Message Sent

input {width:100%;font-size:22px;} #_form_5_submit {color:#fff;font-weight:bold;background:#0ff;padding:25px 55px;width:100%;font-size:22px;}

#_form_5_ { font-size:14px; line-height:1.6; font-family:arial, helvetica, sans-serif; margin:0; } #_form_5_ * { outline:0; } ._form_hide { display:none; visibility:hidden; } ._form_show { display:block; visibility:visible; } #_form_5_._form-top { top:0; } #_form_5_._form-bottom { bottom:0; } #_form_5_._form-left { left:0; } #_form_5_._form-right { right:0; } #_form_5_ input[type="text"],#_form_5_ input[type="date"],#_form_5_ textarea { padding:6px; height:auto; border:#979797 1px solid; border-radius:4px; color:#000 !important; font-size:14px; -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; } #_form_5_ textarea { resize:none; } #_form_5_ ._submit { -webkit-appearance:none; cursor:pointer; font-family:arial, sans-serif; font-size:14px; text-align:center; background:#333 !important; border:0 !important; -moz-border-radius:4px !important; -webkit-border-radius:4px !important; border-radius:4px !important; color:#fff !important; padding:10px !important; } #_form_5_ ._close-icon { cursor:pointer; background-image:url('https://d226aj4ao1t61q.cloudfront.net/esfkyjh1u_forms-close-dark.png'); background-repeat:no-repeat; background-size:14.2px 14.2px; position:absolute; display:block; top:11px; right:9px; overflow:hidden; width:16.2px; height:16.2px; } #_form_5_ ._close-icon:before { position:relative; } #_form_5_ ._form-body { margin-bottom:30px; } #_form_5_ ._form-image-left { width:150px; float:left; } #_form_5_ ._form-content-right { margin-left:164px; } #_form_5_ ._form-branding { color:#fff; font-size:10px; clear:both; text-align:left; margin-top:30px; font-weight:100; } #_form_5_ ._form-branding ._logo { display:block; width:130px; height:14px; margin-top:6px; background-image:url('https://d226aj4ao1t61q.cloudfront.net/hh9ujqgv5_aclogo_li.png'); background-size:130px auto; background-repeat:no-repeat; } #_form_5_ ._form-label,#_form_5_ ._form_element ._form-label { font-weight:bold; margin-bottom:5px; display:block; } #_form_5_._dark ._form-branding { color:#333; } #_form_5_._dark ._form-branding ._logo { background-image:url('https://d226aj4ao1t61q.cloudfront.net/jftq2c8s_aclogo_dk.png'); } #_form_5_ ._form_element { position:relative; margin-bottom:10px; font-size:0; max-width:100%; } #_form_5_ ._form_element * { font-size:14px; } #_form_5_ ._form_element._clear { clear:both; width:100%; float:none; } #_form_5_ ._form_element._clear:after { clear:left; } #_form_5_ ._form_element input[type="text"],#_form_5_ ._form_element input[type="date"],#_form_5_ ._form_element select,#_form_5_ ._form_element textarea:not(.g-recaptcha-response) { display:block; width:100%; -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; } #_form_5_ ._field-wrapper { position:relative; } #_form_5_ ._inline-style { float:left; } #_form_5_ ._inline-style input[type="text"] { width:150px; } #_form_5_ ._inline-style:not(._clear) + ._inline-style:not(._clear) { margin-left:20px; } #_form_5_ ._form_element img._form-image { max-width:100%; } #_form_5_ ._clear-element { clear:left; } #_form_5_ ._full_width { width:100%; } #_form_5_ ._form_full_field { display:block; width:100%; margin-bottom:10px; } #_form_5_ input[type="text"]._has_error,#_form_5_ textarea._has_error { border:#f37c7b 1px solid; } #_form_5_ input[type="checkbox"]._has_error { outline:#f37c7b 1px solid; } #_form_5_ ._error { display:block; position:absolute; font-size:14px; z-index:10000001; } #_form_5_ ._error._above { padding-bottom:4px; bottom:39px; right:0; } #_form_5_ ._error._below { padding-top:4px; top:100%; right:0; } #_form_5_ ._error._above ._error-arrow { bottom:0; right:15px; border-left:5px solid transparent; border-right:5px solid transparent; border-top:5px solid #f37c7b; } #_form_5_ ._error._below ._error-arrow { top:0; right:15px; border-left:5px solid transparent; border-right:5px solid transparent; border-bottom:5px solid #f37c7b; } #_form_5_ ._error-inner { padding:8px 12px; background-color:#f37c7b; font-size:14px; font-family:arial, sans-serif; color:#fff; text-align:center; text-decoration:none; -webkit-border-radius:4px; -moz-border-radius:4px; border-radius:4px; } #_form_5_ ._error-inner._form_error { margin-bottom:5px; text-align:left; } #_form_5_ ._button-wrapper ._error-inner._form_error { position:static; } #_form_5_ ._error-inner._no_arrow { margin-bottom:10px; } #_form_5_ ._error-arrow { position:absolute; width:0; height:0; } #_form_5_ ._error-html { margin-bottom:10px; } .pika-single { z-index:10000001 !important; } #_form_5_ input[type="text"].datetime_date { width:69%; display:inline; } #_form_5_ select.datetime_time { width:29%; display:inline; height:32px; } @media all and (min-width:320px) and (max-width:667px) { ::-webkit-scrollbar { display:none; } #_form_5_ { margin:0; width:100%; min-width:100%; max-width:100%; box-sizing:border-box; } #_form_5_ * { -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; font-size:1em; } #_form_5_ ._form-content { margin:0; width:100%; } #_form_5_ ._form-inner { display:block; min-width:100%; } #_form_5_ ._form-title,#_form_5_ ._inline-style { margin-top:0; margin-right:0; margin-left:0; } #_form_5_ ._form-title { font-size:1.2em; } #_form_5_ ._form_element { margin:0 0 20px; padding:0; width:100%; } #_form_5_ ._form-element,#_form_5_ ._inline-style,#_form_5_ input[type="text"],#_form_5_ label,#_form_5_ p,#_form_5_ textarea:not(.g-recaptcha-response) { float:none; display:block; width:100%; } #_form_5_ ._row._checkbox-radio label { display:inline; } #_form_5_ ._row,#_form_5_ p,#_form_5_ label { margin-bottom:0.7em; width:100%; } #_form_5_ ._row input[type="checkbox"],#_form_5_ ._row input[type="radio"] { margin:0 !important; vertical-align:middle !important; } #_form_5_ ._row input[type="checkbox"] + span label { display:inline; } #_form_5_ ._row span label { margin:0 !important; width:initial !important; vertical-align:middle !important; } #_form_5_ ._form-image { max-width:100%; height:auto !important; } #_form_5_ input[type="text"] { padding-left:10px; padding-right:10px; font-size:16px; line-height:1.3em; -webkit-appearance:none; } #_form_5_ input[type="radio"],#_form_5_ input[type="checkbox"] { display:inline-block; width:1.3em; height:1.3em; font-size:1em; margin:0 0.3em 0 0; vertical-align:baseline; } #_form_5_ button[type="submit"] { padding:20px; font-size:1.5em; } #_form_5_ ._inline-style { margin:20px 0 0 !important; } } #_form_5_ { position:relative; text-align:left; margin:25px auto 0; padding:20px; -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; *zoom:1; background:#fff !important; border:0px solid #b0b0b0 !important; width:500px; -moz-border-radius:0px !important; -webkit-border-radius:0px !important; border-radius:0px !important; color:#000 !important; } #_form_5_ ._form-title { font-size:22px; line-height:22px; font-weight:600; margin-bottom:0; } #_form_5_:before,#_form_5_:after { content:" "; display:table; } #_form_5_:after { clear:both; } #_form_5_._inline-style { width:auto; display:inline-block; } #_form_5_._inline-style input[type="text"],#_form_5_._inline-style input[type="date"] { padding:10px 12px; } #_form_5_._inline-style button._inline-style { position:relative; top:27px; } #_form_5_._inline-style p { margin:0; } #_form_5_._inline-style ._button-wrapper { position:relative; margin:27px 12.5px 0 20px; } #_form_5_ ._form-thank-you { position:relative; left:0; right:0; text-align:center; font-size:18px; } @media all and (min-width:320px) and (max-width:667px) { #_form_5_._inline-form._inline-style ._inline-style._button-wrapper { margin-top:20px !important; margin-left:0 !important; } }

window.cfields = []; window._show_thank_you = function(id, message, trackcmp_url) { var form = document.getElementById('_form_' + id + '_'), thank_you = form.querySelector('._form-thank-you'); form.querySelector('._form-content').style.display = 'none'; thank_you.innerHTML = message; thank_you.style.display = 'block'; if (typeof(trackcmp_url) != 'undefined' && trackcmp_url) { // Site tracking URL to use after inline form submission. _load_script(trackcmp_url); } if (typeof window._form_callback !== 'undefined') window._form_callback(id); }; window._show_error = function(id, message, html) { var form = document.getElementById('_form_' + id + '_'), err = document.createElement('div'), button = form.querySelector('button'), old_error = form.querySelector('._form_error'); if (old_error) old_error.parentNode.removeChild(old_error); err.innerHTML = message; err.className = '_error-inner _form_error _no_arrow'; var wrapper = document.createElement('div'); wrapper.className = '_form-inner'; wrapper.appendChild(err); button.parentNode.insertBefore(wrapper, button); document.querySelector('[id^="_form"][id$="_submit"]').disabled = false; if (html) { var div = document.createElement('div'); div.className = '_error-html'; div.innerHTML = html; err.appendChild(div); } }; window._load_script = function(url, callback) { var head = document.querySelector('head'), script = document.createElement('script'), r = false; script.type = 'text/javascript'; script.charset = 'utf-8'; script.src = url; if (callback) { script.onload = script.onreadystatechange = function() { if (!r && (!this.readyState || this.readyState == 'complete')) { r = true; callback(); } }; } head.appendChild(script); }; (function() { if (window.location.search.search("excludeform") !== -1) return false; var getCookie = function(name) { var match = document.cookie.match(new RegExp('(^|; )' + name + '=([^;]+)')); return match ? match[2] : null; } var setCookie = function(name, value) { var now = new Date(); var time = now.getTime(); var expireTime = time + 1000 * 60 * 60 * 24 * 365; now.setTime(expireTime); document.cookie = name + '=' + value + '; expires=' + now + ';path=/'; } var addEvent = function(element, event, func) { if (element.addEventListener) { element.addEventListener(event, func); } else { var oldFunc = element['on' + event]; element['on' + event] = function() { oldFunc.apply(this, arguments); func.apply(this, arguments); }; } } var _removed = false; var form_to_submit = document.getElementById('_form_5_'); var allInputs = form_to_submit.querySelectorAll('input, select, textarea'), tooltips = [], submitted = false;

var getUrlParam = function(name) { var regexStr = '[?&]' + name + '=([^&#]*)'; var results = new RegExp(regexStr, 'i').exec(window.location.href); return results != undefined ? decodeURIComponent(results[1]) : false; };

for (var i = 0; i < allInputs.length; i++) { var regexStr = "field[(d+)]"; var results = new RegExp(regexStr).exec(allInputs[i].name); if (results != undefined) { allInputs[i].dataset.name = window.cfields[results[1]]; } else { allInputs[i].dataset.name = allInputs[i].name; } var fieldVal = getUrlParam(allInputs[i].dataset.name); if (fieldVal) { if (allInputs[i].dataset.autofill === "false") { continue; } if (allInputs[i].type == "radio" || allInputs[i].type == "checkbox") { if (allInputs[i].value == fieldVal) { allInputs[i].checked = true; } } else { allInputs[i].value = fieldVal; } } } var remove_tooltips = function() { for (var i = 0; i < tooltips.length; i++) { tooltips[i].tip.parentNode.removeChild(tooltips[i].tip); } tooltips = []; }; var remove_tooltip = function(elem) { for (var i = 0; i < tooltips.length; i++) { if (tooltips[i].elem === elem) { tooltips[i].tip.parentNode.removeChild(tooltips[i].tip); tooltips.splice(i, 1); return; } } }; var create_tooltip = function(elem, text) { var tooltip = document.createElement('div'), arrow = document.createElement('div'), inner = document.createElement('div'), new_tooltip = {}; if (elem.type != 'radio' && elem.type != 'checkbox') { tooltip.className = '_error'; arrow.className = '_error-arrow'; inner.className = '_error-inner'; inner.innerHTML = text; tooltip.appendChild(arrow); tooltip.appendChild(inner); elem.parentNode.appendChild(tooltip); } else { tooltip.className = '_error-inner _no_arrow'; tooltip.innerHTML = text; elem.parentNode.insertBefore(tooltip, elem); new_tooltip.no_arrow = true; } new_tooltip.tip = tooltip; new_tooltip.elem = elem; tooltips.push(new_tooltip); return new_tooltip; }; var resize_tooltip = function(tooltip) { var rect = tooltip.elem.getBoundingClientRect(); var doc = document.documentElement, scrollPosition = rect.top - ((window.pageYOffset || doc.scrollTop) - (doc.clientTop || 0)); if (scrollPosition < 40) { tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _below'; } else { tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _above'; } }; var resize_tooltips = function() { if (_removed) return; for (var i = 0; i < tooltips.length; i++) { if (!tooltips[i].no_arrow) resize_tooltip(tooltips[i]); } }; var validate_field = function(elem, remove) { var tooltip = null, value = elem.value, no_error = true; remove ? remove_tooltip(elem) : false; if (elem.type != 'checkbox') elem.className = elem.className.replace(/ ?_has_error ?/g, ''); if (elem.getAttribute('required') !== null) { if (elem.type == 'radio' || (elem.type == 'checkbox' && /any/.test(elem.className))) { var elems = form_to_submit.elements[elem.name]; if (!(elems instanceof NodeList || elems instanceof HTMLCollection) || elems.length <= 1) { no_error = elem.checked; } else { no_error = false; for (var i = 0; i < elems.length; i++) { if (elems[i].checked) no_error = true; } } if (!no_error) { tooltip = create_tooltip(elem, "Please select an option."); } } else if (elem.type =='checkbox') { var elems = form_to_submit.elements[elem.name], found = false, err = []; no_error = true; for (var i = 0; i < elems.length; i++) { if (elems[i].getAttribute('required') === null) continue; if (!found && elems[i] !== elem) return true; found = true; elems[i].className = elems[i].className.replace(/ ?_has_error ?/g, ''); if (!elems[i].checked) { no_error = false; elems[i].className = elems[i].className + ' _has_error'; err.push("Checking %s is required".replace("%s", elems[i].value)); } } if (!no_error) { tooltip = create_tooltip(elem, err.join('
')); } } else if (elem.tagName == 'SELECT') { var selected = true; if (elem.multiple) { selected = false; for (var i = 0; i < elem.options.length; i++) { if (elem.options[i].selected) { selected = true; break; } } } else { for (var i = 0; i < elem.options.length; i++) { if (elem.options[i].selected && !elem.options[i].value) { selected = false; } } } if (!selected) { elem.className = elem.className + ' _has_error'; no_error = false; tooltip = create_tooltip(elem, "Please select an option."); } } else if (value === undefined || value === null || value === '') { elem.className = elem.className + ' _has_error'; no_error = false; tooltip = create_tooltip(elem, "This field is required."); } } if (no_error && elem.name == 'email') { if (!value.match(/^[+_a-z0-9-'&=]+(.[+_a-z0-9-']+)*@[a-z0-9-]+(.[a-z0-9-]+)*(.[a-z]{2,})$/i)) { elem.className = elem.className + ' _has_error'; no_error = false; tooltip = create_tooltip(elem, "Enter a valid email address."); } } if (no_error && /date_field/.test(elem.className)) { if (!value.match(/^dddd-dd-dd$/)) { elem.className = elem.className + ' _has_error'; no_error = false; tooltip = create_tooltip(elem, "Enter a valid date."); } } tooltip ? resize_tooltip(tooltip) : false; return no_error; }; var needs_validate = function(el) { if(el.getAttribute('required') !== null){ return true } if(el.name === 'email' && el.value !== ""){ return true } return false }; var validate_form = function(e) { var err = form_to_submit.querySelector('._form_error'), no_error = true; if (!submitted) { submitted = true; for (var i = 0, len = allInputs.length; i < len; i++) { var input = allInputs[i]; if (needs_validate(input)) { if (input.type == 'text') { addEvent(input, 'blur', function() { this.value = this.value.trim(); validate_field(this, true); }); addEvent(input, 'input', function() { validate_field(this, true); }); } else if (input.type == 'radio' || input.type == 'checkbox') { (function(el) { var radios = form_to_submit.elements[el.name]; for (var i = 0; i < radios.length; i++) { addEvent(radios[i], 'click', function() { validate_field(el, true); }); } })(input); } else if (input.tagName == 'SELECT') { addEvent(input, 'change', function() { validate_field(this, true); }); } else if (input.type == 'textarea'){ addEvent(input, 'input', function() { validate_field(this, true); }); } } } } remove_tooltips(); for (var i = 0, len = allInputs.length; i < len; i++) { var elem = allInputs[i]; if (needs_validate(elem)) { if (elem.tagName.toLowerCase() !== "select") { elem.value = elem.value.trim(); } validate_field(elem) ? true : no_error = false; } } if (!no_error && e) { e.preventDefault(); } resize_tooltips(); return no_error; }; addEvent(window, 'resize', resize_tooltips); addEvent(window, 'scroll', resize_tooltips); window['recaptcha_callback'] = function() { // Get all recaptchas in the DOM (there may be more than one form on the page). var recaptchas = document.getElementsByClassName("g-recaptcha"); for (var i in recaptchas) { // Set the recaptcha element ID, so the recaptcha can be applied to each element. var recaptcha_id = "recaptcha_" + i; recaptchas[i].id = recaptcha_id; var el = document.getElementById(recaptcha_id); if (el != null) { var sitekey = el.getAttribute("data-sitekey"); var stoken = el.getAttribute("data-stoken"); grecaptcha.render(recaptcha_id, {"sitekey":sitekey,"stoken":stoken}); } } }; _load_script("//www.google.com/recaptcha/api.js?onload=recaptcha_callback&render=explicit"); window._old_serialize = null; if (typeof serialize !== 'undefined') window._old_serialize = window.serialize; _load_script("//d3rxaij56vjege.cloudfront.net/form-serialize/0.3/serialize.min.js", function() { window._form_serialize = window.serialize; if (window._old_serialize) window.serialize = window._old_serialize; }); var form_submit = function(e) { e.preventDefault(); if (validate_form()) { // use this trick to get the submit button & disable it using plain javascript document.querySelector('#_form_5_submit').disabled = true; var serialized = _form_serialize(document.getElementById('_form_5_')); var err = form_to_submit.querySelector('._form_error'); err ? err.parentNode.removeChild(err) : false; _load_script('https://macayamiracle59140.activehosted.com/proc.php?' + serialized + '&jsonp=true'); } return false; }; addEvent(form_to_submit, 'submit', form_submit); })();