{"id":1945,"date":"2026-05-04T12:23:35","date_gmt":"2026-05-04T12:23:35","guid":{"rendered":"https:\/\/jonathan.rcm-test-web.co.za\/Ethiopian-Association?page_id=1945"},"modified":"2026-07-28T10:53:24","modified_gmt":"2026-07-28T10:53:24","slug":"membership-application","status":"publish","type":"page","link":"https:\/\/jonathan.rcm-test-web.co.za\/Ethiopian-Association\/membership-application\/","title":{"rendered":"Membership Application"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1945\" class=\"elementor elementor-1945\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-cef7528 e-con-full bg e-flex e-con e-parent\" data-id=\"cef7528\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;background_motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;background_motion_fx_scale_effect&quot;:&quot;yes&quot;,&quot;background_motion_fx_scale_direction&quot;:&quot;in-out&quot;,&quot;background_motion_fx_scale_speed&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:2,&quot;sizes&quot;:[]},&quot;background_motion_fx_scale_range&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:{&quot;start&quot;:20,&quot;end&quot;:80}},&quot;background_motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2e29d78 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"2e29d78\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Member Application\n<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-fb7f3db e-con-full e-flex e-con e-parent\" data-id=\"fb7f3db\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-9aead74 e-con-full e-flex e-con e-child\" data-id=\"9aead74\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ac50c38 elementor-widget elementor-widget-heading\" data-id=\"ac50c38\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Please Note<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f4277e elementor-widget elementor-widget-text-editor\" data-id=\"4f4277e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>After form submission in order to have access to our services payment will need to be made. <br \/>There are 3 Options for payment Cash at our premises, EFT or Bank Desposit.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca7d374 elementor-widget elementor-widget-text-editor\" data-id=\"ca7d374\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Bank: FNB Business Account<br \/>Bank Account: 63083222140<br \/>Branch: 251542<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-da47a7c e-con-full e-flex e-con e-child\" data-id=\"da47a7c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-00611f8 eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"00611f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"eael-contact-form eael-gravity-form placeholder-hide eael-contact-form-align-default\">\n\t\t        <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 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enctype='multipart\/form-data'  id='gform_3'  action='\/Ethiopian-Association\/wp-json\/wp\/v2\/pages\/1945' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_2'><span class='gform-field-label__text'>Full Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_3_2' type='text' value='' class='large'    placeholder='Full Name' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_3_3' type='text' value='' class='large'    placeholder='Last Name' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_4'><span class='gform-field-label__text'>Residential Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_3_4' type='text' value='' class='large'    placeholder='Address' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'><span class='gform-field-label__text'>Country<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_3_5' type='text' value='' class='large'    placeholder='Country' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'><span class='gform-field-label__text'>City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_3_11' type='text' value='' class='large'    placeholder='City' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_8'><span class='gform-field-label__text'>Cell Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_3_8' type='tel' value='' class='large'  placeholder='Cell Number' aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_3_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_9'><span class='gform-field-label__text'>Whatsapp Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_3_9' type='tel' value='' class='large'  placeholder='Whatsapp Number' aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_17'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='Date of Birth'\n\t\t\t\t\tid='input_3_17'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_17'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_3_17' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_3_17' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_3_17' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_18'><span class='gform-field-label__text'>Place of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_3_18' type='text' value='' class='large'    placeholder='Place of Birth' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'><span class='gform-field-label__text'>Gender<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_3_19' type='text' value='' class='large'    placeholder='Gender' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_20'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_3_20' type='text' value='' class='large'    placeholder='Nationality' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_58'><span class='gform-field-label__text'>Age<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_3_58' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_21'><span class='gform-field-label__text'>Occupation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_3_21' type='text' value='' class='large'    placeholder='Occupation' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_22'><span class='gform-field-label__text'>Business Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_3_22' type='text' value='' class='large'    placeholder='Business Name' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_23'><span class='gform-field-label__text'>Business Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_3_23' type='text' value='' class='large'    placeholder='Business Address' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_25\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_25'><span class='gform-field-label__text'>Business Contact Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_25' id='input_3_25' type='tel' value='' class='large'  placeholder='Business Contact Number' aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_3_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_26'><span class='gform-field-label__text'>Position<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_3_26' type='text' value='' class='large'    placeholder='Position' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_27'><span class='gform-field-label__text'>Yearly Membership Payment<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_3_27' type='text' value='' class='large'    placeholder='Yearly Membership Payment' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_30'><span class='gform-field-label__text'>Mother Tongue<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_3_30' type='text' value='' class='large'    placeholder='Mother Tongue' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_31'><span class='gform-field-label__text'>First Additional Language<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_3_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_33\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_33'><span class='gform-field-label__text'>Other Information<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_3_33' class='textarea small'    placeholder='Other Information'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_34\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_34'><span class='gform-field-label__text'>Province<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_3_34' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Province<\/option><option value='Gauteng' >Gauteng<\/option><option value='Limpopo' >Limpopo<\/option><option value='Mpumalanga' >Mpumalanga<\/option><option value='KwaZulu-Natal' >KwaZulu-Natal<\/option><option value='North West' >North West<\/option><option value='Free State' >Free State<\/option><option value='Eastern Cape' >Eastern Cape<\/option><option value='Northern Cape' >Northern Cape<\/option><option value='Western Cape' >Western Cape<\/option><\/select><\/div><\/div><fieldset id=\"field_3_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below 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'>Gauteng<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_35'><div class='gchoice gchoice_3_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='City Of Tshwane'  id='choice_3_35_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_1' id='label_3_35_1' class='gform-field-label gform-field-label--type-inline'>City Of Tshwane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.2' type='checkbox'  value='Ekurhuleni'  id='choice_3_35_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_2' id='label_3_35_2' class='gform-field-label gform-field-label--type-inline'>Ekurhuleni<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.3' type='checkbox'  value='City Of Johannesburg'  id='choice_3_35_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_3' id='label_3_35_3' class='gform-field-label gform-field-label--type-inline'>City Of Johannesburg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.4' type='checkbox'  value='Sedibeng Midvaal'  id='choice_3_35_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_4' id='label_3_35_4' class='gform-field-label gform-field-label--type-inline'>Sedibeng Midvaal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.5' type='checkbox'  value='West Rand'  id='choice_3_35_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_5' id='label_3_35_5' class='gform-field-label gform-field-label--type-inline'>West Rand<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_35_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.6' type='checkbox'  value='Other'  id='choice_3_35_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_35_6' id='label_3_35_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below 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'>Limpopo<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_38'><div class='gchoice gchoice_3_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='Capricorn'  id='choice_3_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_1' id='label_3_38_1' class='gform-field-label gform-field-label--type-inline'>Capricorn<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='Mopani'  id='choice_3_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_2' id='label_3_38_2' class='gform-field-label gform-field-label--type-inline'>Mopani<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='Sekhukhune'  id='choice_3_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_3' id='label_3_38_3' class='gform-field-label gform-field-label--type-inline'>Sekhukhune<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='Vhembe'  id='choice_3_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_4' id='label_3_38_4' class='gform-field-label gform-field-label--type-inline'>Vhembe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.5' type='checkbox'  value='Waterberg'  id='choice_3_38_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_5' id='label_3_38_5' class='gform-field-label gform-field-label--type-inline'>Waterberg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_38_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.6' type='checkbox'  value='Other'  id='choice_3_38_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_38_6' id='label_3_38_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Mpumalanga<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_39'><div class='gchoice gchoice_3_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='Bushbuckridge'  id='choice_3_39_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_39_1' id='label_3_39_1' class='gform-field-label gform-field-label--type-inline'>Bushbuckridge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='Nkomazi'  id='choice_3_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_39_2' id='label_3_39_2' class='gform-field-label gform-field-label--type-inline'>Nkomazi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='Thaba Chwev'  id='choice_3_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_39_3' id='label_3_39_3' class='gform-field-label gform-field-label--type-inline'>Thaba Chwev<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_39_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.4' type='checkbox'  value='Dipaleseng'  id='choice_3_39_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_39_4' id='label_3_39_4' class='gform-field-label gform-field-label--type-inline'>Dipaleseng<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_39_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.5' type='checkbox'  value='Other'  id='choice_3_39_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_39_5' id='label_3_39_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>KwaZulu-Natal<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_40'><div class='gchoice gchoice_3_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Amajuba'  id='choice_3_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_1' id='label_3_40_1' class='gform-field-label gform-field-label--type-inline'>Amajuba<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='uMzinyathi'  id='choice_3_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_2' id='label_3_40_2' class='gform-field-label gform-field-label--type-inline'>uMzinyathi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='uThukela'  id='choice_3_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_3' id='label_3_40_3' class='gform-field-label gform-field-label--type-inline'>uThukela<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Big 5 Hlabisa Municipality'  id='choice_3_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_4' id='label_3_40_4' class='gform-field-label gform-field-label--type-inline'>Big 5 Hlabisa Municipality<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_40_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.5' type='checkbox'  value='Other'  id='choice_3_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_5' id='label_3_40_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>North West<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_41'><div class='gchoice gchoice_3_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Ditsobotla'  id='choice_3_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_1' id='label_3_41_1' class='gform-field-label gform-field-label--type-inline'>Ditsobotla<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Kgetlengrivier'  id='choice_3_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_2' id='label_3_41_2' class='gform-field-label gform-field-label--type-inline'>Kgetlengrivier<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='Moretele'  id='choice_3_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_3' id='label_3_41_3' class='gform-field-label gform-field-label--type-inline'>Moretele<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='Moses Kotane'  id='choice_3_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_4' id='label_3_41_4' class='gform-field-label gform-field-label--type-inline'>Moses Kotane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Other'  id='choice_3_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_41_5' id='label_3_41_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Free State<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_42'><div class='gchoice gchoice_3_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Fezile Dabi District Municipality'  id='choice_3_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_1' id='label_3_42_1' class='gform-field-label gform-field-label--type-inline'>Fezile Dabi District Municipality<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Lejweleputswa'  id='choice_3_42_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_2' id='label_3_42_2' class='gform-field-label gform-field-label--type-inline'>Lejweleputswa<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='Mangaung Metropolitan Municipality'  id='choice_3_42_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_3' id='label_3_42_3' class='gform-field-label gform-field-label--type-inline'>Mangaung Metropolitan Municipality<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='Thabo Mofutsanyana'  id='choice_3_42_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_4' id='label_3_42_4' class='gform-field-label gform-field-label--type-inline'>Thabo Mofutsanyana<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='Other'  id='choice_3_42_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_5' id='label_3_42_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Eastern Cape<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_43'><div class='gchoice gchoice_3_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Emalahleni'  id='choice_3_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_1' id='label_3_43_1' class='gform-field-label gform-field-label--type-inline'>Emalahleni<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='Joe Gqabi District'  id='choice_3_43_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_2' id='label_3_43_2' class='gform-field-label gform-field-label--type-inline'>Joe Gqabi District<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='Alfred Nzo'  id='choice_3_43_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_3' id='label_3_43_3' class='gform-field-label gform-field-label--type-inline'>Alfred Nzo<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.4' type='checkbox'  value='Blue Crane Route'  id='choice_3_43_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_4' id='label_3_43_4' class='gform-field-label gform-field-label--type-inline'>Blue Crane Route<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Other'  id='choice_3_43_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_5' id='label_3_43_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_44\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Northen Cape<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_44'><div class='gchoice gchoice_3_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='John Taolo Gaetsewe'  id='choice_3_44_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_44_1' id='label_3_44_1' class='gform-field-label gform-field-label--type-inline'>John Taolo Gaetsewe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='Pixley Ka Seme'  id='choice_3_44_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_44_2' id='label_3_44_2' class='gform-field-label gform-field-label--type-inline'>Pixley Ka Seme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_44_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.3' type='checkbox'  value='Frances Baard'  id='choice_3_44_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_44_3' id='label_3_44_3' class='gform-field-label gform-field-label--type-inline'>Frances Baard<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_44_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.4' type='checkbox'  value='Namakwa District'  id='choice_3_44_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_44_4' id='label_3_44_4' class='gform-field-label gform-field-label--type-inline'>Namakwa District<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_44_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.5' type='checkbox'  value='Other'  id='choice_3_44_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_44_5' id='label_3_44_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_45\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Western Cape<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_45'><div class='gchoice gchoice_3_45_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='Cape Winelands'  id='choice_3_45_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_1' id='label_3_45_1' class='gform-field-label gform-field-label--type-inline'>Cape Winelands<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_45_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='Overberg'  id='choice_3_45_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_2' id='label_3_45_2' class='gform-field-label gform-field-label--type-inline'>Overberg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_45_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='City Of Cape Town'  id='choice_3_45_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_3' id='label_3_45_3' class='gform-field-label gform-field-label--type-inline'>City Of Cape Town<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_45_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.4' type='checkbox'  value='Central Karoo District'  id='choice_3_45_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_4' id='label_3_45_4' class='gform-field-label gform-field-label--type-inline'>Central Karoo District<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_45_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.5' type='checkbox'  value='Other'  id='choice_3_45_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_5' id='label_3_45_5' 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_3_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_36'><span class='gform-field-label__text'>Other<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_3_36' type='text' value='' class='large'    placeholder='Other' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_32\" 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--no-description field_description_below 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'>Status in South Africa<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_32'><div class='gchoice gchoice_3_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Citizen And Citizenship'  id='choice_3_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_1' id='label_3_32_1' class='gform-field-label gform-field-label--type-inline'>Citizen And Citizenship<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Permanent Resident Non-Citizen'  id='choice_3_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_2' id='label_3_32_2' class='gform-field-label gform-field-label--type-inline'>Permanent Resident Non-Citizen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_32_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='Refuge States'  id='choice_3_32_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_3' id='label_3_32_3' class='gform-field-label gform-field-label--type-inline'>Refuge States<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_32_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.4' type='checkbox'  value='Asylum Seeker'  id='choice_3_32_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_4' id='label_3_32_4' class='gform-field-label gform-field-label--type-inline'>Asylum Seeker<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_32_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.5' type='checkbox'  value='Other'  id='choice_3_32_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_32_5' id='label_3_32_5' 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_3_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_12'><span class='gform-field-label__text'>ID Number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_3_12' type='text' value='' class='large'    placeholder='ID Number'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_49'><span class='gform-field-label__text'>Passport<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_3_49' type='text' value='' class='large'    placeholder='Passport'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_50'><span class='gform-field-label__text'>Refuge States<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_3_50' type='text' value='' class='large'    placeholder='Refuge States'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_51'><span class='gform-field-label__text'>Asylum Seeker Number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_3_51' type='text' value='' class='large'    placeholder='ID Number'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Asylum Seeker Rejection<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_53'>\n\t\t\t<div class='gchoice gchoice_3_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_3_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_53_0' id='label_3_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_3_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_53_1' id='label_3_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Asylum Seeker Documents<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_54'>\n\t\t\t<div class='gchoice gchoice_3_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Vaild'  id='choice_3_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_0' id='label_3_54_0' class='gform-field-label gform-field-label--type-inline'>Vaild<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Over Stay'  id='choice_3_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_1' id='label_3_54_1' class='gform-field-label gform-field-label--type-inline'>Over Stay<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_52'><span class='gform-field-label__text'>Status Other<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_3_52' type='text' value='' class='large'    placeholder='ID Number'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_57\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_57'><span class='gform-field-label__text'>Make Payment<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_57' id='input_3_57' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Cash' >Cash<\/option><option value='EFT' >EFT<\/option><option value='Bank Deposit' >Bank Deposit<\/option><\/select><\/div><\/div><div id=\"field_3_55\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_55'><span class='gform-field-label__text'>Upload Image Of Self<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1073741824' \/><input name='input_55' id='input_3_55' type='file' class='large' aria-describedby=\"gfield_upload_rules_3_55\" onchange='javascript:gformValidateFileSize( this, 1073741824 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_55'>Max. file size: 1 GB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_55'><\/div> <\/div><\/div><div id=\"field_3_48\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_48'><span class='gform-field-label__text'>Proof of Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1073741824' \/><input name='input_48' id='input_3_48' type='file' class='large' aria-describedby=\"gfield_upload_rules_3_48\" onchange='javascript:gformValidateFileSize( this, 1073741824 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_48'>Max. file size: 1 GB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_48'><\/div> <\/div><\/div><div id=\"field_3_56\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_56'><span class='gform-field-label__text'>ID Document\/ Passport or Document of Asylum Seeker\/Refugee<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1073741824' \/><input name='input_56' id='input_3_56' type='file' class='large' aria-describedby=\"gfield_upload_rules_3_56\" onchange='javascript:gformValidateFileSize( this, 1073741824 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_56'>Max. file size: 1 GB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_56'><\/div> <\/div><\/div><div id=\"field_3_59\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Next of Kin Information<\/div><div id=\"field_3_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_60'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_3_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_61'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_3_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_62'><span class='gform-field-label__text'>Cell Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_3_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_63'><span class='gform-field-label__text'>Whatsapp Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_3_63' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_64\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below 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'>Interested Services<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_64'><div class='gchoice gchoice_3_64_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.4' type='checkbox'  value='Company registration'  id='choice_3_64_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_1' id='label_3_64_1' class='gform-field-label gform-field-label--type-inline'>Company registration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.5' type='checkbox'  value='Business cover of up to R700,000'  id='choice_3_64_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_2' id='label_3_64_2' class='gform-field-label gform-field-label--type-inline'>Business cover of up to R700,000<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.6' type='checkbox'  value='Assistance with opening business bank accounts'  id='choice_3_64_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_3' id='label_3_64_3' class='gform-field-label gform-field-label--type-inline'>Assistance with opening business bank accounts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.7' type='checkbox'  value='Business Funding'  id='choice_3_64_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_4' id='label_3_64_4' class='gform-field-label gform-field-label--type-inline'>Business Funding<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.8' type='checkbox'  value='Micro loans'  id='choice_3_64_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_5' id='label_3_64_5' class='gform-field-label gform-field-label--type-inline'>Micro loans<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.9' type='checkbox'  value='Asset finance'  id='choice_3_64_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_6' id='label_3_64_6' class='gform-field-label gform-field-label--type-inline'>Asset finance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.11' type='checkbox'  value='Certificate of Acceptability'  id='choice_3_64_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_7' id='label_3_64_7' class='gform-field-label gform-field-label--type-inline'>Certificate of Acceptability<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.12' type='checkbox'  value='Town planning'  id='choice_3_64_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_8' id='label_3_64_8' class='gform-field-label gform-field-label--type-inline'>Town planning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.13' type='checkbox'  value='Zoning certificate'  id='choice_3_64_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_9' id='label_3_64_9' class='gform-field-label gform-field-label--type-inline'>Zoning certificate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.14' type='checkbox'  value='Permit from the Department of Economic Development'  id='choice_3_64_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_11' id='label_3_64_11' class='gform-field-label gform-field-label--type-inline'>Permit from the Department of Economic Development<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.15' type='checkbox'  value='Fire and Safety Certificate'  id='choice_3_64_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_12' id='label_3_64_12' class='gform-field-label gform-field-label--type-inline'>Fire and Safety Certificate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.16' type='checkbox'  value='Tax number (Tax No.) setup'  id='choice_3_64_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_13' id='label_3_64_13' class='gform-field-label gform-field-label--type-inline'>Tax number (Tax No.) setup<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.17' type='checkbox'  value='Labour law compliance'  id='choice_3_64_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_14' id='label_3_64_14' class='gform-field-label gform-field-label--type-inline'>Labour law compliance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.18' type='checkbox'  value='South African ID applications for Ethiopian children born in South Africa'  id='choice_3_64_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_15' id='label_3_64_15' class='gform-field-label gform-field-label--type-inline'>South African ID applications for Ethiopian children born in South Africa<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.19' type='checkbox'  value='University funding for children who pass Matric'  id='choice_3_64_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_16' id='label_3_64_16' class='gform-field-label gform-field-label--type-inline'>University funding for children who pass Matric<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.21' type='checkbox'  value='R120 000 Funeral cover'  id='choice_3_64_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_17' id='label_3_64_17' class='gform-field-label gform-field-label--type-inline'>R120 000 Funeral cover<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.22' type='checkbox'  value='Renewal and extension of Section 22 (Asylum Seeker Permit) and Section 24 (Refugee Status Permit)'  id='choice_3_64_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_18' id='label_3_64_18' class='gform-field-label gform-field-label--type-inline'>Renewal and extension of Section 22 (Asylum Seeker Permit) and Section 24 (Refugee Status Permit)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.23' type='checkbox'  value='Assistance with obtaining an Asylum Seeker Permit for newcomers'  id='choice_3_64_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_19' id='label_3_64_19' class='gform-field-label gform-field-label--type-inline'>Assistance with obtaining an Asylum Seeker Permit for newcomers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.24' type='checkbox'  value='Resettlement country'  id='choice_3_64_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_21' id='label_3_64_21' class='gform-field-label gform-field-label--type-inline'>Resettlement country<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.25' type='checkbox'  value='Translation services'  id='choice_3_64_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_22' id='label_3_64_22' class='gform-field-label gform-field-label--type-inline'>Translation services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.26' type='checkbox'  value='Assistance with opening personal bank accounts'  id='choice_3_64_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_23' id='label_3_64_23' class='gform-field-label gform-field-label--type-inline'>Assistance with opening personal bank accounts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.27' type='checkbox'  value='Legal services'  id='choice_3_64_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_24' id='label_3_64_24' class='gform-field-label gform-field-label--type-inline'>Legal services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.28' type='checkbox'  value='R1 million life insurance through Absa'  id='choice_3_64_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_25' id='label_3_64_25' class='gform-field-label gform-field-label--type-inline'>R1 million life insurance through Absa<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.29' type='checkbox'  value='Hospital cover'  id='choice_3_64_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_26' id='label_3_64_26' class='gform-field-label gform-field-label--type-inline'>Hospital cover<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.31' type='checkbox'  value='Cover for flood damage'  id='choice_3_64_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_27' id='label_3_64_27' class='gform-field-label gform-field-label--type-inline'>Cover for flood damage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.32' type='checkbox'  value='Cover for fire damage'  id='choice_3_64_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_28' id='label_3_64_28' class='gform-field-label gform-field-label--type-inline'>Cover for fire damage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_64_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.33' type='checkbox'  value='Cover for theft'  id='choice_3_64_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_64_29' id='label_3_64_29' class='gform-field-label gform-field-label--type-inline'>Cover for theft<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_46\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Consent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_46.1' id='input_3_46_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_3_46_1' ><span class='gform-field-label__text'>I understand that I want to be a member of the Ethiopian Association and have read and understand the constitution. I confirm with my signature that I agree to fulfill the duties and responsibilities expected of me as any member.<\/span><\/label><input type='hidden' name='input_46.2' value='I understand that I want to be a member of the Ethiopian Association and have read and understand the constitution. I confirm with my signature that I agree to fulfill the duties and responsibilities expected of me as any member.' class='gform_hidden' \/><input type='hidden' name='input_46.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_3_47\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_47'><span class='gform-field-label__text'>Member Signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_47' id='input_3_47_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_47_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_3_47' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/jonathan.rcm-test-web.co.za\/Ethiopian-Association\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_3_47_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_3_47_resetbutton' src='data:image\/png;base64,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' 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