{"id":11809,"date":"2024-04-03T15:01:28","date_gmt":"2024-04-03T15:01:28","guid":{"rendered":"https:\/\/ccma.in-testing.co.uk\/?page_id=11809"},"modified":"2026-03-30T16:55:54","modified_gmt":"2026-03-30T16:55:54","slug":"create-account","status":"publish","type":"page","link":"https:\/\/soundcheck.ccma.org\/fr\/create-account\/","title":{"rendered":"Single Membership Application"},"content":{"rendered":"\n<!-- Our front-end template -->\n<section id=\"form-block-block_2015e0f1224fdbb6e606b3f9b6740492\"\n    class=\"form-block  bg-white pt-[45px] pb-[100px]  lg:pt-[70px]   lg:pb-[99px]\"\n    >\n    <div class=\"site-container \">\n        \n        <div class=\"form\">\n            <script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_7' style='display:none'><div id='gf_7' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Single Membership Application<\/h2>\n                            <p class='gform_description'>Tabbed user registration form<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/fr\/wp-json\/wp\/v2\/pages\/11809#gf_7' data-formid='7' novalidate><div id='gf_page_steps_7' class='gf_page_steps'><div id='gf_step_7_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Personal Details<\/span><\/div><div id='gf_step_7_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_7_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Membership Details<\/span><\/div><div id='gf_step_7_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Directory Profile<\/span><\/div><div id='gf_step_7_5' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>Confirmation<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_7_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_81\" 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\"  ><b>Before you apply:<\/b> Applications are reviewed and, if approved, you&#8217;ll receive your login details within 5\u20137 business days.\n<br><br>\nIf you have any questions please do not hesitate to contact us at <a href=\"mailto: country@ccma.org\">country@ccma.org<\/a> or by phone at <a href=\"tel: 416-947-1331\">416-947-1331<\/a>.<\/div><div id=\"field_7_75\" 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\"  ><h3 class=\"mb-[35px]\">Single Membership<\/h3><\/div><fieldset id=\"field_7_8\" 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 gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Membership Type<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_8'>\n\t\t\t<div class='gchoice gchoice_7_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Single' checked='checked' id='choice_7_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_8_0' id='label_7_8_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Group'  id='choice_7_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_8_1' id='label_7_8_1' class='gform-field-label gform-field-label--type-inline'>Group<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_69\" 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\"  ><div class=\"membership-choice\">\n<button id=\"btn-single\" class=\"button button-gray\">Single<\/button>\n<button id=\"btn-group\" class=\"button button-gray\">Group<\/button>\n<\/div><\/div><fieldset id=\"field_7_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Membership term<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_71'>\n\t\t\t<div class='gchoice gchoice_7_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='1786'  id='choice_7_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_71_0' id='label_7_71_0' class='gform-field-label gform-field-label--type-inline'>1 Year $95.00<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='1787'  id='choice_7_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_71_1' id='label_7_71_1' class='gform-field-label gform-field-label--type-inline'>2 Years $171.00 (Save 10%)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_71_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='1788'  id='choice_7_71_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_71_2' id='label_7_71_2' class='gform-field-label gform-field-label--type-inline'>5 Years $404.00 (Save 15%)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_13\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Consent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_13.1' id='input_7_13_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_7_13_1' ><span class='gform-field-label__text'>I acknowledge that I meet the CCMA Membership Eligibility Requirements. \u2028<a href=\"https:\/\/soundcheck.ccma.org\/ccma-membership-policy\/\" target=\"_blank\">Review our Eligibility Requirements<\/a><\/span><\/label><input type='hidden' name='input_13.2' value='I acknowledge that I meet the CCMA Membership Eligibility Requirements. \u2028&lt;a href=&quot;https:\/\/soundcheck.ccma.org\/ccma-membership-policy\/&quot; target=&quot;_blank&quot;&gt;Review our Eligibility Requirements&lt;\/a&gt;' class='gform_hidden' \/><input type='hidden' name='input_13.3' value='10' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_7_15\" 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\"  ><h2>Personal Details<\/h2><\/div><div id=\"field_7_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_16'><span class='gform-field-label__text'>Salutation (required)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_7_16' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose salutation (Required)<\/option><option value='Mr.' >Mr.<\/option><option value='Mx.' >Mx.<\/option><option value='Ms.' >Ms.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Dr.' >Dr.<\/option><\/select><\/div><\/div><div id=\"field_7_74\" class=\"gfield gfield--type-username gfield--input-type-username gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_74'><span class='gform-field-label__text'>Username<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_7_74' type='text' value='' class='large'  aria-describedby=\" gfield_description_7_74\"  placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_74'>Create a username or use your preferred email address<\/div><\/div><div id=\"field_7_17\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_17'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_7_17' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_18\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_18'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_7_18' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_19'><span class='gform-field-label__text'>What is your current gender identity?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_7_19' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Gender Identity (Required)<\/option><option value='Transgender' >Transgender<\/option><option value='Genderfluid\/Genderqueer' >Genderfluid\/Genderqueer<\/option><option value='Non-binary' >Non-binary<\/option><option value='Two-spirit' >Two-spirit<\/option><option value='Agender' >Agender<\/option><option value='Woman' >Woman<\/option><option value='Man' >Man<\/option><option value='Prefer not to answer' >Prefer not to answer<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_7_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_20'><span class='gform-field-label__text'>Other Gender Identity<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_7_20' type='text' value='' class='large'    placeholder='Other' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_21\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_21'><span class='gform-field-label__text'>What is your preferred Gender Pronoun?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_7_21' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Gender Pronoun (Required)<\/option><option value='She\/Her\/Hers' >She\/Her\/Hers<\/option><option value='He\/Him\/His' >He\/Him\/His<\/option><option value='Ze\/Hir\/Hirs' >Ze\/Hir\/Hirs<\/option><option value='They\/Them\/Theirs' >They\/Them\/Theirs<\/option><option value='No Pronoun' >No Pronoun<\/option><option value='No Preference' >No Preference<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_7_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_22'><span class='gform-field-label__text'>Other Gender Pronoun<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_7_22' type='text' value='' class='large'    placeholder='Other' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_23'><span class='gform-field-label__text'>Ethnic Background<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_7_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Ethnic Background (Required)<\/option><option value='Black (e.g. African, Caribbean, North American)' >Black (e.g. African, Caribbean, North American)<\/option><option value='East Asian (e.g. Chinese, Japanese, Korean)' >East Asian (e.g. Chinese, Japanese, Korean)<\/option><option value='European' >European<\/option><option value='Indigenous (e.g. First Nations, Inuit, Metis)' >Indigenous (e.g. First Nations, Inuit, Metis)<\/option><option value='Indigenous (Outside of Canada, e.g. Maori, Quechua people, S\u00e1mi, Indigenous Australian)' >Indigenous (Outside of Canada, e.g. Maori, Quechua people, S\u00e1mi, Indigenous Australian)<\/option><option value='Indo-Caribbean (e.g. Trinidadian with origins in India)' >Indo-Caribbean (e.g. Trinidadian with origins in India)<\/option><option value='Jewish' >Jewish<\/option><option value='Latin American (e.g. Argentinean, Chilean, Costa Rican)' >Latin American (e.g. Argentinean, Chilean, Costa Rican)<\/option><option value='Middle Eastern (e.g. Egyptian, Iranian, Palestinian, Syrian)' >Middle Eastern (e.g. Egyptian, Iranian, Palestinian, Syrian)<\/option><option value='South Asian (e.g. Indian, Pakistani, Bangladeshi)' >South Asian (e.g. Indian, Pakistani, Bangladeshi)<\/option><option value='South East Asian (e.g. Indonesian, Thai, Viet)' >South East Asian (e.g. Indonesian, Thai, Viet)<\/option><option value='White' >White<\/option><option value='Prefer not to answer' >Prefer not to answer<\/option><\/select><\/div><\/div><fieldset id=\"field_7_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Canadian Citizenship Status  (Required)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_24'>\n\t\t\t<div class='gchoice gchoice_7_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Citizen'  id='choice_7_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_24_0' id='label_7_24_0' class='gform-field-label gform-field-label--type-inline'>Citizen<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Permanent Resident'  id='choice_7_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_24_1' id='label_7_24_1' class='gform-field-label gform-field-label--type-inline'>Permanent Resident<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Non-Canadian'  id='choice_7_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_24_2' id='label_7_24_2' class='gform-field-label gform-field-label--type-inline'>Non-Canadian<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you identify as a person with a disability? (Required)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_68'>\n\t\t\t<div class='gchoice gchoice_7_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_7_68_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_7_68\"   \/>\n\t\t\t\t\t<label for='choice_7_68_0' id='label_7_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_7_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_68_1' id='label_7_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_68_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Prefer not to say'  id='choice_7_68_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_68_2' id='label_7_68_2' class='gform-field-label gform-field-label--type-inline'>Prefer not to say<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_7_68'><p>Note: &#8216;A Person with a disability&#8217; is a person who has a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and:\u2028<\/br><\/p><\/div><\/fieldset><div id=\"field_7_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><ul><p>\n<li>Who considers themselves to be disadvantaged in employment by reason \u2028of that impairment, or\u2028<\/li>\n<li>Who believes that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment; and\u2028<\/li>\n<li>Includes persons whose functional limitations owing to their impairment may have been accommodated in their current job or workplace.<\/li>\n<\/ul><\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_7_3' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_2' class='gform_page' data-js='page-field-id-3' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_7_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_28\" 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\"  ><h2>Contact Information<\/h2><\/div><div id=\"field_7_42\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_42'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_42' id='input_7_42' type='email' value='' class='large'   placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_29\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_29'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_7_29' type='tel' value='' class='large'  placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_30\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_30'><span class='gform-field-label__text'>Address Line 1<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_7_30' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_31\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_31'><span class='gform-field-label__text'>Address Line 2<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_7_31' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_31\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_31'>Required<\/div><\/div><div id=\"field_7_32\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_32'><span class='gform-field-label__text'>City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_7_32' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_33\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_33'><span class='gform-field-label__text'>Postal\/Zip Code<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_7_33' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_35\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_35'><span class='gform-field-label__text'>Country<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_7_35' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Choose Country' selected='selected'>Choose Country<\/option><option value='Canada' >Canada<\/option><option value='United States' >United States<\/option><option value='---' >&#8212;<\/option><option value='Afghanistan' >Afghanistan<\/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='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/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='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/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 Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/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='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='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/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='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='Guernsey' >Guernsey<\/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 Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/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' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/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='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/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' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/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='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='North Macedonia' >North Macedonia<\/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='Palestine, State of' >Palestine, State of<\/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='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/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='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/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 and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/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='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/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='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/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' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select><\/div><\/div><div id=\"field_7_34\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_34'><span class='gform-field-label__text'>Province or State<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_7_34' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Province or State<\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select><\/div><\/div><div id=\"field_7_112\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_112'><span class='gform-field-label__text'>Province or State<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_112' id='input_7_112' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Province or State<\/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><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_5' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_3' class='gform_page' data-js='page-field-id-5' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_7_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_36\" 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\"  ><h2>Membership Details<\/h2><\/div><div id=\"field_7_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_10'><span class='gform-field-label__text'>Primary Membership Category<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_7_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Category<\/option><option value='Artist' >Artist<\/option><option value='Artist Manager' >Artist Manager<\/option><option value='Association' >Association<\/option><option value='Booking Agent' >Booking Agent<\/option><option value='Consultant' >Consultant<\/option><option value='Festival' >Festival<\/option><option value='Media' >Media<\/option><option value='Music Publisher' >Music Publisher<\/option><option value='Musician' >Musician<\/option><option value='Producer' >Producer<\/option><option value='Public Relations\/Publicity\/Marketing' >Public Relations\/Publicity\/Marketing<\/option><option value='Radio' >Radio<\/option><option value='Record Company' >Record Company<\/option><option value='Recording Studio' >Recording Studio<\/option><option value='Retailer' >Retailer<\/option><option value='Services' >Services<\/option><option value='Songwriter' >Songwriter<\/option><option value='Talent Buyer or Promoter' >Talent Buyer or Promoter<\/option><option value='Television\/Video' >Television\/Video<\/option><option value='Venue' >Venue<\/option><\/select><\/div><\/div><div id=\"field_7_93\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_93'><span class='gform-field-label__text'>Primary Instrument<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_7_93' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_91\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_91'><span class='gform-field-label__text'>Organization<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_7_91' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_90'><span class='gform-field-label__text'>Manager<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_7_90' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_90\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_90'>Please enter &#8220;N\/A&#8221; if you are not working with a manager.<\/div><\/div><div id=\"field_7_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_85'><span class='gform-field-label__text'>Agent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_7_85' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_85\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_85'>Please enter &#8220;N\/A&#8221; if you are not working with an agent.<\/div><\/div><div id=\"field_7_87\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_87'><span class='gform-field-label__text'>Distributor<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_7_87' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_87\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_87'>Please enter &#8220;N\/A&#8221; if you are not working with a distributor.<\/div><\/div><div id=\"field_7_86\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_86'><span class='gform-field-label__text'>Label<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_7_86' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_86\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_86'>Please enter &#8220;N\/A&#8221; if you are not working with a label.<\/div><\/div><div id=\"field_7_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_88'><span class='gform-field-label__text'>Artist Roster<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_7_88' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_88\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_88'>List any other artists signed to the label.<\/div><\/div><div id=\"field_7_92\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_92'><span class='gform-field-label__text'>General Manager<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_7_92' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_92\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_92'><i>Please enter &#8220;N\/A&#8221; if not applicable. <\/i><\/div><\/div><div id=\"field_7_98\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_98'><span class='gform-field-label__text'>Program Director<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_7_98' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_98\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_98'>Please enter &#8220;N\/A&#8221; if not applicable.<\/div><\/div><div id=\"field_7_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_94'><span class='gform-field-label__text'>Music Director<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_7_94' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_94\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_94'>Please enter &#8220;N\/A&#8221; if not applicable.<\/div><\/div><div id=\"field_7_96\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_96'><span class='gform-field-label__text'>Moniker<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_7_96' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_96\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_96'>Please enter &#8220;N\/A&#8221; if not applicable.<\/div><\/div><div id=\"field_7_95\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_95'><span class='gform-field-label__text'>Frequency<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_7_95' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_95\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_95'>Please enter &#8220;N\/A&#8221; if not applicable.<\/div><\/div><div id=\"field_7_113\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_113'><span class='gform-field-label__text'>Second Membership Category (if applicable)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_7_113' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_113\"  placeholder='Separate items with comma&#039;s'  aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_113'>Separate items with comma&#8217;s<\/div><\/div><div id=\"field_7_76\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Please provide two industry references.<\/h4><\/div><div id=\"field_7_39\" 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\"  ><h3 class=\"gsection_title\">Reference 1<\/h3><\/div><div id=\"field_7_40\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_40'><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_7_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_41\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_41'><span class='gform-field-label__text'>Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_41' id='input_7_41' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_72\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_72'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_72' id='input_7_72' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_43\" 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\"  ><h3 class=\"gsection_title\">Reference 2<\/h3><\/div><div id=\"field_7_44\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_44'><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_7_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_45\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_45'><span class='gform-field-label__text'>Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_45' id='input_7_45' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_7_46\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_46'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_46' id='input_7_46' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_6' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_4' class='gform_page' data-js='page-field-id-6' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_7_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_47\" 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\"  ><h2>Directory Profile<\/h2><\/div><fieldset id=\"field_7_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you want to be included in the CCMA Member Directory \u2028(only accessed by members)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_11'>\n\t\t\t<div class='gchoice gchoice_7_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Yes'  id='choice_7_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_11_0' id='label_7_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No'  id='choice_7_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_11_1' id='label_7_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_97\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_97'><span class='gform-field-label__text'>Stage \/ Directory Name (This is what other members will see)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_7_97' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_55\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_55'><span class='gform-field-label__text'>Personal website<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_7_55' type='text' value='' class='large'    placeholder='http:\/\/www'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_56\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_56'><span class='gform-field-label__text'>Facebook<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_7_56' type='text' value='' class='large'    placeholder='facebook.com\/username'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_57\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_57'><span class='gform-field-label__text'>Instagram<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_7_57' type='text' value='' class='large'    placeholder='@handle'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_58\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_58'><span class='gform-field-label__text'>TikTok<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_7_58' type='text' value='' class='large'    placeholder='@handle'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_59\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_59'><span class='gform-field-label__text'>Twitter<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_7_59' type='text' value='' class='large'    placeholder='@handle'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_60\" 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\"  ><label class='gfield_label gform-field-label' for='input_7_60'><span class='gform-field-label__text'>YouTube<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_7_60' type='text' value='' class='large'    placeholder='@handle'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_62\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_62'><span class='gform-field-label__text'>Age Range<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_7_62' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Age Range<\/option><option value='18 - 30' >18 &#8211; 30<\/option><option value='31 - 40' >31 &#8211; 40<\/option><option value='41 - 50' >41 &#8211; 50<\/option><option value='51 - 60' >51 &#8211; 60<\/option><option value='60+' >60+<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_7' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_7' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_5' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_7_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_64\" 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\"  ><h2>Confirmation<\/h2>\n<h3>Industry Survey<\/h3>\n<p>As an Association one of our key goals is learning more about you, our members. We have a strong desire to proudly represent the diversity found within our genre. All information collected will be confidential and will be utilized by the internal CCMA team to create programs that are comprehensive and inclusive for all members.<\/p>\n\n<a href=\"\/privacy-policy\/\">Read our Privacy Policy<\/a><\/div><div id=\"field_7_12\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_12'><span class='gform-field-label__text'>Tell us a little about yourself and your involvement in the music industry (200 words max)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_7_12' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_7_14\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Privacy Information<\/h3>\n<p>The new Canadian Anti-Spam Law (CASL) requires that we obtain consent from CCMA Members in order to send communication through email. Please note you may choose to not receive email from the CCMA; however, if you do so you will not receive any email communications, thus forfeiting your right to vote in the CCMA Awards Program.<\/p><\/div><fieldset id=\"field_7_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you consent to receive email communications from the CCMA?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_66'>\n\t\t\t<div class='gchoice gchoice_7_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Yes'  id='choice_7_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_66_0' id='label_7_66_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='No'  id='choice_7_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_66_1' id='label_7_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_7' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_7' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_7' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_7' id='gform_theme_7' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_7' id='gform_style_settings_7' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_7' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='7' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='KuyHAAZXGDAbrLrP5POZqCIDxhBj3lB0vgRoleA+BpqP0bYShrWYknCUsFYOBJkvIWj7nrLRlKDRtbZvB+f98OVMWJuMle9Kp+V0x6LMUfSegxw=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_7' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_7' id='gform_target_page_number_7' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_7' id='gform_source_page_number_7' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>        <\/div>\n            <\/div>\n<\/section>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-11809","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.6 (Yoast SEO v28.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Single Membership Application | CCMA<\/title>\n<meta name=\"description\" content=\"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.\" \/>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:locale:alternate\" content=\"en_ca\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Single Membership Application\" \/>\n<meta property=\"og:description\" content=\"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/soundcheck.ccma.org\/fr\/create-account\/\" \/>\n<meta property=\"og:site_name\" content=\"https:\/\/soundcheck.ccma.org\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/CCMAOfficial\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-30T16:55:54+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@CCMAofficial\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/create-account\\\/\",\"url\":\"https:\\\/\\\/soundcheck.ccma.org\\\/create-account\\\/\",\"name\":\"Single Membership Application | CCMA\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#website\"},\"datePublished\":\"2024-04-03T15:01:28+00:00\",\"dateModified\":\"2026-03-30T16:55:54+00:00\",\"description\":\"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/create-account\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/soundcheck.ccma.org\\\/create-account\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/create-account\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/soundcheck.ccma.org\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Single Membership Application\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#website\",\"url\":\"https:\\\/\\\/soundcheck.ccma.org\\\/\",\"name\":\"https:\\\/\\\/soundcheck.ccma.org\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/soundcheck.ccma.org\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#organization\",\"name\":\"Canadian Country Music Association\",\"alternateName\":\"CCMA\",\"url\":\"https:\\\/\\\/soundcheck.ccma.org\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/soundcheck.ccma.org\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/ccma_logo_black_2026_export.svg\",\"contentUrl\":\"https:\\\/\\\/soundcheck.ccma.org\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/ccma_logo_black_2026_export.svg\",\"width\":404,\"height\":78,\"caption\":\"Canadian Country Music Association\"},\"image\":{\"@id\":\"https:\\\/\\\/soundcheck.ccma.org\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/CCMAOfficial\",\"https:\\\/\\\/x.com\\\/CCMAofficial\",\"https:\\\/\\\/www.tiktok.com\\\/@ccmaofficial?lang=en\",\"https:\\\/\\\/www.instagram.com\\\/ccmaofficial\\\/\",\"https:\\\/\\\/www.youtube.com\\\/c\\\/ccmaofficial\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/canadian-country-music-association-ccma-\\\/posts\\\/?feedView=all\"],\"description\":\"The Canadian Country Music Association has been the home of Canada's country music industry since 1976. Through education, communication, promotion and recognition, we support our members and celebrate the artists who make Canadian country music great.\",\"email\":\"country@ccma.org\",\"telephone\":\"(416) 947-1331\",\"legalName\":\"Canadian Country Music Association\",\"foundingDate\":\"1976-06-10\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"1\",\"maxValue\":\"10\"}}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Single Membership Application | CCMA","description":"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.","robots":{"index":"noindex","follow":"follow"},"og_locale":"fr_FR","og_type":"article","og_title":"Single Membership Application","og_description":"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.","og_url":"https:\/\/soundcheck.ccma.org\/fr\/create-account\/","og_site_name":"https:\/\/soundcheck.ccma.org","article_publisher":"https:\/\/www.facebook.com\/CCMAOfficial","article_modified_time":"2026-03-30T16:55:54+00:00","twitter_card":"summary_large_image","twitter_site":"@CCMAofficial","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/soundcheck.ccma.org\/create-account\/","url":"https:\/\/soundcheck.ccma.org\/create-account\/","name":"Single Membership Application | CCMA","isPartOf":{"@id":"https:\/\/soundcheck.ccma.org\/#website"},"datePublished":"2024-04-03T15:01:28+00:00","dateModified":"2026-03-30T16:55:54+00:00","description":"Learn about the benefits of a single membership and discover how it can enhance your experience with exclusive access.","breadcrumb":{"@id":"https:\/\/soundcheck.ccma.org\/create-account\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/soundcheck.ccma.org\/create-account\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/soundcheck.ccma.org\/create-account\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/soundcheck.ccma.org\/"},{"@type":"ListItem","position":2,"name":"Single Membership Application"}]},{"@type":"WebSite","@id":"https:\/\/soundcheck.ccma.org\/#website","url":"https:\/\/soundcheck.ccma.org\/","name":"https:\/\/soundcheck.ccma.org","description":"","publisher":{"@id":"https:\/\/soundcheck.ccma.org\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/soundcheck.ccma.org\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/soundcheck.ccma.org\/#organization","name":"Canadian Country Music Association","alternateName":"CCMA","url":"https:\/\/soundcheck.ccma.org\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/soundcheck.ccma.org\/#\/schema\/logo\/image\/","url":"https:\/\/soundcheck.ccma.org\/wp-content\/uploads\/2026\/03\/ccma_logo_black_2026_export.svg","contentUrl":"https:\/\/soundcheck.ccma.org\/wp-content\/uploads\/2026\/03\/ccma_logo_black_2026_export.svg","width":404,"height":78,"caption":"Canadian Country Music Association"},"image":{"@id":"https:\/\/soundcheck.ccma.org\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/CCMAOfficial","https:\/\/x.com\/CCMAofficial","https:\/\/www.tiktok.com\/@ccmaofficial?lang=en","https:\/\/www.instagram.com\/ccmaofficial\/","https:\/\/www.youtube.com\/c\/ccmaofficial","https:\/\/www.linkedin.com\/company\/canadian-country-music-association-ccma-\/posts\/?feedView=all"],"description":"The Canadian Country Music Association has been the home of Canada's country music industry since 1976. Through education, communication, promotion and recognition, we support our members and celebrate the artists who make Canadian country music great.","email":"country@ccma.org","telephone":"(416) 947-1331","legalName":"Canadian Country Music Association","foundingDate":"1976-06-10","numberOfEmployees":{"@type":"QuantitativeValue","minValue":"1","maxValue":"10"}}]}},"_links":{"self":[{"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/pages\/11809","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/comments?post=11809"}],"version-history":[{"count":0,"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/pages\/11809\/revisions"}],"wp:attachment":[{"href":"https:\/\/soundcheck.ccma.org\/fr\/wp-json\/wp\/v2\/media?parent=11809"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}