<link href="https://www.emailmeform.com/builder/styles/dynamic.php?t=post" rel="stylesheet" type="text/css"></link> <link href="https://www.emailmeform.com/builder/theme_css/Jjbc4cFuGc5B" rel="stylesheet" type="text/css"></link> <script src="https://ajax.googleapis.com/ajax/libs/jquery/1.4.4/jquery.min.js" type="text/javascript"> </script> <script type="text/javascript"> if (typeof jQuery == 'undefined'){ document.write(unescape("%3Cscript src='http://www.emailmeform.com/builder/js/jquery-1.4.4.min.js' type='text/javascript'%3E%3C/script%3E")); } </script> <script src="https://ajax.googleapis.com/ajax/libs/jqueryui/1.7.2/jquery-ui.min.js" type="text/javascript"> </script> <script type="text/javascript"> if (typeof $.ui == 'undefined'){ document.write(unescape("%3Cscript src='http://www.emailmeform.com/builder/js/jquery-ui-1.7.2.custom.min.js' type='text/javascript'%3E%3C/script%3E")); } </script> <script src="https://www.emailmeform.com/builder/js/dynamic.php?t=post&t2=0&use_CDN=true" type="text/javascript"> </script> <br /> <div id="emf-container-outer"> <div id="emf-container"> <div id="emf-logo"> <a href="http://www.blogger.com/blogger.g?blogID=8184879236651185787">EmailMeForm</a> </div> <form action="http://www.emailmeform.com/builder/form/Jjbc4cFuGc5B" class="leftLabel" enctype="multipart/form-data" id="emf-form" method="post" name="emf-form"> <div class="emf-head-widget" id="emf-form-instruction"> <div class="emf-bold" id="emf-form-title"> Form Title </div> <div id="emf-form-description"> This is your form description. Click here to edit. </div> </div> <ul> <li class="emf-li-field emf-field-new_name data_container" id="emf-li-0" style="text-align: left;"> <label class="emf-label-desc" for="element_0">Name *</label> <div class="emf-div-field"> <input class="validate[required] emf-input-w60" id="element_2" name="element_2" type="text" value="" /> <label class="emf-bottom-label emf-text-center" for="element_2">First</label> <input class="validate[required] emf-input-w100" id="element_3" name="element_3" type="text" value="" /> <label class="emf-bottom-label emf-text-center" for="element_3">Last</label> </div> <div class="emf-clear"> </div> </li> <li class="emf-li-field emf-field-email data_container" id="emf-li-5" style="text-align: left;"> <label class="emf-label-desc" for="element_5">Email *</label> <div class="emf-div-field"> <input class="validate[required,custom[email]]" id="element_5" name="element_5" size="30" type="text" value="" /> </div> <div class="emf-clear"> </div> </li> <li class="emf-li-field emf-field-url data_container" id="emf-li-6" style="text-align: left;"> <label class="emf-label-desc" for="element_6">Web Site</label> <div class="emf-div-field"> <input class="validate[optional,funcCall[url_ex,optional]]" id="element_6" name="element_6" size="30" type="text" value="" /> </div> <div class="emf-clear"> </div> </li> <li class="emf-li-field emf-field-textarea data_container" id="emf-li-7" style="text-align: left;"> <label class="emf-label-desc" for="element_7">messages *</label> <div class="emf-div-field"> <textarea class="validate[required]" cols="45" id="element_7" name="element_7" rows="10"></textarea> </div> <div class="emf-clear"> </div> </li> <li id="emf-li-recaptcha"> <script type="text/javascript"> //<![CDATA[ $(function(){ $('#recaptcha_response_field').addClass('validate[required]'); }); //]]> </script> <div> <script type="text/javascript"> //<![CDATA[ var RecaptchaOptions = { theme: 'clean', custom_theme_widget: 'emf-recaptcha_widget' }; //]]> </script> <script src="https://www.google.com/recaptcha/api/challenge?k=6LchicQSAAAAAGksQmNaDZMw3aQITPqZEsX77l%0A%0AT9" type="text/javascript"> </script> <noscript>&amp;amp;amp;amp;amp;amp;amp;amp;lt;iframe src="https://www.google.com/recaptcha/api/noscript?k=6LchicQSAAAAAGksQmNaDZMw3aQITPqZEsX77lT 9" height="300" width="500" frameborder="0"&amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;/iframe&amp;amp;a mp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;br /&amp;amp;amp;amp;amp;amp;amp;amp;gt; &amp;amp;amp;amp;amp;amp;amp;amp;lt;textarea name="recaptcha_challenge_field" rows="3" cols="40"&amp;amp;amp;amp;amp;amp;amp;amp;gt; &amp;amp;amp;amp;amp;amp;amp;amp;lt;/textarea&amp;amp;amp;amp;amp;amp;amp;amp;gt; &amp;amp;amp;amp;amp;amp;amp;amp;lt;input type="hidden" name="recaptcha_response_field" value="manual_challenge" /&amp;amp;amp;amp;amp;amp;amp;amp;gt;</noscript> </div> </li> <li class="left" id="emf-li-post-button"> <input onmouseover="return true;" type="submit" value="Send email" /> </li> </ul> <input name="element_counts" type="hidden" value="8" /> <input name="embed" type="hidden" value="forms" /> </form> </div> </div> <br /> <div style="text-align: center;"> <span style="color: black; font-family: "verdana"; font-size: x-small;">Powered by</span><span style="bottom: -5px; padding-left: 3px; position: relative;"><img src="https://www.emailmeform.com/builder/images/footer-logo.png" /></span><span style="color: black; font-family: "verdana"; font-size: x-small;">EMF</span> <a href="http://www.emailmeform.com/" style="text-decoration: none;" target="_blank"><span style="color: black; font-family: "verdana"; font-size: x-small;">Online Form Builder</span></a><br /> <a href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/J%0A%0Ajbc4cFuGc5B" style="font-size: 70%; line-height: 20px; text-decoration: none;" target="_blank"><span style="color: black; font-family: "verdana"; font-size: x-small;">Report Abuse</span></a> </div> <script type="text/javascript"> //<![CDATA[ EMF_jQuery(function(){ EMF_jQuery("#emf-form").validationEngine({ validationEventTriggers:"blur", scroll:true }); EMF_jQuery("#emf-form ul li").mousedown(highlight_field_on_mousedown); EMF_jQuery("#emf-form ul li input, #emf-form ul li textarea, #emf-form ul li select").focus(highlight_field_on_focus); var form_obj=EMF_jQuery("#emf-container form"); if(form_obj.length>0 && form_obj.attr('action').indexOf('#')==-1 && window.location.hash){ form_obj.attr('action', form_obj.attr('action')+window.location.hash); } init_rules(); }); EMF_jQuery(window).load(function(){ post_message_for_frame_height(); }); var emf_widgets={text : function(index){ return $("#element_"+index).val(); } ,number : function(index){ return $("#element_"+index).val(); } ,textarea : function(index){ return $("#element_"+index).val(); } ,checkbox : function(index){ var arr=new Array(); $("input[name='element_"+index+"[]']:checked").each(function(){ arr[arr.length]=this.value; }); var result=arr.join(", "); return result; } ,radio : function(index){ var result=""; $("input[name=element_"+index+"]:checked").each(function(){ result=this.value; }); return result; } ,select : function(index){ return $("#element_"+index).val(); } ,email : function(index){ return $("#element_"+index).val(); } ,phone : function(index){ var arr=new Array(); $("input[id^=element_"+index+"_]").each(function(){ arr[arr.length]=this.value; }); var result=""; if(arr.length>0){ result=arr.join("-"); }else{ result=$("#element_"+index).val(); } return result; } ,datetime : function(index){ var result=""; var date_part=""; if($("#element_"+index+"_year").length==1){ date_part=$("#element_"+index+"_year-mm").val()+"/"+$("#element_"+index+"_year-dd").val()+"/ "+$("#element_"+index+"_year").val(); } var time_part=""; if($("#element_"+index+"_hour").length==1){ time_part=$("#element_"+index+"_hour").val()+":"+$("#element_"+index+"_minute").val()+" "+$("#element_"+index+"_ampm").val(); } if(date_part && time_part){ result=date_part+" "+time_part; }else{ result=date_part ? date_part : time_part; } return result; } ,url : function(index){ return $("#element_"+index).val(); } ,file : function(index){ return $("#element_"+index).val(); } ,select_multiple : function(index){ return $("#element_"+index).val(); } ,price : function(index){ var result=""; var arr=new Array(); $("input[id^=element_"+index+"_]").each(function(){ arr[arr.length]=this.value; }); result=arr.join("."); return result; } ,hidden : function(index){ return $("#element_"+index).val(); } ,section_break : function(index){ return ""; } ,page_break : function(index){ return ""; } ,deprecated : function(index){ return $("#element_"+index).val(); } ,address : function(index){ var result=""; var element_arr=$("input,select").filter("[name='element_"+index+"[]']").toArray(); result=element_arr[0].value+" "+element_arr[1].value+"\n" +element_arr[2].value+","+element_arr[3].value+" "+element_arr[4].value+"\n" +element_arr[5].value return result; } ,name : function(index){ var arr=new Array(); $("input[id^=element_"+index+"_]").each(function(){ arr[arr.length]=this.value; }); var result=arr.join(" "); return result; } }; var emf_condition_id_to_js_map={1 : function(field_value, value){ return field_value.indexOf(value)>-1; } ,2 : function(field_value, value){ return field_value.indexOf(value)==-1; } ,3 : function(field_value, value){ return field_value.indexOf(value)==0; } ,4 : function(field_value, value){ return field_value.indexOf(value)==field_value.length-value.length; } ,5 : function(field_value, value){ return field_value==value; } ,6 : function(field_value, value){ return field_value!=value; } ,7 : function(field_value, value){ return field_value==value; } ,8 : function(field_value, value){ return field_value>value; } ,9 : function(field_value, value){ return field_value<value; } ,10 : function(field_value, value){ var date_for_field_value=Date.parse(field_value); var date_for_value=Date.parse(value); if(date_for_field_value && date_for_value){ return date_for_field_value == date_for_value; } return false; } ,11 : function(field_value, value){ var date_for_field_value=Date.parse(field_value); var date_for_value=Date.parse(value); if(date_for_field_value && date_for_value){ return date_for_field_value < date_for_value; } return false; } ,12 : function(field_value, value){ var date_for_field_value=Date.parse(field_value); var date_for_value=Date.parse(value); if(date_for_field_value && date_for_value){ return date_for_field_value > date_for_value; } return false; } }; var emf_group_to_field_rules_map=[]; var emf_group_to_page_rules_for_confirmation_map=[]; //]]> </script>