{"id":597,"date":"2021-02-14T00:22:19","date_gmt":"2021-02-14T00:22:19","guid":{"rendered":"https:\/\/syracusegrows.org\/?page_id=597"},"modified":"2021-02-14T21:13:20","modified_gmt":"2021-02-14T21:13:20","slug":"member-garden-renewal-form","status":"publish","type":"page","link":"https:\/\/syracusegrows.org\/member-garden-renewal-form\/","title":{"rendered":"Member Garden Renewal Form"},"content":{"rendered":"<div class=\"wpb_row clearfix vc_row-fluid cs-row-container-wrap\"><div class=\"bg-color-left\" style=\"background-color: ;\"><\/div><div class=\"bg-color-right\" style=\"background-color: ;\"><\/div><div class=\"ww-parallax-bg\" style=\"background:#FFF ; opacity :0;\"><\/div><div class=\"container cs-row-container cshero_661149ff8e5cd stripe-video-content \" ><div class=\"row\" style=\"color:  !important;\">\n\t<div class=\"vc_col-sm-9 wpb_column vc_column_container  \" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t\n\t<div class=\"wpb_text_column wpb_content_element \">\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t\n                <div class='gf_browser_chrome gform_wrapper' id='gform_wrapper_8' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/wp-json\/wp\/v2\/pages\/597'>\n                        <div class='gform_heading'>\n                            <span class='gform_description'><\/span>\n                        <\/div>\n                        <div class='gform_body'><ul id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below'><li id='field_8_1'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Garden Information<\/h2><\/li><li id='field_8_2'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_8_2' >Garden Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_8_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_8_3'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Garden Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_8_3' >\n                         <span class='ginput_full address_line_1' id='input_8_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_8_3_1' value=''    aria-required=\"true\"\/>\n                                        <label for='input_8_3_1' id='input_8_3_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_8_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_8_3_2' value=''   \/>\n                                        <label for='input_8_3_2' id='input_8_3_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_8_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_8_3_3' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_3_3' id='input_8_3_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_8_3_4_container' >\n                                        <select name='input_3.4' id='input_8_3_4'     aria-required=\"true\"><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' selected='selected'>New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_8_3_4' id='input_8_3_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_8_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_8_3_5' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_3_5' id='input_8_3_5_label' >ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_8_3_6' value='United States'\/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_8_4'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Garden Type<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_4'><li class='gchoice_8_4_1'>\n\t\t\t\t\t\t\t\t<input name='input_4.1' type='checkbox'  value='Shared Harvest'  id='choice_8_4_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_1' id='label_8_4_1'>Shared Harvest<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_2'>\n\t\t\t\t\t\t\t\t<input name='input_4.2' type='checkbox'  value='Combo Shared \/ Individual'  id='choice_8_4_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_2' id='label_8_4_2'>Combo Shared \/ Individual<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_3'>\n\t\t\t\t\t\t\t\t<input name='input_4.3' type='checkbox'  value='School Garden'  id='choice_8_4_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_3' id='label_8_4_3'>School Garden<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_4'>\n\t\t\t\t\t\t\t\t<input name='input_4.4' type='checkbox'  value='Individual Plots'  id='choice_8_4_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_4' id='label_8_4_4'>Individual Plots<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_5'>\n\t\t\t\t\t\t\t\t<input name='input_4.5' type='checkbox'  value='Donation Garden'  id='choice_8_4_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_5' id='label_8_4_5'>Donation Garden<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_6'>\n\t\t\t\t\t\t\t\t<input name='input_4.6' type='checkbox'  value='Market Garden'  id='choice_8_4_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_6' id='label_8_4_6'>Market Garden<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_4_7'>\n\t\t\t\t\t\t\t\t<input name='input_4.7' type='checkbox'  value='Other'  id='choice_8_4_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_4_7' id='label_8_4_7'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_8_5'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_8_5' >Garden Type: Other<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_8_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_8_6'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_8_6' >Garden Description (to appear on the Syracuse Grows website)<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_8_6' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_8_7'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Garden Leader<\/h2><\/li><li id='field_8_8'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Garden Leader Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_8_8'>\n                            \n                            <span id='input_8_8_3_container' class='name_first' >\n                                                    <input type='text' name='input_8.3' id='input_8_8_3' value='' aria-label='First name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_8_8_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_8_6_container' class='name_last' >\n                                                    <input type='text' name='input_8.6' id='input_8_8_6' value='' aria-label='Last name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_8_8_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id='field_8_9'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Garden Leader Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_8_9' >\n                         <span class='ginput_full address_line_1' id='input_8_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_8_9_1' value=''    aria-required=\"true\"\/>\n                                        <label for='input_8_9_1' id='input_8_9_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_8_9_2_container' >\n                                        <input type='text' name='input_9.2' id='input_8_9_2' value=''   \/>\n                                        <label for='input_8_9_2' id='input_8_9_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_8_9_3_container' >\n                                    <input type='text' name='input_9.3' id='input_8_9_3' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_9_3' id='input_8_9_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_8_9_4_container' >\n                                        <select name='input_9.4' id='input_8_9_4'     aria-required=\"true\"><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' selected='selected'>New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_8_9_4' id='input_8_9_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_8_9_5_container' >\n                                    <input type='text' name='input_9.5' id='input_8_9_5' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_9_5' id='input_8_9_5_label' >ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_9.6' id='input_8_9_6' value='United States'\/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_8_10'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_8_10' >Garden Leader Email<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_8_10' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\" \/>\n                        <\/div><\/li><li id='field_8_11'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_8_11' >Garden Leader Phone Number<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_8_11' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id='field_8_12'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >List this contact information on Syracuse Grows website?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_12'><li class='gchoice_8_12_1'>\n\t\t\t\t\t\t\t\t<input name='input_12.1' type='checkbox'  value='Yes'  id='choice_8_12_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_12_1' id='label_8_12_1'>Yes<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_8_13'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Information to list:<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_13'><li class='gchoice_8_13_1'>\n\t\t\t\t\t\t\t\t<input name='input_13.1' type='checkbox'  value='Email' checked='checked' id='choice_8_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_13_1' id='label_8_13_1'>Email<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice_8_13_2'>\n\t\t\t\t\t\t\t\t<input name='input_13.2' type='checkbox'  value='Phone' checked='checked' id='choice_8_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_13_2' id='label_8_13_2'>Phone<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_8_14'  class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Register a secondary contact?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_8_14'><li class='gchoice_8_14_1'>\n\t\t\t\t\t\t\t\t<input name='input_14.1' type='checkbox'  value='Yes'  id='choice_8_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_14_1' id='label_8_14_1'>Yes<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_8_15'  class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Secondary Contact<\/h2><\/li><li id='field_8_16'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Secondary Contact Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_8_16'>\n                            \n                            <span id='input_8_16_3_container' class='name_first' >\n                                                    <input type='text' name='input_16.3' id='input_8_16_3' value='' aria-label='First name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_8_16_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_8_16_6_container' class='name_last' >\n                                                    <input type='text' name='input_16.6' id='input_8_16_6' value='' aria-label='Last name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_8_16_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id='field_8_17'  class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Secondary Contact Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_8_17' >\n                         <span class='ginput_full address_line_1' id='input_8_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_8_17_1' value=''    aria-required=\"true\"\/>\n                                        <label for='input_8_17_1' id='input_8_17_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_8_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_8_17_2' value=''   \/>\n                                        <label for='input_8_17_2' id='input_8_17_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_8_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_8_17_3' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_17_3' id='input_8_17_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_8_17_4_container' >\n                                        <select name='input_17.4' id='input_8_17_4'     aria-required=\"true\"><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' selected='selected'>New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_8_17_4' id='input_8_17_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_8_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_8_17_5' value=''    aria-required=\"true\"\/>\n                                    <label for='input_8_17_5' id='input_8_17_5_label' >ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_8_17_6' value='United States'\/>\n 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