{"id":19,"date":"2017-07-11T10:41:56","date_gmt":"2017-07-11T09:41:56","guid":{"rendered":"http:\/\/89.145.103.204\/~alliancescotland\/membership\/?page_id=19"},"modified":"2024-06-25T11:02:49","modified_gmt":"2024-06-25T10:02:49","slug":"organisation-online-application-form","status":"publish","type":"page","link":"https:\/\/www.alliance-scotland.org.uk\/membership\/become-a-member\/organisation-online-application-form\/","title":{"rendered":"Organisation online application form"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Privacy Statement<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The ALLIANCE is committed to ensuring that your privacy is protected. The personal data on this form is being collected for the following purpose: to manage your membership and keep you informed about the work of the ALLIANCE and issues relating to the health and social care agenda including events and training. We may also forward you information from third parties that we think may be of interest to you.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The ALLIANCE and its sub-contractors will not distribute or disclose your personal information to third parties unless we have your written permission or are required by law to do so. We comply with the Data Protection Act 1998 and GDPR (May 2018) when handling your personal information. If you have any concerns about how we use your personal information, contact Head of Finance and IT at: <a href=\"mailto:DPO@alliance-scotland.org.uk\">DPO@alliance-scotland.org.uk<\/a>. Alternatively, you have the right to complain to the <a href=\"https:\/\/ico.org.uk\/concerns\/\">ICO https:\/\/ico.org.uk\/concerns\/ (this link will take you away from our website).<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You also have the right to object to how we process your personal information, the right to access, correct, sometimes delete and restrict the personal and sensitive personal information we use. Together with the right to receive your information in a machine-readable format for transfer to another organisation and not to be subject to a decision based solely on automated processing, including profiling<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We will retain your personal information for the duration of your membership. For our full <a href=\"https:\/\/www.alliance-scotland.org.uk\/privacy-policy\/\">privacy policy<\/a>, please visit our website.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By signing this form you are consenting to us processing your personal information for the above purposes, which is our legal basis for processing your personal information.<\/p>\n\n\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_5' style='display:none'><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Organisation Application Form<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_5' id='gform_5'  action='\/membership\/wp-json\/wp\/v2\/pages\/19#gf_5' data-formid='5' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcV7f8jAAAAAJ6KQ3vjFlFQKiDIOuG3SYqwfPeq' data-tabindex='0'><input id=\"input_3e4bd660fbbdde3592fb2f320f8ce751\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_3e4bd660fbbdde3592fb2f320f8ce751\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_5' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>5<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_5_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_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_5_58\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_58'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='gfield_description' id='gfield_description_5_58'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_58' id='input_5_58' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_5_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Tell us about your organisation<\/h3><\/div><div id=\"field_5_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_2'><span class='gform-field-label__text'>Organisation 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_2' id='input_5_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'><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_4' id='input_5_4' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_29'><span class='gform-field-label__text'>Telephone number<\/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_29' id='input_5_29' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_5_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_5_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_6_1' id='input_5_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_5_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_6_3' id='input_5_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_5_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_5_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_5_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_6_5' id='input_5_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_5_6_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_5\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_5'><span class='gform-field-label__text'>Website<\/span><\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_5' id='input_5_5' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_5_31\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_31'><span class='gform-field-label__text'>Brief summary of main aims and objectives of your organisation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_31'>This information will be used to list your organisation as a member on our website A-Z. <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_5_31' class='textarea large'  aria-describedby=\"gfield_description_5_31\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_32\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_32'><span class='gform-field-label__text'>Organisation sector\/type<\/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_32' id='input_5_32' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Access panel' >Access panel<\/option><option value='Charity' >Charity<\/option><option value='Citizens advice bureau' >Citizens advice bureau<\/option><option value='Education\/research' >Education\/research<\/option><option value='General practice' >General practice<\/option><option value='Housing association' >Housing association<\/option><option value='Library' >Library<\/option><option value='Private company' >Private company<\/option><option value='Professional body' >Professional body<\/option><option value='Public sector body' >Public sector body<\/option><option value='Social enterprise' >Social enterprise<\/option><option value='Third sector interface' >Third sector interface<\/option><option value='Other*' >Other*<\/option><\/select><\/div><\/div><div id=\"field_5_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_33'><span class='gform-field-label__text'>Please specify<\/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_5_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_34'><span class='gform-field-label__text'>Charity\/Companies House Reference Number (where available)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_5_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_5_43' 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_5_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><fieldset id=\"field_5_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Geographical coverage<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_35'>Where does your organisation deliver services or provide support to.  \n\nPlease select all that apply. <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_35'><div class='gchoice gchoice_5_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='UK Wide'  id='choice_5_35_1'   aria-describedby=\"gfield_description_5_35\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_1' id='label_5_35_1' class='gform-field-label gform-field-label--type-inline'>UK Wide<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.2' type='checkbox'  value='Scotland Wide'  id='choice_5_35_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_2' id='label_5_35_2' class='gform-field-label gform-field-label--type-inline'>Scotland Wide<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.3' type='checkbox'  value='Internationally'  id='choice_5_35_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_3' id='label_5_35_3' class='gform-field-label gform-field-label--type-inline'>Internationally<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.4' type='checkbox'  value='Aberdeen City'  id='choice_5_35_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_4' id='label_5_35_4' class='gform-field-label gform-field-label--type-inline'>Aberdeen City<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.5' type='checkbox'  value='Aberdeenshire'  id='choice_5_35_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_5' id='label_5_35_5' class='gform-field-label gform-field-label--type-inline'>Aberdeenshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.6' type='checkbox'  value='Angus'  id='choice_5_35_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_6' id='label_5_35_6' class='gform-field-label gform-field-label--type-inline'>Angus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.7' type='checkbox'  value='Argyll and Bute'  id='choice_5_35_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_7' id='label_5_35_7' class='gform-field-label gform-field-label--type-inline'>Argyll and Bute<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.8' type='checkbox'  value='Clackmannanshire'  id='choice_5_35_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_8' id='label_5_35_8' class='gform-field-label gform-field-label--type-inline'>Clackmannanshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.9' type='checkbox'  value='Dumfries and Galloway'  id='choice_5_35_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_9' id='label_5_35_9' class='gform-field-label gform-field-label--type-inline'>Dumfries and Galloway<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.11' type='checkbox'  value='Dundee'  id='choice_5_35_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_11' id='label_5_35_11' class='gform-field-label gform-field-label--type-inline'>Dundee<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.12' type='checkbox'  value='East Ayrshire'  id='choice_5_35_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_12' id='label_5_35_12' class='gform-field-label gform-field-label--type-inline'>East Ayrshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.13' type='checkbox'  value='East Dunbartonshire'  id='choice_5_35_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_13' id='label_5_35_13' class='gform-field-label gform-field-label--type-inline'>East Dunbartonshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.14' type='checkbox'  value='East Lothian'  id='choice_5_35_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_14' id='label_5_35_14' class='gform-field-label gform-field-label--type-inline'>East Lothian<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.15' type='checkbox'  value='East Renfrewshire'  id='choice_5_35_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_15' id='label_5_35_15' class='gform-field-label gform-field-label--type-inline'>East Renfrewshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.16' type='checkbox'  value='Edinburgh City'  id='choice_5_35_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_16' id='label_5_35_16' class='gform-field-label gform-field-label--type-inline'>Edinburgh City<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.17' type='checkbox'  value='Falkirk'  id='choice_5_35_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_17' id='label_5_35_17' class='gform-field-label gform-field-label--type-inline'>Falkirk<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.18' type='checkbox'  value='Fife'  id='choice_5_35_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_18' id='label_5_35_18' class='gform-field-label gform-field-label--type-inline'>Fife<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.19' type='checkbox'  value='Glasgow City'  id='choice_5_35_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_19' id='label_5_35_19' class='gform-field-label gform-field-label--type-inline'>Glasgow City<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.21' type='checkbox'  value='Highland'  id='choice_5_35_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_21' id='label_5_35_21' class='gform-field-label gform-field-label--type-inline'>Highland<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.22' type='checkbox'  value='Inverclyde'  id='choice_5_35_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_22' id='label_5_35_22' class='gform-field-label gform-field-label--type-inline'>Inverclyde<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.23' type='checkbox'  value='Midlothian'  id='choice_5_35_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_23' id='label_5_35_23' class='gform-field-label gform-field-label--type-inline'>Midlothian<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.24' type='checkbox'  value='Moray'  id='choice_5_35_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_24' id='label_5_35_24' class='gform-field-label gform-field-label--type-inline'>Moray<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.25' type='checkbox'  value='North Ayrshire'  id='choice_5_35_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_25' id='label_5_35_25' class='gform-field-label gform-field-label--type-inline'>North Ayrshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.26' type='checkbox'  value='North Lanarkshire'  id='choice_5_35_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_26' id='label_5_35_26' class='gform-field-label gform-field-label--type-inline'>North Lanarkshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.27' type='checkbox'  value='Orkney Islands'  id='choice_5_35_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_27' id='label_5_35_27' class='gform-field-label gform-field-label--type-inline'>Orkney Islands<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.28' type='checkbox'  value='Perth and Kinross'  id='choice_5_35_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_28' id='label_5_35_28' class='gform-field-label gform-field-label--type-inline'>Perth and Kinross<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.29' type='checkbox'  value='Renfrewshire'  id='choice_5_35_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_29' id='label_5_35_29' class='gform-field-label gform-field-label--type-inline'>Renfrewshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.31' type='checkbox'  value='Scottish Borders'  id='choice_5_35_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_31' id='label_5_35_31' class='gform-field-label gform-field-label--type-inline'>Scottish Borders<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.32' type='checkbox'  value='Shetland Islands'  id='choice_5_35_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_32' id='label_5_35_32' class='gform-field-label gform-field-label--type-inline'>Shetland Islands<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.33' type='checkbox'  value='South Ayrshire'  id='choice_5_35_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_33' id='label_5_35_33' class='gform-field-label gform-field-label--type-inline'>South Ayrshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.34' type='checkbox'  value='South Lanarkshire'  id='choice_5_35_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_34' id='label_5_35_34' class='gform-field-label gform-field-label--type-inline'>South Lanarkshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.35' type='checkbox'  value='Stirling'  id='choice_5_35_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_35' id='label_5_35_35' class='gform-field-label gform-field-label--type-inline'>Stirling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.36' type='checkbox'  value='West Dunbartonshire'  id='choice_5_35_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_36' id='label_5_35_36' class='gform-field-label gform-field-label--type-inline'>West Dunbartonshire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.37' type='checkbox'  value='Western Isles'  id='choice_5_35_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_37' id='label_5_35_37' class='gform-field-label gform-field-label--type-inline'>Western Isles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_35_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.38' type='checkbox'  value='Other*'  id='choice_5_35_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_35_38' id='label_5_35_38' class='gform-field-label gform-field-label--type-inline'>Other*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_36'><span class='gform-field-label__text'>If other, please specify<\/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_36' id='input_5_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Main groups\/communities supported<\/span><\/legend><div class='gfield_description' id='gfield_description_5_37'>Does your organisation deliver services or provide specific support to any of the following groups. Please select up to three that apply. <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_37'><div class='gchoice gchoice_5_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='Children and young people'  id='choice_5_37_1'   aria-describedby=\"gfield_description_5_37\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_1' id='label_5_37_1' class='gform-field-label gform-field-label--type-inline'>Children and young people<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.2' type='checkbox'  value='Minority race &amp; ethnicity'  id='choice_5_37_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_2' id='label_5_37_2' class='gform-field-label gform-field-label--type-inline'>Minority race &amp; ethnicity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.3' type='checkbox'  value='Unpaid carers'  id='choice_5_37_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_3' id='label_5_37_3' class='gform-field-label gform-field-label--type-inline'>Unpaid carers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.4' type='checkbox'  value='Romany\/Gypsy\/Traveller'  id='choice_5_37_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_4' id='label_5_37_4' class='gform-field-label gform-field-label--type-inline'>Romany\/Gypsy\/Traveller<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.5' type='checkbox'  value='Refugees\/Asylum seekers'  id='choice_5_37_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_5' id='label_5_37_5' class='gform-field-label gform-field-label--type-inline'>Refugees\/Asylum seekers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.6' type='checkbox'  value='LGBTQIA+'  id='choice_5_37_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_6' id='label_5_37_6' class='gform-field-label gform-field-label--type-inline'>LGBTQIA+<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.7' type='checkbox'  value='Men'  id='choice_5_37_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_7' id='label_5_37_7' class='gform-field-label gform-field-label--type-inline'>Men<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.8' type='checkbox'  value='Women'  id='choice_5_37_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_8' id='label_5_37_8' class='gform-field-label gform-field-label--type-inline'>Women<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.9' type='checkbox'  value='Health\/Social care professionals'  id='choice_5_37_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_9' id='label_5_37_9' class='gform-field-label gform-field-label--type-inline'>Health\/Social care professionals<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_37_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.11' type='checkbox'  value='Other*'  id='choice_5_37_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_37_11' id='label_5_37_11' class='gform-field-label gform-field-label--type-inline'>Other*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'><span class='gform-field-label__text'>If other, please specify<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='0' data-text-counter-template='{current} of {max} max characters'><input name='input_38' id='input_5_38' type='text' value='' class='large' maxlength='0'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Services\/support delivered<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_39'>Help us to learn more about what services and support your organisation provides.  \n\nPlease select all that apply. <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_39'><div class='gchoice gchoice_5_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='Advice provision'  id='choice_5_39_1'   aria-describedby=\"gfield_description_5_39\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_1' id='label_5_39_1' class='gform-field-label gform-field-label--type-inline'>Advice provision<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='Arts &amp; Music'  id='choice_5_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_2' id='label_5_39_2' class='gform-field-label gform-field-label--type-inline'>Arts &amp; Music<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='Befriending'  id='choice_5_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_3' id='label_5_39_3' class='gform-field-label gform-field-label--type-inline'>Befriending<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.4' type='checkbox'  value='Care at home'  id='choice_5_39_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_4' id='label_5_39_4' class='gform-field-label gform-field-label--type-inline'>Care at home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.5' type='checkbox'  value='Care home'  id='choice_5_39_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_5' id='label_5_39_5' class='gform-field-label gform-field-label--type-inline'>Care home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.6' type='checkbox'  value='Counselling &amp; therapy services'  id='choice_5_39_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_6' id='label_5_39_6' class='gform-field-label gform-field-label--type-inline'>Counselling &amp; therapy services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.7' type='checkbox'  value='Education &amp; Training'  id='choice_5_39_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_7' id='label_5_39_7' class='gform-field-label gform-field-label--type-inline'>Education &amp; Training<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.8' type='checkbox'  value='Independent advocacy'  id='choice_5_39_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_8' id='label_5_39_8' class='gform-field-label gform-field-label--type-inline'>Independent advocacy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.9' type='checkbox'  value='Nature &amp; outdoor activity'  id='choice_5_39_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_9' id='label_5_39_9' class='gform-field-label gform-field-label--type-inline'>Nature &amp; outdoor activity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.11' type='checkbox'  value='Peer support'  id='choice_5_39_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_11' id='label_5_39_11' class='gform-field-label gform-field-label--type-inline'>Peer support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.12' type='checkbox'  value='Physical activity'  id='choice_5_39_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_12' id='label_5_39_12' class='gform-field-label gform-field-label--type-inline'>Physical activity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.13' type='checkbox'  value='Policy influencing'  id='choice_5_39_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_13' id='label_5_39_13' class='gform-field-label gform-field-label--type-inline'>Policy influencing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.14' type='checkbox'  value='Primary care provider'  id='choice_5_39_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_14' id='label_5_39_14' class='gform-field-label gform-field-label--type-inline'>Primary care provider<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.15' type='checkbox'  value='Rehabilitation support'  id='choice_5_39_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_15' id='label_5_39_15' class='gform-field-label gform-field-label--type-inline'>Rehabilitation support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.16' type='checkbox'  value='Research'  id='choice_5_39_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_16' id='label_5_39_16' class='gform-field-label gform-field-label--type-inline'>Research<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.17' type='checkbox'  value='Respite &amp; short breaks'  id='choice_5_39_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_17' id='label_5_39_17' class='gform-field-label gform-field-label--type-inline'>Respite &amp; short breaks<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.18' type='checkbox'  value='Secondary care provider'  id='choice_5_39_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_18' id='label_5_39_18' class='gform-field-label gform-field-label--type-inline'>Secondary care provider<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.19' type='checkbox'  value='Self directed support'  id='choice_5_39_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_19' id='label_5_39_19' class='gform-field-label gform-field-label--type-inline'>Self directed support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.21' type='checkbox'  value='Signposting'  id='choice_5_39_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_21' id='label_5_39_21' class='gform-field-label gform-field-label--type-inline'>Signposting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.22' type='checkbox'  value='Support\/helpline'  id='choice_5_39_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_22' id='label_5_39_22' class='gform-field-label gform-field-label--type-inline'>Support\/helpline<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_39_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.23' type='checkbox'  value='Other*'  id='choice_5_39_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_39_23' id='label_5_39_23' class='gform-field-label gform-field-label--type-inline'>Other*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_40'><span class='gform-field-label__text'>If other, please specify<\/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_5_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_3col gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Primary focus<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_41'>Help us to better understand which areas of health, long term conditions or disabilities your organisation works to support.  \n\nPlease select up to three that apply. <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_41'><div class='gchoice gchoice_5_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Multiple\/all long term conditions'  id='choice_5_41_1'   aria-describedby=\"gfield_description_5_41\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_1' id='label_5_41_1' class='gform-field-label gform-field-label--type-inline'>Multiple\/all long term conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Age related health'  id='choice_5_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_2' id='label_5_41_2' class='gform-field-label gform-field-label--type-inline'>Age related health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='Addiction\/substance misuse'  id='choice_5_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_3' id='label_5_41_3' class='gform-field-label gform-field-label--type-inline'>Addiction\/substance misuse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='Cancer'  id='choice_5_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_4' id='label_5_41_4' class='gform-field-label gform-field-label--type-inline'>Cancer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Cardiovascular conditions'  id='choice_5_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_5' id='label_5_41_5' class='gform-field-label gform-field-label--type-inline'>Cardiovascular conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.6' type='checkbox'  value='Congenital conditions'  id='choice_5_41_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_6' id='label_5_41_6' class='gform-field-label gform-field-label--type-inline'>Congenital conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.7' type='checkbox'  value='Dementia &amp; Alzheimers'  id='choice_5_41_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_7' id='label_5_41_7' class='gform-field-label gform-field-label--type-inline'>Dementia &amp; Alzheimers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.8' type='checkbox'  value='Dermatological conditions'  id='choice_5_41_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_8' id='label_5_41_8' class='gform-field-label gform-field-label--type-inline'>Dermatological conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.9' type='checkbox'  value='Learning disabilities'  id='choice_5_41_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_9' id='label_5_41_9' class='gform-field-label gform-field-label--type-inline'>Learning disabilities<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.11' type='checkbox'  value='Mental health'  id='choice_5_41_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_11' id='label_5_41_11' class='gform-field-label gform-field-label--type-inline'>Mental health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.12' type='checkbox'  value='Men&#039;s health'  id='choice_5_41_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_12' id='label_5_41_12' class='gform-field-label gform-field-label--type-inline'>Men&#8217;s health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.13' type='checkbox'  value='Musco-skeletal conditions'  id='choice_5_41_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_13' id='label_5_41_13' class='gform-field-label gform-field-label--type-inline'>Musco-skeletal conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.14' type='checkbox'  value='Neurodiversity'  id='choice_5_41_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_14' id='label_5_41_14' class='gform-field-label gform-field-label--type-inline'>Neurodiversity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.15' type='checkbox'  value='Neurological conditions'  id='choice_5_41_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_15' id='label_5_41_15' class='gform-field-label gform-field-label--type-inline'>Neurological conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.16' type='checkbox'  value='Palliative care'  id='choice_5_41_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_16' id='label_5_41_16' class='gform-field-label gform-field-label--type-inline'>Palliative care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.17' type='checkbox'  value='Rare disease'  id='choice_5_41_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_17' id='label_5_41_17' class='gform-field-label gform-field-label--type-inline'>Rare disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.18' type='checkbox'  value='Respiratory conditions'  id='choice_5_41_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_18' id='label_5_41_18' class='gform-field-label gform-field-label--type-inline'>Respiratory conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.19' type='checkbox'  value='Sensory'  id='choice_5_41_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_19' id='label_5_41_19' class='gform-field-label gform-field-label--type-inline'>Sensory<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.21' type='checkbox'  value='Women&#039;s Health'  id='choice_5_41_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_21' id='label_5_41_21' class='gform-field-label gform-field-label--type-inline'>Women&#8217;s Health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.22' type='checkbox'  value='Addressing social determinants of health'  id='choice_5_41_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_22' id='label_5_41_22' class='gform-field-label gform-field-label--type-inline'>Addressing social determinants of health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_41_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.23' type='checkbox'  value='Other*'  id='choice_5_41_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_41_23' id='label_5_41_23' class='gform-field-label gform-field-label--type-inline'>Other*<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'><span class='gform-field-label__text'>If other, please specify<\/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_42' id='input_5_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_5_24' 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_5_24' 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_5_3' class='gform_page' data-js='page-field-id-24' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_5_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Membership Type<\/h3><div class='gsection_description' id='gfield_description_5_13'>Please select the appropriate membership type and size, using the following guidance on our website: https:\/\/www.alliance-scotland.org.uk\/membership\/become-a-member\/types-and-fees\/<\/div><\/div><div id=\"field_5_15\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_15'><span class='gform-field-label__text'>Membership Type<\/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_15' id='input_5_15' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please Select...' >Please Select&#8230;<\/option><option value='Standard Small (\u00a320)' >Standard Small (\u00a320)<\/option><option value='Standard Medium (\u00a365)' >Standard Medium (\u00a365)<\/option><option value='Standard Large (\u00a3160)' >Standard Large (\u00a3160)<\/option><option value='Associate Small (\u00a320)' >Associate Small (\u00a320)<\/option><option value='Associate Medium (\u00a365)' >Associate Medium (\u00a365)<\/option><option value='Associate Large (\u00a3160)' >Associate Large (\u00a3160)<\/option><option value='Corporate Small (\u00a3100)' >Corporate Small (\u00a3100)<\/option><option value='Corporate Medium (\u00a3250)' >Corporate Medium (\u00a3250)<\/option><option value='Corporate Large (\u00a3500)' >Corporate Large (\u00a3500)<\/option><\/select><\/div><\/div><div id=\"field_5_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Membership contact details<\/h3><\/div><fieldset id=\"field_5_8\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nominated contact<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_8'>Please provide details for a nominated contact who will be recorded as the main point of contact for your organisation\u2019s membership. This individual will receive updates as relevant for your wider organisation.<\/div><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_8'>\n                            <span id='input_5_8_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_8.2' id='input_5_8_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr' >Dr<\/option><option value='Miss' >Miss<\/option><option value='Mr' >Mr<\/option><option value='Mrs' >Mrs<\/option><option value='Ms' >Ms<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_5_8_2' class='gform-field-label gform-field-label--type-sub '>Prefix<\/label>\n                                                  <\/span>\n                            <span id='input_5_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_5_8_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_8_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_5_8_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_8_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'><span class='gform-field-label__text'>Job Title<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_5_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_10\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_10'><span class='gform-field-label__text'>Email address<\/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_10' id='input_5_10' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_11\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-uk gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_11'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_5_11' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><fieldset id=\"field_5_45\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Finance contact<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_45'>Please provide details for a nominated finance contact for your organisation\u2019s membership. This individual will be copied into all correspondence relating to your membership billing. <\/div><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_45'>\n                            <span id='input_5_45_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_45.2' id='input_5_45_2'    aria-required='false'   >\n                          <option value=''><\/option><option value='Dr.' >Dr.<\/option><option value='Miss' >Miss<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Ms.' >Ms.<\/option><option value='Mx.' >Mx.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_5_45_2' class='gform-field-label gform-field-label--type-sub '>Prefix<\/label>\n                                                  <\/span>\n                            <span id='input_5_45_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.3' id='input_5_45_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_45_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_45_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.6' id='input_5_45_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_45_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_46'><span class='gform-field-label__text'>Job Title<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_5_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_47\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_47'><span class='gform-field-label__text'>Email address<\/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_47' id='input_5_47' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_48\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-uk gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_48'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_5_48' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_5_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Membership invoicing<\/h3><div class='gsection_description' id='gfield_description_5_52'>Once your application has been submitted and approved, the ALLIANCE will generate a membership invoice for your organisation. If you would like this to include a purchase order number please include this below.<\/div><\/div><div id=\"field_5_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_12'><span class='gform-field-label__text'>Purchase Order Number (if applicable)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_5_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_5_50' 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_5_50' 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_5_4' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_5_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Communication preferences<\/h3><div class='gsection_description' id='gfield_description_5_51'>As well as receiving our weekly bulletin and exclusive monthly newsletter please tick if you wish to be added to the following ALLIANCE mailing lists. <\/div><\/div><fieldset id=\"field_5_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Additional ALLIANCE newsletters<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_49'><div class='gchoice gchoice_5_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='Person Centred Voices'  id='choice_5_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_49_1' id='label_5_49_1' class='gform-field-label gform-field-label--type-inline'>Person Centred Voices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='Women&#039;s Health Mailing List'  id='choice_5_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_49_2' id='label_5_49_2' class='gform-field-label gform-field-label--type-inline'>Women&#8217;s Health Mailing List<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_49_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.3' type='checkbox'  value='Digital Digest'  id='choice_5_49_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_49_3' id='label_5_49_3' class='gform-field-label gform-field-label--type-inline'>Digital Digest<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_49_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.4' type='checkbox'  value='Children and Young People Mailing List'  id='choice_5_49_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_49_4' id='label_5_49_4' class='gform-field-label gform-field-label--type-inline'>Children and Young People Mailing List<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_49_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.5' type='checkbox'  value='Sensory Hub Newsletter'  id='choice_5_49_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_49_5' id='label_5_49_5' class='gform-field-label gform-field-label--type-inline'>Sensory Hub Newsletter<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_53\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referral and discovery information<\/h3><div class='gsection_description' id='gfield_description_5_53'>Please tell us how you first heard about membership of the ALLIANCE. This helps us understand how organisations discover our work and improve how we reach and engage with new members. <\/div><\/div><fieldset id=\"field_5_55\" 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'>How did you find out about ALLIANCE Membership?<\/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_5_55'>\n\t\t\t<div class='gchoice gchoice_5_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='ALLIANCE weekly bulletin'  id='choice_5_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_0' id='label_5_55_0' class='gform-field-label gform-field-label--type-inline'>ALLIANCE weekly bulletin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='ALLIANCE website'  id='choice_5_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_1' id='label_5_55_1' class='gform-field-label gform-field-label--type-inline'>ALLIANCE website<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='ALLIANCE event'  id='choice_5_55_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_2' id='label_5_55_2' class='gform-field-label gform-field-label--type-inline'>ALLIANCE event<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Member referral'  id='choice_5_55_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_3' id='label_5_55_3' class='gform-field-label gform-field-label--type-inline'>Member referral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Social media'  id='choice_5_55_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_4' id='label_5_55_4' class='gform-field-label gform-field-label--type-inline'>Social media<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Referral from an ALLIANCE colleague*'  id='choice_5_55_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_5' id='label_5_55_5' class='gform-field-label gform-field-label--type-inline'>Referral from an ALLIANCE colleague*<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Other*'  id='choice_5_55_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_6' id='label_5_55_6' class='gform-field-label gform-field-label--type-inline'>Other*<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_56'><span class='gform-field-label__text'>Please specify<\/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_56' id='input_5_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_5_26' 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_5_26' 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_5_5' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_5_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Final review and consent<\/h3><\/div><fieldset id=\"field_5_22\" 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_above 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_22.1' id='input_5_22_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_5_22_1' ><span class='gform-field-label__text'>I have read and understood what the membership package entails and agree to proceed with membership of the ALLIANCE<\/span><\/label><input type='hidden' name='input_22.2' value='I have read and understood what the membership package entails and agree to proceed with membership of the ALLIANCE' class='gform_hidden' \/><input type='hidden' name='input_22.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_5_27\" 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_above field_validation_below gfield_visibility_visible\"  ><small>This site is protected by reCAPTCHA and the Google <a href=\"https:\/\/policies.google.com\/privacy\">Privacy Policy<\/a> and <a href=\"https:\/\/policies.google.com\/terms\">Terms of Service<\/a> apply.<\/small><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_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='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> <input type='hidden' name='gform_ajax' value='form_id=5&amp;title=1&amp;description=1&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=72c1a4a180ad5483e51ac5e39bc66252' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_5' value='iframe' \/>\n       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