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document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(4).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(3).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(2).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(1).fsNameFirst {"+"\n");
document.write("  width: calc(35% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(4).fsNamePrefix, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(4).fsNameInitial, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(4).fsNameMiddle, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(4).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(3).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(3).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(3).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(3).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(2).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(2).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(2).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(2).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(1).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(1).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(1).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(1).fsNameSuffix {"+"\n");
document.write("  width: calc(15% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(5).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(4).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(3).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(2).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(1).fsNameFirst {"+"\n");
document.write("  width: calc(32% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(5).fsNamePrefix, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(5).fsNameInitial, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(5).fsNameMiddle, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(5).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(4).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(4).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(4).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(4).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(3).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(3).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(3).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(3).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(2).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(2).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(2).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(2).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(1).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(1).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(1).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(1).fsNameSuffix {"+"\n");
document.write("  width: calc(12% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(6).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(5).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(4).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(3).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(2).fsNameFirst,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(6):nth-last-child(1).fsNameFirst {"+"\n");
document.write("  width: calc(28% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(6).fsNamePrefix, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(6).fsNameInitial, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(6).fsNameMiddle, .fsSubFieldGroup .fsSubField:nth-child(1):nth-last-child(6).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(5).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(5).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(5).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(2):nth-last-child(5).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(4).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(4).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(4).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(3):nth-last-child(4).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(3).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(3).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(3).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(4):nth-last-child(3).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(2).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(2).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(2).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(5):nth-last-child(2).fsNameSuffix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(6):nth-last-child(1).fsNamePrefix,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(6):nth-last-child(1).fsNameInitial,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(6):nth-last-child(1).fsNameMiddle,"+"\n");
document.write(".fsSubFieldGroup .fsSubField:nth-child(6):nth-last-child(1).fsNameSuffix {"+"\n");
document.write("  width: calc(11% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubField.fsFieldAddress {"+"\n");
document.write("  width: 100%;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubField.fsFieldAddress2 {"+"\n");
document.write("  width: 100%;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubField.fsFieldCity {"+"\n");
document.write("  width: calc(60% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubField.fsFieldState {"+"\n");
document.write("  width: calc(30% - 10px);"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubFieldGroup ~ select[name*=\'-country\'] {"+"\n");
document.write("  margin-top: 10px !important;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSubField.fsFieldAddress,"+"\n");
document.write(".fsBody .fsSubField.fsFieldAddress2 {"+"\n");
document.write("  margin-bottom: 10px;"+"\n");
document.write("}"+"\n");
document.write("@media all and (max-width: 699px), all and (device-height: 1024px) and (device-width: 768px) and (orientation: portrait), all and (device-height: 1024px) and (device-width: 768px) and (orientation: landscape) {"+"\n");
document.write("  .fsBody .fsSubField.fsFieldCity {"+"\n");
document.write("    margin-bottom: 10px;"+"\n");
document.write("  }"+"\n");
document.write("  .fsBody .fsSubField.fsFieldState {"+"\n");
document.write("    width: calc(70% - 10px);"+"\n");
document.write("  }"+"\n");
document.write("}"+"\n");
document.write("@media (max-width: 40em) {"+"\n");
document.write("  div.fsSubField.fsFieldState {"+"\n");
document.write("    margin-right: 10px;"+"\n");
document.write("  }"+"\n");
document.write("}"+"\n");
document.write("div.fsSliderValue {"+"\n");
document.write("  padding: 6.5px 13px;"+"\n");
document.write("  -moz-border-radius: 0px;"+"\n");
document.write("  -webkit-border-radius: 0px;"+"\n");
document.write("  border-radius: 0px;"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  line-height: 19px;"+"\n");
document.write("  color: #ffffff;"+"\n");
document.write("  background-color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv {"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  background-color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv .ui-state-default,"+"\n");
document.write(".fsSliderDiv .ui-widget-content .ui-state-default {"+"\n");
document.write("  background-color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv .ui-state-active,"+"\n");
document.write(".fsSliderDiv .ui-widget-content .ui-state-active {"+"\n");
document.write("  background-color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv .ui-corner-all, .fsSliderDiv.ui-corner-all {"+"\n");
document.write("  -moz-border-radius-topleft: 0px;"+"\n");
document.write("  -webkit-border-top-left-radius: 0px;"+"\n");
document.write("  border-top-left-radius: 0px;"+"\n");
document.write("  -moz-border-radius-topright: 0px;"+"\n");
document.write("  -webkit-border-top-right-radius: 0px;"+"\n");
document.write("  border-top-right-radius: 0px;"+"\n");
document.write("  -moz-border-radius-bottomleft: 0px;"+"\n");
document.write("  -webkit-border-bottom-left-radius: 0px;"+"\n");
document.write("  border-bottom-left-radius: 0px;"+"\n");
document.write("  -moz-border-radius-bottomright: 0px;"+"\n");
document.write("  -webkit-border-bottom-right-radius: 0px;"+"\n");
document.write("  border-bottom-right-radius: 0px;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv.ui-widget-content {"+"\n");
document.write("  border: 1px solid #d4d4d4 !important;"+"\n");
document.write("}"+"\n");
document.write(".fsSliderDiv .ui-widget-header {"+"\n");
document.write("  background-color: #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsCurrency {"+"\n");
document.write("  margin-right: 5px !important;"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  line-height: 38px;"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsCurrency.fsCurrencySuffix {"+"\n");
document.write("  margin-right: 0 !important;"+"\n");
document.write("  margin-left: 5px !important;"+"\n");
document.write("}"+"\n");
document.write(".fsCurrency ~ input.fsField {"+"\n");
document.write("  width: calc(96% - 5px) !important;"+"\n");
document.write("}"+"\n");
document.write(".fsRowBody input[type=\"email\"] ~ p {"+"\n");
document.write("  margin-top: 10px;"+"\n");
document.write("}"+"\n");
document.write("@font-face {"+"\n");
document.write("  font-family: \'TextMask\';"+"\n");
document.write("  src: url(\"/forms/fonts/3/password.ttf\") format(\"truetype\");"+"\n");
document.write("  font-weight: 400;"+"\n");
document.write("  font-style: normal;"+"\n");
document.write("}"+"\n");
document.write(".fsTextMask {"+"\n");
document.write("  font-family: \'TextMask\' !important;"+"\n");
document.write("}"+"\n");
document.write(".fsRowBody input[type=\"text\"] ~ p {"+"\n");
document.write("  margin-top: 10px;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__fields__quantity {"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__fields__fixed-amount,"+"\n");
document.write(".fsProductField__fields__no-charge {"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__info__name {"+"\n");
document.write("  font-size: 19px;"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__info__description {"+"\n");
document.write("  margin-top: 5px;"+"\n");
document.write("  font-size: 9px;"+"\n");
document.write("  line-height: 9px;"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__fields__sold-out {"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  color: #ee0000;"+"\n");
document.write("}"+"\n");
document.write(".fsProductField__wait-list {"+"\n");
document.write("  margin-top: 10px;"+"\n");
document.write("}"+"\n");
document.write("@media (max-width: 40em) {"+"\n");
document.write("  .fsProductField__image {"+"\n");
document.write("    -moz-border-radius: 0px;"+"\n");
document.write("    -webkit-border-radius: 0px;"+"\n");
document.write("    border-radius: 0px;"+"\n");
document.write("  }"+"\n");
document.write("  .fsProductField__fields__fixed-amount,"+"\n");
document.write("  .fsProductField__fields__quantity {"+"\n");
document.write("    font-size: 13px;"+"\n");
document.write("  }"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix {"+"\n");
document.write("  font-size: 9px;"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix th,"+"\n");
document.write(".fsMatrix td {"+"\n");
document.write("  border-top: 1px solid #d4d4d4;"+"\n");
document.write("  border-left: 1px solid #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix th:nth-child(2) {"+"\n");
document.write("  -moz-border-radius: 0px 0 0 0;"+"\n");
document.write("  -webkit-border-radius: 0px;"+"\n");
document.write("  border-radius: 0px 0 0 0;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix tr:first-child th:last-child {"+"\n");
document.write("  -moz-border-radius: 0 0px 0 0;"+"\n");
document.write("  -webkit-border-radius: 0;"+"\n");
document.write("  border-radius: 0 0px 0 0;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix tr:last-child td:last-child {"+"\n");
document.write("  -moz-border-radius: 0 0 0px 0;"+"\n");
document.write("  -webkit-border-radius: 0;"+"\n");
document.write("  border-radius: 0 0 0px 0;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix tr:last-child th {"+"\n");
document.write("  -moz-border-radius: 0 0 0 0px;"+"\n");
document.write("  -webkit-border-radius: 0;"+"\n");
document.write("  border-radius: 0 0 0 0px;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix tr:last-child th,"+"\n");
document.write(".fsMatrix tr:last-child td {"+"\n");
document.write("  border-bottom: 1px solid #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix tr th:last-child,"+"\n");
document.write(".fsMatrix tr td:last-child {"+"\n");
document.write("  border-right: 1px solid #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix th.fsMatrixLabelColumn {"+"\n");
document.write("  text-align: center;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix th.fsMatrixLabelRow {"+"\n");
document.write("  text-align: right;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrix th.fsMatrixLabelColumn,"+"\n");
document.write(".fsMatrix th.fsMatrixLabelRow {"+"\n");
document.write("  padding: 4.5px;"+"\n");
document.write("}"+"\n");
document.write(".fsMatrixCol1 {"+"\n");
document.write("  background: #eaeaea;"+"\n");
document.write("  background: rgba(234,234,234, 0.2);"+"\n");
document.write("}"+"\n");
document.write(".fsMatrixCol2 {"+"\n");
document.write("  background: #d4d4d4;"+"\n");
document.write("  background: rgba(212,212,212, 0.2);"+"\n");
document.write("}"+"\n");
document.write(".rtl .fsMatrix th, .rtl .fsMatrix td {"+"\n");
document.write("  border-right: 1px solid #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsForm input[type=\"file\"]::-webkit-file-upload-button, .fsForm .fsFileUploadButton {"+"\n");
document.write("  height: 38px;"+"\n");
document.write("  -moz-border-radius: 0px;"+"\n");
document.write("  -webkit-border-radius: 0px;"+"\n");
document.write("  border-radius: 0px;"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("  color: #ffffff;"+"\n");
document.write("  background-color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsFileUploadName {"+"\n");
document.write("  font-size: 13px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fieldset-content .always-ltr {"+"\n");
document.write("  margin-top: 10px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fieldset-content select span,"+"\n");
document.write(".fsBody .fieldset-content .always-ltr span, .fsBody .fieldset-content .always-ltr-align-right span {"+"\n");
document.write("  top: 9.5px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fieldset-content select {"+"\n");
document.write("  margin-right: 10px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fieldset-content span {"+"\n");
document.write("  right: 5px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .ui-datepicker-trigger {"+"\n");
document.write("  top: 9.5px;"+"\n");
document.write("  margin-left: 10px;"+"\n");
document.write("}"+"\n");
document.write(".fsSignatureClear {"+"\n");
document.write("  font-size: 9px;"+"\n");
document.write("  color: #262626;"+"\n");
document.write("}"+"\n");
document.write(".fsSignature + div {"+"\n");
document.write("  margin-left: 10px;"+"\n");
document.write("  line-height: 9px;"+"\n");
document.write("}"+"\n");
document.write(".wf-active .fsSignature {"+"\n");
document.write("  font-family: Arial, Tahoma, sans-serif;"+"\n");
document.write("}"+"\n");
document.write("img.fsCreditCardLogo {"+"\n");
document.write("  margin-top: 5px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSectionHeader {"+"\n");
document.write("  background-color: #edeff0;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsForm .fsSectionHeading {"+"\n");
document.write("  margin-bottom: 10px;"+"\n");
document.write("  text-align: left;"+"\n");
document.write("  font-size: 29px;"+"\n");
document.write("  font-weight: 400;"+"\n");
document.write("  font-style: normal;"+"\n");
document.write("  line-height: 29px;"+"\n");
document.write("  color: #595d64;"+"\n");
document.write("}"+"\n");
document.write(".fsborderradius .fsBody .fsSectionHeader {"+"\n");
document.write("  -moz-border-radius: 0px;"+"\n");
document.write("  -webkit-border-radius: 0px;"+"\n");
document.write("  border-radius: 0px;"+"\n");
document.write("}"+"\n");
document.write(".fsborderradius .fsBody .fsSectionHeader {"+"\n");
document.write("  margin-bottom: 40px;"+"\n");
document.write("}"+"\n");
document.write(".fsBody .fsSectionHeader {"+"\n");
document.write("  padding: 20px;"+"\n");
document.write("}"+"\n");
document.write(".fsForm select[multiple=\"multiple\"]::-webkit-scrollbar-thumb,"+"\n");
document.write(".fsForm textarea::-webkit-scrollbar-thumb {"+"\n");
document.write("  background-color: #d4d4d4;"+"\n");
document.write("}"+"\n");
document.write(".fsForm .fsSubmit {"+"\n");
document.write("  margin-top: 40px;"+"\n");
document.write("  padding: 20px 0;"+"\n");
document.write("}"+"\n");
document.write(".fsPreviousButton,"+"\n");
document.write(".fsSubmitButton,"+"\n");
document.write(".fsNextButton {"+"\n");
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document.write("                                                </div>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-7\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65051546\" lang=\"en\" fs-field-type=\"number\" fs-field-validation-name=\"Amount of gift\">"+"\n");
document.write("                                                                                                        <label id=\"label65051546\" class=\"fsLabel\" for=\"field65051546\">Amount of gift                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                                            <span class=\"fsCurrency fsCurrencyPrefix\">$</span>"+"\n");
document.write("            "+"\n");
document.write("        <input type=\"number\" step=\"any\" id=\"field65051546\" name=\"field65051546\"  class=\"fsField fsFormatNumber fsNumberDecimals-2\" disabled=\"disabled\" />"+"\n");
document.write("    "+"\n");
document.write("    <script>"+"\n");
document.write("    //This script is to address some quirkiness of Safari where commas are interchangeable with decimal points on number fields."+"\n");
document.write("    //Normal attempts to restrict the comma such as our own validation or .replace(\",\", \"\") results in the value of the field being removed entirely."+"\n");
document.write("    //Below the keypress itself is being blocked as a workaround to keep our value."+"\n");
document.write("    document.getElementById(\"field65051546\").addEventListener(\"keydown\", function blockComma(e) {"+"\n");
document.write("    if (e.code === \'Comma\') {"+"\n");
document.write("    e.preventDefault();}})"+"\n");
document.write("    </script>"+"\n");
document.write("                        <span class=\"fsCurrency fsCurrencySuffix\"></span>"+"\n");
document.write("            "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
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document.write("                        "+"\n");
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document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-8\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65352497\" lang=\"en\" fs-field-type=\"number\" fs-field-validation-name=\"Total gifts\">"+"\n");
document.write("                                                                                                        <label id=\"label65352497\" class=\"fsLabel\" for=\"field65352497\">Total gifts                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                                            <span class=\"fsCurrency fsCurrencyPrefix\">$</span>"+"\n");
document.write("            "+"\n");
document.write("        <input type=\"number\" step=\"any\" id=\"field65352497\" name=\"field65352497\"  class=\"fsField fsFormatNumber fsNumberDecimals-2\" disabled=\"disabled\" />"+"\n");
document.write("    "+"\n");
document.write("    <script>"+"\n");
document.write("    //This script is to address some quirkiness of Safari where commas are interchangeable with decimal points on number fields."+"\n");
document.write("    //Normal attempts to restrict the comma such as our own validation or .replace(\",\", \"\") results in the value of the field being removed entirely."+"\n");
document.write("    //Below the keypress itself is being blocked as a workaround to keep our value."+"\n");
document.write("    document.getElementById(\"field65352497\").addEventListener(\"keydown\", function blockComma(e) {"+"\n");
document.write("    if (e.code === \'Comma\') {"+"\n");
document.write("    e.preventDefault();}})"+"\n");
document.write("    </script>"+"\n");
document.write("                        <span class=\"fsCurrency fsCurrencySuffix\"></span>"+"\n");
document.write("            "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-9\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65051583\" aria-describedby=\"fsSupporting65051583\" lang=\"en\" fs-field-type=\"datetime\" fs-field-validation-name=\"Gift date\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend65051583\" id=\"label65051583\">"+"\n");
document.write("                            <legend id=\"fsLegend65051583\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Gift date<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                <!-- Used to pull in url for jquery -->"+"\n");
document.write("        <span aria-hidden=\"true\" style=\"display:none;\" id=\"fsCalendar65051583ImageUrl\">https://doctorswithoutborders.formstack.com/forms/images/2/calendar.png</span>"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    <input data-skip-validation data-date-format=\"F d, Y\" type=\"hidden\" id=\"field65051583Format\" name=\"field65051583Format\" value=\"MDY\" />"+"\n");
document.write("    "+"\n");
document.write("                    <div class=\"hidden\"><label for=\"field65051583M\">Month</label></div>"+"\n");
document.write("        <select id=\"field65051583M\" name=\"field65051583M\" class=\" fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"January\">January</option>"+"\n");
document.write("                    <option value=\"February\">February</option>"+"\n");
document.write("                    <option value=\"March\">March</option>"+"\n");
document.write("                    <option value=\"April\">April</option>"+"\n");
document.write("                    <option value=\"May\">May</option>"+"\n");
document.write("                    <option value=\"June\">June</option>"+"\n");
document.write("                    <option value=\"July\">July</option>"+"\n");
document.write("                    <option value=\"August\">August</option>"+"\n");
document.write("                    <option value=\"September\">September</option>"+"\n");
document.write("                    <option value=\"October\">October</option>"+"\n");
document.write("                    <option value=\"November\">November</option>"+"\n");
document.write("                    <option value=\"December\">December</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <div class=\"hidden\"><label for=\"field65051583D\">Day</label></div>"+"\n");
document.write("        <select id=\"field65051583D\" name=\"field65051583D\" class=\" fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"01\">01</option>"+"\n");
document.write("                    <option value=\"02\">02</option>"+"\n");
document.write("                    <option value=\"03\">03</option>"+"\n");
document.write("                    <option value=\"04\">04</option>"+"\n");
document.write("                    <option value=\"05\">05</option>"+"\n");
document.write("                    <option value=\"06\">06</option>"+"\n");
document.write("                    <option value=\"07\">07</option>"+"\n");
document.write("                    <option value=\"08\">08</option>"+"\n");
document.write("                    <option value=\"09\">09</option>"+"\n");
document.write("                    <option value=\"10\">10</option>"+"\n");
document.write("                    <option value=\"11\">11</option>"+"\n");
document.write("                    <option value=\"12\">12</option>"+"\n");
document.write("                    <option value=\"13\">13</option>"+"\n");
document.write("                    <option value=\"14\">14</option>"+"\n");
document.write("                    <option value=\"15\">15</option>"+"\n");
document.write("                    <option value=\"16\">16</option>"+"\n");
document.write("                    <option value=\"17\">17</option>"+"\n");
document.write("                    <option value=\"18\">18</option>"+"\n");
document.write("                    <option value=\"19\">19</option>"+"\n");
document.write("                    <option value=\"20\">20</option>"+"\n");
document.write("                    <option value=\"21\">21</option>"+"\n");
document.write("                    <option value=\"22\">22</option>"+"\n");
document.write("                    <option value=\"23\">23</option>"+"\n");
document.write("                    <option value=\"24\">24</option>"+"\n");
document.write("                    <option value=\"25\">25</option>"+"\n");
document.write("                    <option value=\"26\">26</option>"+"\n");
document.write("                    <option value=\"27\">27</option>"+"\n");
document.write("                    <option value=\"28\">28</option>"+"\n");
document.write("                    <option value=\"29\">29</option>"+"\n");
document.write("                    <option value=\"30\">30</option>"+"\n");
document.write("                    <option value=\"31\">31</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <div class=\"hidden\"><label for=\"field65051583Y\">Year</label></div>"+"\n");
document.write("        <select id=\"field65051583Y\" name=\"field65051583Y\" class=\" fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"2016\">2016</option>"+"\n");
document.write("                    <option value=\"2017\">2017</option>"+"\n");
document.write("                    <option value=\"2018\">2018</option>"+"\n");
document.write("                    <option value=\"2019\">2019</option>"+"\n");
document.write("                    <option value=\"2020\">2020</option>"+"\n");
document.write("                    <option value=\"2021\">2021</option>"+"\n");
document.write("                    <option value=\"2022\">2022</option>"+"\n");
document.write("                    <option value=\"2023\">2023</option>"+"\n");
document.write("                    <option value=\"2024\">2024</option>"+"\n");
document.write("                    <option value=\"2025\">2025</option>"+"\n");
document.write("                    <option value=\"2026\">2026</option>"+"\n");
document.write("                </select>"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    <input data-skip-validation type=\"text\" id=\"fsCalendar65051583Link\" class=\"fsCalendarPickerLink\" style=\"display:none;\" aria-hidden=\"true\" disabled=\"disabled\" />"+"\n");
document.write("        <div id=\"fsCalendar65051583\" class=\"fsCalendar\" style=\" position:absolute\"></div>"+"\n");
document.write("        "+"\n");
document.write("                                                                                                        <div id=\"fsSupporting65051583\" class=\"fsSupporting\">This information does not have to be exact. Please feel free to enter the approximate date that your gift was processed by MSF</div>"+"\n");
document.write("                                                                        "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-10\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65352534\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"Year\">"+"\n");
document.write("                                                                                                        <label id=\"label65352534\" class=\"fsLabel fsRequiredLabel\" for=\"field65352534\">Year<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field65352534\" name=\"field65352534\" size=\"1\"required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"2020\">2020</option>"+"\n");
document.write("        <option value=\"2019\" selected=\"selected\">2019</option>"+"\n");
document.write("        <option value=\"2018\">2018</option>"+"\n");
document.write("        <option value=\"2017\">2017</option>"+"\n");
document.write("        <option value=\"2016\">2016</option>"+"\n");
document.write("        <option value=\"2015\">2015</option>"+"\n");
document.write("        <option value=\"2014\">2014</option>"+"\n");
document.write("        <option value=\"2013\">2013</option>"+"\n");
document.write("        <option value=\"2012\">2012</option>"+"\n");
document.write("        <option value=\"2011\">2011</option>"+"\n");
document.write("        <option value=\"2010\">2010</option>"+"\n");
document.write("        <option value=\"2009\">2009</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-11\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65051674\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"Payment method\">"+"\n");
document.write("                                                                                                        <label id=\"label65051674\" class=\"fsLabel fsRequiredLabel\" for=\"field65051674\">Payment method<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field65051674\" name=\"field65051674\" size=\"1\"required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"Online\">Online</option>"+"\n");
document.write("        <option value=\"Phone\">Phone</option>"+"\n");
document.write("        <option value=\"Mail\">Mail</option>"+"\n");
document.write("        <option value=\"IRA\">IRA</option>"+"\n");
document.write("        <option value=\"Donor-Advised Fund\">Donor-Advised Fund</option>"+"\n");
document.write("        <option value=\"Other financial institution\">Other financial institution</option>"+"\n");
document.write("        <option value=\"Other/unknown\">Other/unknown</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-12\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell71708278\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Name of financial institution distributing the gift\">"+"\n");
document.write("                                                                                                        <label id=\"label71708278\" class=\"fsLabel fsRequiredLabel\" for=\"field71708278\">Name of financial institution distributing the gift<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field71708278\""+"\n");
document.write("  name=\"field71708278\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"       disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-13\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell65125402\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"Check number\">"+"\n");
document.write("                                                                                                        <label id=\"label65125402\" class=\"fsLabel\" for=\"field65125402\">Check number                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field65125402\""+"\n");
document.write("  name=\"field65125402\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow2961307-14\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell60940758\" aria-describedby=\"fsSupporting60940758\" lang=\"en\" fs-field-type=\"textarea\" fs-field-validation-name=\"Please provide any additional details about your request\">"+"\n");
document.write("                                                                                                        <label id=\"label60940758\" class=\"fsLabel\" for=\"field60940758\">Please provide any additional details about your request                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    "+"\n");
document.write("<textarea id=\"field60940758\""+"\n");
document.write("          class=\"fsField \""+"\n");
document.write("          name=\"field60940758\""+"\n");
document.write("          rows=\"10\""+"\n");
document.write("          cols=\"50\""+"\n");
document.write("                                                                      ></textarea>"+"\n");
document.write("                                                                                                        <div id=\"fsSupporting60940758\" class=\"fsSupporting\">Optional</div>"+"\n");
document.write("                                                                        "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                    </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("</div>"+"\n");
document.write("  "+"\n");
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