panel.businessdecisionmakers.com
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72.15.205.152
Public Scan
Submitted URL: https://links.productreportcard.com/11f3e2ac239c495eb2b80c8153a8a946/bwlkr9gc/05V63HNJ/ct.aspx
Effective URL: https://panel.businessdecisionmakers.com/account/registrationv2
Submission: On August 18 via manual from US — Scanned from DE
Effective URL: https://panel.businessdecisionmakers.com/account/registrationv2
Submission: On August 18 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
Name: login_form —
<form name="login_form" id="login_form" class="cf">
<div id="login_container" class="cf">
<ul id="header_items" class="dropmenu">
<li id="login_menu" class="dropmenu-trigger">
<span class="login-img"></span>
<a class="login-menu-toggle" href="javascript:void(0)">Login</a>
<span class="tooltip-arrow"></span>
<ul class="login-menu-container dropmenu-submenu" id="login_menu_container" style="display: none">
<script src="https://www.google.com/recaptcha/api.js?render=6LdyaNYUAAAAAEalqAmKf-yaYxFbJ-3LsKiu_2Lw"></script>
<script type="text/javascript">
$(document).ready(function() {
var errors = [];
displayPageErrors(errors);
});
grecaptcha.ready(function() {
grecaptcha.execute('6LdyaNYUAAAAAEalqAmKf-yaYxFbJ-3LsKiu_2Lw', {
action: 'homepage'
}).then(function(token) {
$('#RecaptchaToken').val(token);
});
});
</script>
<style>
.grecaptcha-badge {
visibility: hidden;
}
</style>
<input name="__RequestVerificationToken" type="hidden" value="shLZY2BxM22Pgu8F1HPQFbkzz6n5Wh9Vg20FkVUFh8E_SL-oymCHq8mpPzgdIc9bNl7pVrLoSC6HvDMbcNFWMKQloAy-uRMxD9akmT0tgc01">
<li>
<label><span class="required-label-wrapper"><span>Email Address</span></span><input id="EmailAddress" name="EmailAddress" placeholder="Enter Email Address" type="text" value=""></label>
</li>
<li>
<label><span class="required-label-wrapper"><span>Password</span></span><input id="Password" name="Password" placeholder="Enter Password" type="password"></label>
</li>
<li class="google-terms"> This site is protected by reCAPTCHA and the Google <a class="google-terms-link" href="https://policies.google.com/privacy">Privacy Policy</a> and
<a class="google-terms-link" href="https://policies.google.com/terms">Terms of Service</a> apply. </li>
<input type="hidden" id="RecaptchaToken" name="RecaptchaToken"
value="HFMm9lIRZDbjwZDV9QHEVBHQ82bDsWHBU1JiQwWycXaRJ6MBQzS0U1X29HMDVFcyQ2WQRzVhwWG1pUI3AxQEMLZgQ5YXBtFWNKc3JLNFdlKVUkDXw2HWJvOk5SCk9PFlxXWW1mLgs6P2grKGFJJF0iSgQkG3tHKG5IYVd7a013eSsZWR8WMAsWQVI1Z3RLB21cVnNVBVFpZ3wmZ2d3CVVKHHgbd3wcEg">
<li class="login-btn">
<a href="javascript:void(0)" id="login_submit" class="btn submit" data-login-url="/Panel/Account/_Login?returnUrl=">Login</a>
</li>
<li class="forgot-password">
<a href="/ForgotPassword.aspx">Forgot Password?</a>
</li>
</ul>
</li>
</ul>
</div>
<input type="hidden" name="__key" id="__key_0" value="7f174027-c70e-4d3e-8505-7aa03dd1561f">
</form>POST RegistrationV2
<form action="RegistrationV2" method="post" id="registration_form_v2">
<input id="MemberExternalId" name="MemberExternalId" type="hidden" value="">
<input id="MemberGuid" name="MemberGuid" type="hidden" value="">
<div>
<div class="content active cf">
<div id="reg_path_container">
<input type="hidden" id="profileAnswersModelJson" name="ProfileAnswersModelJson">
<!-- Loop through and conditionally display registration questions and demographic questions -->
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="FirstName"><span style="color:red">*</span>First Name</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_0__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[0].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_0__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[0].RegistrationQuestion.Field" type="hidden" value="FirstName"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="0">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="LastName"><span style="color:red">*</span>Last Name</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_1__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[1].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_1__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[1].RegistrationQuestion.Field" type="hidden" value="LastName"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="1">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Email"><span style="color:red">*</span>Email Address</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_2__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[2].RegistrationQuestion.Value" type="text" value=""><small class="form-text text-muted">Enter Email
Address</small><input id="RegistrationQuestionsDTO_2__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[2].RegistrationQuestion.Field" type="hidden" value="Email"></div><input type="hidden" name="RegistrationQuestionsDTO.Index"
value="2">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="ConfirmEmail"></label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_3__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[3].RegistrationQuestion.Value" type="text" value=""><small class="form-text text-muted">Confirm Email
Address</small><input id="RegistrationQuestionsDTO_3__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[3].RegistrationQuestion.Field" type="hidden" value="ConfirmEmail"></div><input type="hidden"
name="RegistrationQuestionsDTO.Index" value="3">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Password"><span style="color:red">*</span>Password</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_4__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[4].RegistrationQuestion.Value" type="password"><small class="form-text text-muted">Enter
Password</small><input id="RegistrationQuestionsDTO_4__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[4].RegistrationQuestion.Field" type="hidden" value="Password"></div><input type="hidden"
name="RegistrationQuestionsDTO.Index" value="4">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="ConfirmPassword"></label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_5__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[5].RegistrationQuestion.Value" type="password"><small class="form-text text-muted">Confirm
Password</small><input id="RegistrationQuestionsDTO_5__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[5].RegistrationQuestion.Field" type="hidden" value="ConfirmPassword"></div><input type="hidden"
name="RegistrationQuestionsDTO.Index" value="5">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Country">Country</label></div>
<div class="col-sm-5"><select class="col-sm-5" data-states-url="/Panel/Account/GetStates" id="countries_ddl" name="RegistrationQuestionsDTO[6].RegistrationQuestion.Value" onchange="OnCountriesChange(this)">
<option value="">(Select One)</option>
<option value="213">United States of America</option>
<option value="38">Canada</option>
<option value="131">Mexico</option>
<option value="212">United Kingdom</option>
<option value="13">Australia</option>
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="27">Bosnia and Herzegovina</option>
<option value="28">Botswana</option>
<option value="29">Brazil</option>
<option value="30">British Virgin Islands</option>
<option value="31">Brunei</option>
<option value="32">Bulgaria</option>
<option value="33">Burkina Faso</option>
<option value="34">Myanmar</option>
<option value="35">Burundi</option>
<option value="36">Cambodia</option>
<option value="37">Cameroon</option>
<option value="39">Cape Verde</option>
<option value="40">Central African Republic</option>
<option value="41">Chad</option>
<option value="42">Chile</option>
<option value="43">China</option>
<option value="44">Colombia</option>
<option value="45">Comoros</option>
<option value="46">Congo</option>
<option value="47">Congo (Zaire)</option>
<option value="48">Cook Islands</option>
<option value="49">Costa Rica</option>
<option value="50">Cote d'Ivoire (Ivory Coast)</option>
<option value="51">Croatia</option>
<option value="52">Cuba</option>
<option value="53">Cyprus</option>
<option value="54">Czech Republic</option>
<option value="55">Denmark</option>
<option value="56">Djibouti</option>
<option value="57">Dominica</option>
<option value="58">Dominican Republic</option>
<option value="59">Ecuador</option>
<option value="60">Egypt</option>
<option value="61">El Salvador</option>
<option value="62">Equatorial Guinea</option>
<option value="63">Eritrea</option>
<option value="64">Estonia</option>
<option value="65">Ethiopia</option>
<option value="66">Falkland Islands</option>
<option value="67">Federated States of Micronesia</option>
<option value="68">Fiji</option>
<option value="69">Finland</option>
<option value="70">France</option>
<option value="71">French Guiana</option>
<option value="72">French Polynesia</option>
<option value="73">Gabon</option>
<option value="74">Gaza Strip and West Bank</option>
<option value="75">Georgia</option>
<option value="76">Germany</option>
<option value="77">Ghana</option>
<option value="78">Gibraltar</option>
<option value="79">Greece</option>
<option value="80">Greenland</option>
<option value="81">Grenada</option>
<option value="82">Guadeloupe</option>
<option value="83">Guam</option>
<option value="84">Guatemala</option>
<option value="85">Guinea</option>
<option value="86">Guinea-Bissau</option>
<option value="87">Guyana</option>
<option value="88">Haiti</option>
<option value="89">Honduras</option>
<option value="90">Hong Kong</option>
<option value="91">Hungary</option>
<option value="92">Iceland</option>
<option value="93">India</option>
<option value="94">Indonesia</option>
<option value="95">Iran</option>
<option value="96">Iraq</option>
<option value="97">Ireland</option>
<option value="98">Israel</option>
<option value="99">Italy</option>
<option value="101">Jamaica</option>
<option value="102">Japan</option>
<option value="103">Jordan</option>
<option value="104">Kazakhstan</option>
<option value="105">Kenya</option>
<option value="106">Kiribati</option>
<option value="107">Kuwait</option>
<option value="108">Kyrgyzstan</option>
<option value="109">Laos</option>
<option value="110">Latvia</option>
<option value="111">Lebanon</option>
<option value="112">Lesotho</option>
<option value="113">Liberia</option>
<option value="114">Libya</option>
<option value="115">Liechtenstein</option>
<option value="116">Lithuania</option>
<option value="117">Luxembourg</option>
<option value="118">Macau</option>
<option value="119">Macedonia</option>
<option value="120">Madagascar</option>
<option value="121">Malawi</option>
<option value="122">Malaysia</option>
<option value="123">Maldives</option>
<option value="124">Mali</option>
<option value="125">Malta</option>
<option value="126">Marshall Islands</option>
<option value="127">Martinique</option>
<option value="128">Mauritania</option>
<option value="129">Mauritius</option>
<option value="130">Mayotte</option>
<option value="132">Moldova</option>
<option value="133">Monaco</option>
<option value="134">Mongolia</option>
<option value="135">Montserrat</option>
<option value="229">Montenegro</option>
<option value="136">Morocco</option>
<option value="137">Mozambique</option>
<option value="138">Namibia</option>
<option value="139">Nauru</option>
<option value="140">Nepal</option>
<option value="141">Netherlands</option>
<option value="142">Netherlands Antilles</option>
<option value="143">New Caledonia</option>
<option value="144">New Zealand</option>
<option value="145">Nicaragua</option>
<option value="146">Niger</option>
<option value="147">Nigeria</option>
<option value="148">North Korea</option>
<option value="149">Northern Mariana Islands</option>
<option value="150">Norway</option>
<option value="151">Oman</option>
<option value="152">Pakistan</option>
<option value="153">Palau</option>
<option value="154">Panama</option>
<option value="155">Papua New Guinea</option>
<option value="156">Paraguay</option>
<option value="157">Peru</option>
<option value="158">Philippines</option>
<option value="159">Pitcairn Islands</option>
<option value="160">Poland</option>
<option value="161">Portugal</option>
<option value="162">Puerto Rico</option>
<option value="163">Qatar</option>
<option value="164">Reunion</option>
<option value="165">Romania</option>
<option value="166">Russia</option>
<option value="167">Rwanda</option>
<option value="168">Saint Kitts and Nevis</option>
<option value="169">Saint Lucia</option>
<option value="170">Saint Pierre and Miquelon</option>
<option value="171">Saint Vincent and the Grenadines</option>
<option value="172">Samoa</option>
<option value="173">San Marino</option>
<option value="174">Sao Tome and Principe</option>
<option value="175">Saudi Arabia</option>
<option value="176">Senegal</option>
<option value="178">Seychelles</option>
<option value="230">Serbia</option>
<option value="179">Sierra Leone</option>
<option value="180">Singapore</option>
<option value="181">Slovakia</option>
<option value="182">Slovenia</option>
<option value="183">Solomon Islands</option>
<option value="184">Somalia</option>
<option value="185">South Africa</option>
<option value="186">South Korea</option>
<option value="187">Spain</option>
<option value="188">Sri Lanka</option>
<option value="189">Sudan</option>
<option value="190">Suriname</option>
<option value="191">Swaziland</option>
<option value="192">Sweden</option>
<option value="193">Switzerland</option>
<option value="194">Syria</option>
<option value="195">Taiwan</option>
<option value="196">Tajikistan</option>
<option value="197">Tanzania</option>
<option value="198">Thailand</option>
<option value="199">The Gambia</option>
<option value="200">The Holy See</option>
<option value="201">Togo</option>
<option value="202">Tonga</option>
<option value="203">Trinidad and Tobago</option>
<option value="204">Tunisia</option>
<option value="206">Turkmenistan</option>
<option value="207">Turks and Caicos Islands</option>
<option value="208">Tuvalu</option>
<option value="209">Uganda</option>
<option value="210">Ukraine</option>
<option value="211">United Arab Emirates</option>
<option value="214">United States Virgin Islands</option>
<option value="215">Uruguay</option>
<option value="216">Uzbekistan</option>
<option value="217">Vanuatu</option>
<option value="218">Venezuela</option>
<option value="219">Vietnam</option>
<option value="220">West Bank and Gaza Strip</option>
<option value="221">Western Sahara</option>
<option value="222">Zambia</option>
<option value="223">Zimbabwe</option>
<option value="224">Faroe</option>
<option value="225">Niue</option>
<option value="226">Palestine</option>
<option value="227">The Cayman Islands</option>
<option value="228">Yemen</option>
<option value="-1">Unknown</option>
</select><input id="RegistrationQuestionsDTO_6__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[6].RegistrationQuestion.Field" type="hidden" value="Country"></div><input type="hidden" name="RegistrationQuestionsDTO.Index"
value="6">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Address1">Address 1</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_7__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[7].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_7__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[7].RegistrationQuestion.Field" type="hidden" value="Address1"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="7">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Address2">Address 2</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_8__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[8].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_8__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[8].RegistrationQuestion.Field" type="hidden" value="Address2"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="8">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="City">City</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_9__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[9].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_9__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[9].RegistrationQuestion.Field" type="hidden" value="City"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="9">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="State">State/Province or Territory</label></div>
<div class="col-sm-5"><select class="col-sm-5" disabled="disabled" id="states_ddl" name="RegistrationQuestionsDTO[10].RegistrationQuestion.Value"></select><input id="RegistrationQuestionsDTO_10__RegistrationQuestion_Field"
name="RegistrationQuestionsDTO[10].RegistrationQuestion.Field" type="hidden" value="State"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="10">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="ZipPostalCode">Zip/Postal Code</label></div>
<div class="col-sm-5"><input class="col-sm-5" disabled="disabled" id="zip_input" name="RegistrationQuestionsDTO[11].RegistrationQuestion.Value" type="text" value=""><input id="RegistrationQuestionsDTO_11__RegistrationQuestion_Field"
name="RegistrationQuestionsDTO[11].RegistrationQuestion.Field" type="hidden" value="ZipPostalCode"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="11">
</div>
<div class="form-group col-sm-12 " data-bind="with: Questions()[0]">
<div data-bind="template: 'base-question-template'">
<div class="question-wrapper cf unanswered" data-bind="template: { name: Template }, css: { unanswered: IsUnanswered }">
<input type="hidden" name="QuestionId" data-bind="value: QuestionId" value="101">
<!-- ko if: IsRequired -->
<span style="color:red">*</span>
<!-- /ko -->
<p class="question-text" style="display:inline" data-bind="html: QuestionText">Please select the ethnic group(s) with which you identify</p>
<div class="answers-container container" style="margin-left:0; margin-right:0" data-bind="foreach: OptionColumns">
<div class="answers row multi-column-count" data-bind="foreach: $data">
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="497">
<span data-bind="html: OptionText">American Indian or Alaskan Native</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="498">
<span data-bind="html: OptionText">Asian Indian</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="495">
<span data-bind="html: OptionText">Black or African American</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="494">
<span data-bind="html: OptionText">Caucasian</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="499">
<span data-bind="html: OptionText">Chinese</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="500">
<span data-bind="html: OptionText">Filipino</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="496">
<span data-bind="html: OptionText">Hispanic</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="501">
<span data-bind="html: OptionText">Japanese</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="502">
<span data-bind="html: OptionText">Korean</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="507">
<span data-bind="html: OptionText">Middle Eastern</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="57193">
<span data-bind="html: OptionText">Other Asian</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="504">
<span data-bind="html: OptionText">Pacific Islander</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="503">
<span data-bind="html: OptionText">Vietnamese</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="506">
<span data-bind="html: OptionText">Other Race</span>
</label>
</div>
<div style="padding-left:0;">
<label style="margin-top: 5px;">
<input style="width: auto; padding-left:0;
height: auto;
margin-right: 15px;
margin-top: 5px;" type="checkbox" name="MultiAnswer" data-bind="checked: $parents[1].MultiAnswer, disable: Disable, attr: { value: OptionValue }, css: { 'exclusive-answer': IsExclusive }" value="224225"
class="exclusive-answer">
<span data-bind="html: OptionText">Prefer not to answer</span>
</label>
</div>
</div>
</div>
<!-- ko if: ValidationMessage --><!-- /ko -->
<!-- ko if: HasChildQuestions --><!-- /ko -->
</div>
<!-- ko if: HasConditionalQuestions --><!-- /ko -->
</div>
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="CellPhone">Cell Phone</label></div>
<div class="col-sm-5"><input class="col-sm-5" id="RegistrationQuestionsDTO_13__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[13].RegistrationQuestion.Value" type="text" value=""><input
id="RegistrationQuestionsDTO_13__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[13].RegistrationQuestion.Field" type="hidden" value="CellPhone"></div><input type="hidden" name="RegistrationQuestionsDTO.Index" value="13">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="Gender">Gender</label></div>
<div class="col-sm-5"><select class="col-sm-5" id="RegistrationQuestionsDTO_14__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[14].RegistrationQuestion.Value">
<option value="">(Select One)</option>
<option value="1">Male</option>
<option value="2">Female</option>
<option value="3">Other</option>
<option value="4">Prefer not to answer</option>
</select><input id="RegistrationQuestionsDTO_14__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[14].RegistrationQuestion.Field" type="hidden" value="Gender"></div><input type="hidden" name="RegistrationQuestionsDTO.Index"
value="14">
</div>
<div class="form-group col-sm-12">
<div class="col-sm-2"><label for="BirthDate">Birth Date</label></div>
<div class="col-sm-5"><input class="bootstrap-datepicker col-sm-5 " id="RegistrationQuestionsDTO_15__RegistrationQuestion_Value" name="RegistrationQuestionsDTO[15].RegistrationQuestion.Value" placeholder="MM/DD/YYYY" type="text"
value=""><input id="RegistrationQuestionsDTO_15__RegistrationQuestion_Field" name="RegistrationQuestionsDTO[15].RegistrationQuestion.Field" type="hidden" value="BirthDate"></div><input type="hidden" name="RegistrationQuestionsDTO.Index"
value="15">
</div>
<div class="form-group col-sm-12">
<label class="label">
<div class="g-recaptcha" data-callback="" data-sitekey="6LdbpwMTAAAAAMKVtmpH3PYOqvzcl5tKcX3L0YkS" id="recaptcha_container">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LdbpwMTAAAAAMKVtmpH3PYOqvzcl5tKcX3L0YkS&co=aHR0cHM6Ly9wYW5lbC5idXNpbmVzc2RlY2lzaW9ubWFrZXJzLmNvbTo0NDM.&hl=de&v=x19joXI_IeQnFJ7YnfDapSZq&size=normal&cb=6pzc993crv3s"
width="304" height="78" role="presentation" name="a-krdgzxhd8srn" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</label>
</div>
<div class="btn submit">
<a id="submit_profile_answers" href="javascript:void(0)" data-bind="click: submitProfileAnswers">Continue</a>
</div>
</div>
</div>
</div>
<input type="hidden" name="__key" id="__key_1" value="7f174027-c70e-4d3e-8505-7aa03dd1561f">
</form>Text Content
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