We would like to request the following country:<\/label><div class='ginput_container ginput_container_select'><select name='input_77' id='input_33_77' class='large gfield_select'     aria-invalid=\"false\" ><option value='Country with greatest need' >Country with greatest need<\/option><option value='Kenya' >Kenya<\/option><option value='Rwanda' >Rwanda<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Malawi' >Malawi<\/option><option value='Liberia' >Liberia<\/option><option value='Chennai, India' >Chennai, India<\/option><option value='Vizag, India' >Vizag, India<\/option><option value='Tanzania' >Tanzania<\/option><option value='Mozambique' >Mozambique<\/option><option value='South Sudan' >South Sudan<\/option><option value='Uganda' >Uganda<\/option><option value='To be determined' >To be determined<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_33_88' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_33\").val(\"2\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_33\").val(\"2\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_33_2' class='gform_page' data-js='page-field-id-88' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_33_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_33_94\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_94\" ><h3 class=\"gsection_title\">Contact Information<\/h3><\/div><fieldset id=\"field_33_19\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_19\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mailing Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_33_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_33_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_33_19_1' value=''    aria-required='false'    \/>\n                                        <label for='input_33_19_1' id='input_33_19_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_33_19_2_container' >\n                                        <input type='text' name='input_19.2' id='input_33_19_2' value=''     aria-required='false'   \/>\n                                        <label for='input_33_19_2' id='input_33_19_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_33_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_33_19_3' value=''    aria-required='false'    \/>\n                                    <label for='input_33_19_3' id='input_33_19_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_33_19_4_container' >\n                                        <select name='input_19.4' id='input_33_19_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_33_19_4' id='input_33_19_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_33_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_33_19_5' value=''    aria-required='false'    \/>\n                                    <label for='input_33_19_5' id='input_33_19_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_33_19_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_33_93\" class=\"gfield gfield--type-form gfield--input-type-form gform-theme__no-reset--children gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_93\" ><label class='gfield_label gform-field-label' for='input_33_93'>Add additional contacts for receiving partnership reports and Zoe updates<\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-1\">\n\t\t\t\t\tName\t\t\t\t<\/th>\n\t\t\t\t\t\t<th class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Name\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit Additional Contact {0} where Name is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete Additional Contact {0} where Name is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"2\">\n\t\t\t\tThere are no <span>Additional Contacts.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"33\"\n\t\t        data-nestedformid=\"73\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd Additional Contact\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of additional contacts reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_93\"\n                id=\"input_33_93\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><\/div><fieldset id=\"field_33_83\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_83\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Request Additional Information:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_33_83'><div class='gchoice gchoice_33_83_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.1' type='checkbox'  value='This is a church partnership and we would like to learn about resources to share with our staff and\/or congregation.'  id='choice_33_83_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_83_1' id='label_33_83_1' class='gform-field-label gform-field-label--type-inline'>This is a church partnership and we would like to learn about resources to share with our staff and\/or congregation.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_33_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_33\").val(\"1\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_33\").val(\"1\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_33_86' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_33\").val(\"3\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_33\").val(\"3\");  jQuery(\"#gform_33\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_33_3' class='gform_page' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_33_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_33_99\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_99\" ><h3 class=\"gsection_title\">Payment Options<\/h3><\/div><div id=\"field_33_72\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_72\" ><p style=\"font-size: 16px; color: #1a2312; padding: 20px; background-color: #f8f6f1; border-radius: 15px;\">Soon after empowerment groups are formed, the youth-led families begin attending trainings and receive resources to begin working towards self-sufficiency.  As such, it is very helpful to receive the first payment towards your pledge as soon as the children begin meeting or in advance if possible.  Payments may be made on your own time schedule, but we do ask that at least a third of the total commitment is paid each year.<\/p><\/div><fieldset id=\"field_33_78\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_78\" ><legend class='gfield_label gform-field-label' >Do you need help recruiting a funding partner?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_33_78'>\n\t\t\t<div class='gchoice gchoice_33_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Yes, please recruit a funding partner for me.'  id='choice_33_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_78_0' id='label_33_78_0' class='gform-field-label gform-field-label--type-inline'>Yes, please recruit a funding partner for me.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_33_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='No, I currently have a funding partner.'  id='choice_33_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_78_1' id='label_33_78_1' class='gform-field-label gform-field-label--type-inline'>No, I currently have a funding partner.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_33_79\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_79\" ><label class='gfield_label gform-field-label' for='input_33_79'>What is the name of your funding partner?<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_33_79' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_79\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_33_79'>Please note, your partner will also need to fill out this form so that we have complete contact information.<\/div><\/div><fieldset id=\"field_33_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_22\" ><legend class='gfield_label gform-field-label' >Payment Options<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_33_22'>\n\t\t\t<div class='gchoice gchoice_33_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='I\/We would like to set-up recurring payments or make a one-time payment via eCheck or credit card. (After choosing this option and clicking on the &quot;submit&quot; button below, you will be redirected to on-line payment options.)'  id='choice_33_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_22_0' id='label_33_22_0' class='gform-field-label gform-field-label--type-inline'>I\/We would like to set-up recurring payments or make a one-time payment via eCheck or credit card. (After choosing this option and clicking on the \"submit\" button below, you will be redirected to on-line payment options.)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_33_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='I\/We will send our donation in form of a check directly to the Zoe Empowers office.'  id='choice_33_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_22_1' id='label_33_22_1' class='gform-field-label gform-field-label--type-inline'>I\/We will send our donation in form of a check directly to the Zoe Empowers office.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_33_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='I have a question or other payment plan.'  id='choice_33_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_33_22_2' id='label_33_22_2' class='gform-field-label gform-field-label--type-inline'>I have a question or other payment plan.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_33_80\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_80\" ><label class='gfield_label gform-field-label' for='input_33_80'>Please list your question or payment plan below.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_80' id='input_33_80' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_33_67\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_33_67\" ><label class='gfield_label gform-field-label' for='input_33_67'>Have a comment or question? 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