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	<title>Sponsor Agreement | Global Clinical Knowledge</title>


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			<p class="form-instructions"><p><span style="color:#162d56;"><strong><u>Sponsor Agreement</u><br />
<br />
Just getting started? </strong></span><br />
&nbsp; &nbsp;1. Request the Prospectus from <a href="mailto:info@globalclinicalknowledge.com?subject=GCK%20Sponsor%20and%20Exhibit%20Inquiry">info@globalclinicalknowledge.com</a><br />
&nbsp; &nbsp;2. Review our <a href="https://globalclinicalknowledge.i4adev.com/sponsorship-opportunities/">sponsor page</a><span style="color:#162d56;"><br />
<br />
<strong>Policies and Notes:&nbsp;</strong></span><br />
-Sponsorships cannot be cancelled, transferred or refunded once confirmed.<br />
-All Product Theaters, Clinical Insights Forums and tabletop exhibits are promotional and non-CME in nature.<br />
-Sponsor participation is subject to applicable industry compliance guidelines.<br />
-Final agenda, faculty and host institutions will be finalized per regional program.<br />
-<a href="https://globalclinicalknowledge.i4adev.com/exhibit-sponsor-terms-and-conditions/">Sponsor terms and conditions</a></p>

<p>Once completed a GCK team member will reach out to confirm payment details and provide further instructions.</p>
</p>
		

	<form action="index.cfm?id=2&popup=false" method="POST" id="iform" name="iform" enctype="multipart/form-data">
		
		<input type="hidden" id="num_questions" name="num_questions" value="10">
		<input type="hidden" name="form_id" value="2">
		<input type="hidden" name="report_id" value="">
		<input type="hidden" name="AllowedUploads" value="doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png">
		
		
			<input type="hidden" name="formtitle" value="Sponsor Agreement">
		
	
<script>
	$(function () {
		// reset payment token in case user clicked Back button in browser
		$('#paymentToken').val('');
		
		//$('#business_radio').trigger('change');
		
		
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		if(!sent) sent = 0;  //make sure we have this!
		if (!validForm) validForm = false;
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			var jsDesc = "Company";
			
				obj = document.iform.response_1;
				val = "";
				
				val = obj.value;
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			var jsDesc = "First Name";
			
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			var jsDesc = "Last Name";
			
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			var jsDesc = "Email";
			
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			var jsDesc = "Phone Number";
			
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			var jsDesc = "Indicate the Regional Forum(s) this applies to. To select multiple, hold either the control or command button while selecting options.";
			
				obj = document.iform.response_6;
				val = "";
				
				if (obj.selectedIndex == -1) {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Indicate which sponsorship(s) this applies to. To select multiple, hold either the control or command button while selecting options.";
			
				obj = document.iform.response_7;
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					arrReqMissing[arrReqMissing.length] = jsDesc;
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			var jsDesc = "If the above selection(s) are for more than one Regional Forum, specify which sponsorship(s) apply to each location.";
			
			
			var jsDesc = "By completing this form, you and your company accept and agree to the terms and conditions.";
			
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					if (n == 0) {
						arrReqMissing[arrReqMissing.length] = jsDesc;
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			var jsDesc = "Indicate payment type. Credit card payments will incur a 3% service fee. Payment will not be processed until a representative from GCK reaches out to confirm your sponsorship(s). ";
			
				obj = document.iform.response_10;
				val = "";
				
					
						n = 0;
						for (i=0;i<obj.length;i++) {
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			errStr = "";
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	  			text: errStr,
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			  			title: 'Maximum allowable length',
			  			html: true,
			  			text: "One or more field responses exceeds the maximum allowable length of 2147483647 characters. Please adjust your responses and re-submit.",
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			  			type: 'info',
			  			confirmButtonText: 'Ok',
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	  			text: "Your request is processing. Please do not click Submit more than once.",
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	  			confirmButtonText: 'Ok',
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		// now set the value of a hidden field for the associated radio button
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		document.getElementById(itemID).value = 1;
		// now call the calcTotalFix function to recaculate the total amount due
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	}

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		var priceFields = $(".calculateTotal");
		// console.log('priceFields length: ' + priceFields.length);
		var updateTotal = 0; // initialize total before looping over array
		var processedRadioButtons = [];	/// reset array every time this function is called
		for (var i=0; i < priceFields.length; i++) {
			myFieldObj = priceFields[i];
			if (myFieldObj.value == '') { myFieldObj.value = 0; }
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			price = myFieldObj.getAttribute('price');

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			}

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			if(fieldtype === 'radioval'){
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				if(arrNum > -1) {
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					calculatedValue = parseFloat(price);
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					processedRadioButtons.push(fieldName);
				}
				// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
			} else {
				if (price === undefined || price === null) {
				// check to see if it's a radio price field first
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				  			title: 'Numbers only',
				  			html: true,
				  			text: "Open Prices must be numbers only, no formatting is allowed.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					calculatedValue = parseFloat(value);
					// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
				} else {
					if (!IsNumeric(value)) {
						//alert("Price fields only allow numbers.");
						swal({
				  			title: 'Price fields',
				  			html: true,
				  			text: "Price fields only allow numbers.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					myVal = parseFloat(value);
					// console.log('in parseint with 10 - fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / myVal: ' + myVal);
					calculatedValue = myVal * parseFloat(price);

				}
			}


			// console.log('Field id: ' + fieldID + ' / Fieldtype: ' + fieldtype + ' / Field name: ' + fieldName + ' / value: ' + value + ' / Price: ' + price + ' / Calculated Field Total: ' + calculatedValue);
			updateTotal = updateTotal + calculatedValue;
		}

		// update hidden total amount
		if (document.iform.hiddentotal) { document.iform.hiddentotal.value = updateTotal; }
		// console.log('The updateTotal is now: ' + updateTotal);
		
		
		// update total value with formatted amount
		if (typeof(formatCurrency) == "function") { document.iform.total.value = formatCurrency(updateTotal); }
		
		if ($('#ordertotal_work').length > 0) {
            $('#ordertotal_work').val(updateTotal.toFixed(2));
        }
        
        if ($('#pmt_method').length > 0) {
        	$('#pmt_method').val('');
        }
        $('.paymentProfileRadio').prop('checked', false);
        $('.card').removeClass('active');
        
		// need to update the cc_info tag fields...
		if (typeof(checkTotal) == "function") { checkTotal(); }
	}

	/* remove after confirming ok without it - 8/8/13 CJV */
	function calcTotal(myField){
		thisVal = myField.value;
		// alert(thisVal);
		if (thisVal == '') {
			thisVal = 0;
			myField.value = 0;
			}
			if (!IsNumeric(myField.value)) {
				//alert('Please enter only numbers or decimal points in a price field');
				swal({
		  			title: 'Price field',
		  			html: true,
		  			text: "Please enter only numbers or decimal points in a price field.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				myField.value = 0;
				thisVal = 0;
				}
				// get the current total
				var origTotal = document.iform.hiddentotal.value;
				// now backout the prior value from the total
				var priorTotal = origTotal - myField.priorval;
				if(priorTotal == ''){
					priorTotal = 0;
					}
				// add the open price to the total
				updateTotal = parseFloat(eval(priorTotal)) + parseFloat(eval(thisVal));
				// update hidden total amount
				document.iform.hiddentotal.value = updateTotal;
				
					
				// update total value with formatted amount
				document.iform.total.value = formatCurrency(updateTotal);
		checkTotal(); // need to update the cc_info tag fields...
	}
	/* */

	function setOpenPriceInput(thisField,thisPrice){
		if(thisPrice == ''){
			thisField.priorval = 0;
		} else {
			thisField.priorval = thisPrice;
		}
	}

	
		var div_bottom_moved = false;

		function addLoadEvent(func) {
 			var oldonload = window.onload;
  			if (typeof window.onload != 'function') {
    			window.onload = func;
  			}
  			else {
    			window.onload = function() {
      				if (oldonload) {
        				oldonload();
      				}
      				func();
    			}
  			}
 		}

		addLoadEvent(calcTotalFix);
	
</script>

	
<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
</style>


<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
		iTemp = strFileName.indexOf(":");
		
		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
		}
		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				obj.value = '';
				return false;
			}
		}
	}
	function clearRadio(rd) {
		if (document.iform) {
			var v;
			var ln;
			var ev;
			submitted = 0;
			v = "document.iform." + rd + ".length";
			ln = eval(v);
			// This will ensure we uncheck if there is only 1 radio button..
			v = "document.iform." + rd + ".checked = false;";
			ev = eval(v);
			// Now loop through the list of radio buttons and uncheck them all
			for (i=0;i<ln;i++) {
				v = "document.iform." + rd + "[" + i + "].checked = false;";
				//console.log(v);
				ev = eval(v);
			}
			calcTotalFix();
		}
	}
</script>


<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-9" class="layout form item outer row-1 item-9 row_num-20 row_pos-160 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Company<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_1"
									name="response_1"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-1 item-9"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_1_required"
							VALUE="The field Company is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_1" value="Company">
				<INPUT TYPE="hidden" NAME="response_1_question_id" VALUE="9">
				<INPUT TYPE="hidden" NAME="question_type_1" value="Text">
				<INPUT TYPE="hidden" NAME="label_1" value="Company">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-7" class="layout form item outer row-2 item-7 row_num-40 row_pos-160 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_2"
									name="response_2"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-2 item-7"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_2_required"
							VALUE="The field First Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_2" value="First Name">
				<INPUT TYPE="hidden" NAME="response_2_question_id" VALUE="7">
				<INPUT TYPE="hidden" NAME="question_type_2" value="Text">
				<INPUT TYPE="hidden" NAME="label_2" value="First Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-8" class="layout form item outer row-3 item-8 row_num-40 row_pos-320 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Last Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-3 item-8"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_3_required"
							VALUE="The field Last Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_3" value="Last Name">
				<INPUT TYPE="hidden" NAME="response_3_question_id" VALUE="8">
				<INPUT TYPE="hidden" NAME="question_type_3" value="Text">
				<INPUT TYPE="hidden" NAME="label_3" value="Last Name">

				
			</div> <!-- /inner -->

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				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
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		<div id="form-item-10" class="layout form item outer row-4 item-10 row_num-60 row_pos-160 rowlength-2 type-Email" style="clear:both;;position:relative;">

			<div class="inner">

				
							Email<span class="text-danger"> *</span>
					

								<script type="text/javascript" src="/i4a/ams/include/checkemail.js"></script>
							

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:200px;"
								
									
										onchange="VerifyEmailAddress('iform', this.name,'Email')" value=""
									
								
								class="form-control type-Email row-4 item-10"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_4_required"
							VALUE="The field Email is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_4" value="Email">
				<INPUT TYPE="hidden" NAME="response_4_question_id" VALUE="10">
				<INPUT TYPE="hidden" NAME="question_type_4" value="Email">
				<INPUT TYPE="hidden" NAME="label_4" value="Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-11" class="layout form item outer row-5 item-11 row_num-60 row_pos-320 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Phone Number<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_5"
									name="response_5"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-5 item-11"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_5_required"
							VALUE="The field Phone Number is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_5" value="Phone Number">
				<INPUT TYPE="hidden" NAME="response_5_question_id" VALUE="11">
				<INPUT TYPE="hidden" NAME="question_type_5" value="Text">
				<INPUT TYPE="hidden" NAME="label_5" value="Phone Number">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12" class="layout form item outer row-6 item-12 row_num-80 row_pos-160 rowlength-1 type-MultiSelect" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Indicate the Regional Forum(s) this applies to. To select multiple, hold either the control or command button while selecting options.<span class="text-danger"> *</span>
					

								<select
									id="response_6"
									name="response_6"
									
									
										size="3" multiple="multiple"
									
									
									class="form-control type-MultiSelect row-6 item-12"
									>
									
									
										<option value="Salt Lake City, UT" >Salt Lake City, UT</option>
									
										<option value="Houston, TX" >Houston, TX</option>
									
										<option value="Minneapolis, MN" >Minneapolis, MN</option>
									
										<option value="Indianapolis, IN" >Indianapolis, IN</option>
									
								</select>
							
							
						<INPUT
							TYPE="hidden"
							NAME="response_6_required"
							VALUE="The field Indicate the Regional Forum(s) this applies to. To select multiple, hold either the control or command button while selecting options. is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_6" value="Indicate the Regional Forum(s) this applies to. To select multiple, hold either the control or command button while selecting options.">
				<INPUT TYPE="hidden" NAME="response_6_question_id" VALUE="12">
				<INPUT TYPE="hidden" NAME="question_type_6" value="MultiSelect">
				<INPUT TYPE="hidden" NAME="label_6" value="Regional Forum(s)">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-13" class="layout form item outer row-7 item-13 row_num-100 row_pos-160 rowlength-1 type-MultiSelect" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Indicate which sponsorship(s) this applies to. To select multiple, hold either the control or command button while selecting options.<span class="text-danger"> *</span>
					

								<select
									id="response_7"
									name="response_7"
									
									
										size="3" multiple="multiple"
									
									
									class="form-control type-MultiSelect row-7 item-13"
									>
									
									
										<option value="Clinical Insights Forum" >Clinical Insights Forum</option>
									
										<option value="Advisory Board" >Advisory Board</option>
									
										<option value="Product Theater" >Product Theater</option>
									
										<option value="Tabletop Exhibit ($6,000)" >Tabletop Exhibit ($6,000)</option>
									
								</select>
							
							
						<INPUT
							TYPE="hidden"
							NAME="response_7_required"
							VALUE="The field Indicate which sponsorship(s) this applies to. To select multiple, hold either the control or command button while selecting options. is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_7" value="Indicate which sponsorship(s) this applies to. To select multiple, hold either the control or command button while selecting options.">
				<INPUT TYPE="hidden" NAME="response_7_question_id" VALUE="13">
				<INPUT TYPE="hidden" NAME="question_type_7" value="MultiSelect">
				<INPUT TYPE="hidden" NAME="label_7" value="Sponsorship">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-14" class="layout form item outer row-8 item-14 row_num-120 row_pos-160 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							If the above selection(s) are for more than one Regional Forum, specify which sponsorship(s) apply to each location.
					

							<input type="text"
								
									id="response_8"
									name="response_8"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-8 item-14"
							><!-- input -->

							
				<input type="hidden" name="question_8" value="If the above selection(s) are for more than one Regional Forum, specify which sponsorship(s) apply to each location.">
				<INPUT TYPE="hidden" NAME="response_8_question_id" VALUE="14">
				<INPUT TYPE="hidden" NAME="question_type_8" value="Text">
				<INPUT TYPE="hidden" NAME="label_8" value="Info on Sponsorship">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-15" class="layout form item outer row-9 item-15 row_num-140 row_pos-160 rowlength-1 type-Radio" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							By completing this form, you and your company accept and agree to the terms and conditions.<span class="text-danger"> *</span>
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_9"
											id="radioVal_15_1"
											fieldtype="radioprice"
											price="0"
											value="I accept and agree to the terms and conditions"

											
											class="item type-radio type-Radio row-9 item-15 "
											>
											

													I accept and agree to the terms and conditions

												
										</label>
									</div>
							
							
									<br /><a href="javascript:void(0);" onclick="clearRadio('response_9');">Clear Selection</a>
								
							
						<INPUT
							TYPE="hidden"
							NAME="response_9_required"
							VALUE="The field By completing this form, you and your company accept and agree to the terms and conditions. is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_9" value="By completing this form, you and your company accept and agree to the terms and conditions.">
				<INPUT TYPE="hidden" NAME="response_9_question_id" VALUE="15">
				<INPUT TYPE="hidden" NAME="question_type_9" value="Radio">
				<INPUT TYPE="hidden" NAME="label_9" value="Confirmation">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-21" class="layout form item outer row-10 item-21 row_num-160 row_pos-160 rowlength-1 type-Radio" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Indicate payment type. Credit card payments will incur a 3% service fee. Payment will not be processed until a representative from GCK reaches out to confirm your sponsorship(s).<span class="text-danger"> *</span>
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_10"
											id="radioVal_21_1"
											fieldtype="radioprice"
											price="0"
											value="Check"

											
											class="item type-radio type-Radio row-10 item-21 "
											>
											

													Check

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_10"
											id="radioVal_21_2"
											fieldtype="radioprice"
											price="0"
											value="ACH"

											
											class="item type-radio type-Radio row-10 item-21 "
											>
											

													ACH

												
													<br />
												
												
										</label>
									</div>
							
								
						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_10"
											id="radioVal_21_3"
											fieldtype="radioprice"
											price="0"
											value="Credit Card"

											
											class="item type-radio type-Radio row-10 item-21 "
											>
											

													Credit Card

												
										</label>
									</div>
							
							
									<br /><a href="javascript:void(0);" onclick="clearRadio('response_10');">Clear Selection</a>
								
							
						<INPUT
							TYPE="hidden"
							NAME="response_10_required"
							VALUE="The field Indicate payment type. Credit card payments will incur a 3% service fee. Payment will not be processed until a representative from GCK reaches out to confirm your sponsorship(s). is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_10" value="Indicate payment type. Credit card payments will incur a 3% service fee. Payment will not be processed until a representative from GCK reaches out to confirm your sponsorship(s). ">
				<INPUT TYPE="hidden" NAME="response_10_question_id" VALUE="21">
				<INPUT TYPE="hidden" NAME="question_type_10" value="Radio">
				<INPUT TYPE="hidden" NAME="label_10" value="Payment Type">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
</div><!-- /form_layout_wrapper -->


		<div id="_ssdiv2" style="display:none">
			<input type="hidden" id="fld_uploadfields" name="UploadFields" value="">
			<input type="hidden" id="fld_id_column" name="id_column" value="ID">
			<input type="hidden" id="fld_id_value" name="id_value" value="">
			<input type="hidden" id="fld_form_overrideid" name="form_overrideID" value="0">
			
			<input type="hidden" id="fld_ss_form_testid" name="ss_form_testid" value="0" />
			<div id="_ssdiv">
				<p style="background-color: blue"><input type="text" name="ss_address2" value="" /></p>
			</div>
		</div>
		
			<input type="hidden" name="form_isEdit" value="0">
		
	
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						-webkit-transform:scale(0.77);transform-origin:0 0;
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					<input type="hidden" name="use_ssl" value="1">
				
			
				<INPUT TYPE="hidden" NAME="send_mail_ind" VALUE="0">
				<INPUT TYPE="hidden" NAME="no_opt_out" VALUE="1">
			
	
			<div id="frm_submit_button">
				<br />
				<button class="btn btn-primary" type="button" data-loading-text="Please wait..." id="submitBtn"
					
						onclick="startValidate();"
					
				>Submit Form</button>
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			<div id="frm_verisign_seal_box">
				
				
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				<div id="frm_required_copy_bottom">
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		</div><!-- div_bottom -->
	
		
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