{"id":128,"date":"2024-06-05T20:20:13","date_gmt":"2024-06-05T20:20:13","guid":{"rendered":"https:\/\/eggalliance.com\/?page_id=128"},"modified":"2024-06-05T20:20:15","modified_gmt":"2024-06-05T20:20:15","slug":"formod3","status":"publish","type":"page","link":"https:\/\/eggalliance.com\/?page_id=128","title":{"rendered":"FormOD3"},"content":{"rendered":"<div class=\"wp-block-uagb-container uagb-block-3800d99a alignfull uagb-is-root-container\"><div class=\"uagb-container-inner-blocks-wrap\"><\/div><\/div><div class=\"wp-block-uagb-advanced-heading uagb-block-4c44ce69\"><h2 class=\"uagb-heading-text\">Egg Donor Application<\/h2><\/div><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-3177e0f1-0971-4a74-833e-7cc49bf8bffd wpforms-render-modern\" id=\"wpforms-74\"><form id=\"wpforms-form-74\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"74\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F128&#038;wpforms_form_id=74\" data-token=\"3bba66ec3de0f1623114ad520db5f860\" data-token-time=\"1781185944\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-74-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-74-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-74-field_1-error\" required><label for=\"wpforms-74-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-74-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-74-field_1-last-error\" required><label for=\"wpforms-74-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-74-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_27\">Birth Date  (MM\/DD) <\/label><input type=\"text\" id=\"wpforms-74-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-74-field_27-error\" ><\/div><div id=\"wpforms-74-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_41\">Birth Date  (YYYY)<\/label><input type=\"text\" id=\"wpforms-74-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-74-field_41-error\" ><\/div><div id=\"wpforms-74-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_3\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-74-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" aria-errormessage=\"wpforms-74-field_3-error\" required><\/div><div id=\"wpforms-74-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_28\">Telephone Number<\/label><input type=\"text\" id=\"wpforms-74-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-74-field_28-error\" ><\/div><div id=\"wpforms-74-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_50\">Place of Birth<\/label><input type=\"text\" id=\"wpforms-74-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-74-field_50-error\" ><\/div><div id=\"wpforms-74-field_51-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_51\">Are you a United States citizen or permanent resident?<\/label><select id=\"wpforms-74-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-74-field_52-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_52\">Are you adopted?<\/label><select id=\"wpforms-74-field_52\" class=\"wpforms-field-medium\" name=\"wpforms[fields][52]\"><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_53\">Ethniciity<\/label><input type=\"text\" id=\"wpforms-74-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-74-field_53-error\" ><\/div><div id=\"wpforms-74-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_7\">Height (cm \/ feet, inches)<\/label><input type=\"text\" id=\"wpforms-74-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-74-field_7-error\" ><\/div><div id=\"wpforms-74-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_11\">Weight (Kg\/Pounds)<\/label><input type=\"text\" id=\"wpforms-74-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-74-field_11-error\" ><\/div><div id=\"wpforms-74-field_31-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_31\">ABO Blood Types <\/label><select id=\"wpforms-74-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\"><option value=\"A\"  class=\"choice-1 depth-1\"  >A<\/option><option value=\"B\"  class=\"choice-2 depth-1\"  >B<\/option><option value=\"AB\"  class=\"choice-3 depth-1\"  >AB<\/option><option value=\"O\"  class=\"choice-4 depth-1\"  >O<\/option><option value=\"Unknown\"  class=\"choice-5 depth-1\"  >Unknown<\/option><\/select><div id=\"wpforms-74-field_31-description\" class=\"wpforms-field-description\">A B AB O Unknown\r\n<\/div><\/div><div id=\"wpforms-74-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_32\">Rh Types<\/label><select id=\"wpforms-74-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\"><option value=\"Positive\"  class=\"choice-1 depth-1\"  >Positive<\/option><option value=\"Negative\"  class=\"choice-2 depth-1\"  >Negative<\/option><option value=\"Unknown\"  class=\"choice-5 depth-1\"  >Unknown<\/option><\/select><div id=\"wpforms-74-field_32-description\" class=\"wpforms-field-description\">Positive Negative Unknown\r\n<\/div><\/div><div id=\"wpforms-74-field_36-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_36\">Gender at Birth<\/label><select id=\"wpforms-74-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\"><option value=\"Female\"  class=\"choice-1 depth-1\"  >Female<\/option><option value=\"Male\"  class=\"choice-2 depth-1\"  >Male<\/option><\/select><div id=\"wpforms-74-field_36-description\" class=\"wpforms-field-description\">Female Male<\/div><\/div><div id=\"wpforms-74-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_37\">Current Gender <\/label><select id=\"wpforms-74-field_37\" class=\"wpforms-field-medium\" name=\"wpforms[fields][37]\"><option value=\"Female\"  class=\"choice-1 depth-1\"  >Female<\/option><option value=\"Male\"  class=\"choice-9 depth-1\"  >Male<\/option><option value=\"Other\"  class=\"choice-8 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-74-field_37-description\" class=\"wpforms-field-description\">Female Male Other<\/div><\/div><div id=\"wpforms-74-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_54\">Street Address<\/label><input type=\"text\" id=\"wpforms-74-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-74-field_54-error\" ><\/div><div id=\"wpforms-74-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_55\">City<\/label><input type=\"text\" id=\"wpforms-74-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-74-field_55-error\" ><\/div><div id=\"wpforms-74-field_58-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_58\">State<\/label><select id=\"wpforms-74-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\"><option value=\"AL\"  class=\"choice-1 depth-1\"  >AL<\/option><option value=\"AK\"  class=\"choice-9 depth-1\"  >AK<\/option><option value=\"AZ\"  class=\"choice-8 depth-1\"  >AZ<\/option><option value=\"AR\"  class=\"choice-10 depth-1\"  >AR<\/option><option value=\"CA\"  class=\"choice-11 depth-1\"  >CA<\/option><option value=\"CO\"  class=\"choice-12 depth-1\"  >CO<\/option><option value=\"CT\"  class=\"choice-13 depth-1\"  >CT<\/option><option value=\"DE\"  class=\"choice-14 depth-1\"  >DE<\/option><option value=\"FL\"  class=\"choice-15 depth-1\"  >FL<\/option><option value=\"GA\"  class=\"choice-16 depth-1\"  >GA<\/option><option value=\"HI\"  class=\"choice-17 depth-1\"  >HI<\/option><option value=\"ID\"  class=\"choice-18 depth-1\"  >ID<\/option><option value=\"IL\"  class=\"choice-19 depth-1\"  >IL<\/option><option value=\"IN\"  class=\"choice-20 depth-1\"  >IN<\/option><option value=\"IA\"  class=\"choice-21 depth-1\"  >IA<\/option><option value=\"KS\"  class=\"choice-22 depth-1\"  >KS<\/option><option value=\"KY\"  class=\"choice-23 depth-1\"  >KY<\/option><option value=\"LA\"  class=\"choice-24 depth-1\"  >LA<\/option><option value=\"ME\"  class=\"choice-25 depth-1\"  >ME<\/option><option value=\"MD\"  class=\"choice-26 depth-1\"  >MD<\/option><option value=\"MA\"  class=\"choice-27 depth-1\"  >MA<\/option><option value=\"MI\"  class=\"choice-28 depth-1\"  >MI<\/option><option value=\"MN\"  class=\"choice-29 depth-1\"  >MN<\/option><option value=\"MS\"  class=\"choice-30 depth-1\"  >MS<\/option><option value=\"MO\"  class=\"choice-31 depth-1\"  >MO<\/option><option value=\"MT\"  class=\"choice-32 depth-1\"  >MT<\/option><option value=\"NE\"  class=\"choice-33 depth-1\"  >NE<\/option><option value=\"NV\"  class=\"choice-34 depth-1\"  >NV<\/option><option value=\"NH\"  class=\"choice-35 depth-1\"  >NH<\/option><option value=\"NJ\"  class=\"choice-36 depth-1\"  >NJ<\/option><option value=\"NM\"  class=\"choice-37 depth-1\"  >NM<\/option><option value=\"NY\"  class=\"choice-38 depth-1\"  >NY<\/option><option value=\"NC\"  class=\"choice-39 depth-1\"  >NC<\/option><option value=\"ND\"  class=\"choice-40 depth-1\"  >ND<\/option><option value=\"OH\"  class=\"choice-41 depth-1\"  >OH<\/option><option value=\"OK\"  class=\"choice-42 depth-1\"  >OK<\/option><option value=\"OR\"  class=\"choice-43 depth-1\"  >OR<\/option><option value=\"PA\"  class=\"choice-44 depth-1\"  >PA<\/option><option value=\"RI\"  class=\"choice-45 depth-1\"  >RI<\/option><option value=\"SC\"  class=\"choice-46 depth-1\"  >SC<\/option><option value=\"SD\"  class=\"choice-47 depth-1\"  >SD<\/option><option value=\"TN\"  class=\"choice-48 depth-1\"  >TN<\/option><option value=\"TX\"  class=\"choice-49 depth-1\"  >TX<\/option><option value=\"UT\"  class=\"choice-50 depth-1\"  >UT<\/option><option value=\"VT\"  class=\"choice-51 depth-1\"  >VT<\/option><option value=\"VA\"  class=\"choice-52 depth-1\"  >VA<\/option><option value=\"WA\"  class=\"choice-53 depth-1\"  >WA<\/option><option value=\"WV\"  class=\"choice-54 depth-1\"  >WV<\/option><option value=\"WI\"  class=\"choice-55 depth-1\"  >WI<\/option><option value=\"WY\"  class=\"choice-56 depth-1\"  >WY<\/option><option value=\"AS\"  class=\"choice-57 depth-1\"  >AS<\/option><option value=\"DS\"  class=\"choice-58 depth-1\"  >DS<\/option><option value=\"GU\"  class=\"choice-59 depth-1\"  >GU<\/option><option value=\"MP\"  class=\"choice-60 depth-1\"  >MP<\/option><option value=\"PR\"  class=\"choice-61 depth-1\"  >PR<\/option><option value=\"US\"  class=\"choice-62 depth-1\"  >US<\/option><\/select><div id=\"wpforms-74-field_58-description\" class=\"wpforms-field-description\">AL\r\nAK\r\nAZ\r\nAR\r\nCA\r\nCO\r\nCT\r\nDE\r\nFL\r\nGA\r\nHI\r\nID\r\nIL\r\nIN\r\nIA\r\nKS\r\nKY\r\nLA\r\nME\r\nMD\r\nMA\r\nMI\r\nMN\r\nMS\r\nMO\r\nMT\r\nNE\r\nNV\r\nNH\r\nNJ\r\nNM\r\nNY\r\nNC\r\nND\r\nOH\r\nOK\r\nOR\r\nPA\r\nRI\r\nSC\r\nSD\r\nTN\r\nTX\r\nUT\r\nVT\r\nVA\r\nWA\r\nWV\r\nWI\r\nWY\r\nAS (American Samoa)\r\nDC (District of Columbia)\r\nGU (Guam)\r\nMP (Northern Mariana Islands)\r\nPR (Puerto Rico)\r\nVI (U.S. Virgin Islands)\r\n<\/div><\/div><div id=\"wpforms-74-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_56\">Zip Code<\/label><input type=\"text\" id=\"wpforms-74-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-74-field_56-error\" ><\/div><div id=\"wpforms-74-field_59-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_59\">Country: United State<\/label><select id=\"wpforms-74-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-9 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-74-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_57\">Other Country<\/label><input type=\"text\" id=\"wpforms-74-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-74-field_57-error\" ><\/div><div id=\"wpforms-74-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_34\">AMH Level (ng\/ml  normal 2~5)<\/label><input type=\"text\" id=\"wpforms-74-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-74-field_34-error\" ><\/div><div id=\"wpforms-74-field_5-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_5\">Eye Color<\/label><select id=\"wpforms-74-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\"><option value=\"Brown\"  class=\"choice-1 depth-1\"  >Brown<\/option><option value=\"Blue\"  class=\"choice-2 depth-1\"  >Blue<\/option><option value=\"Black\"  class=\"choice-3 depth-1\"  >Black<\/option><option value=\"Green\"  class=\"choice-4 depth-1\"  >Green<\/option><option value=\"Hazel\"  class=\"choice-5 depth-1\"  >Hazel<\/option><option value=\"Gray\"  class=\"choice-6 depth-1\"  >Gray<\/option><option value=\"Amber\"  class=\"choice-7 depth-1\"  >Amber<\/option><\/select><div id=\"wpforms-74-field_5-description\" class=\"wpforms-field-description\">Brown\r\nBlue\r\nBlack\r\nGreen\r\nHazel\r\nGray\r\nAmber\r\nOther<\/div><\/div><div id=\"wpforms-74-field_30-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_30\">Hair Color<\/label><select id=\"wpforms-74-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\"><option value=\"Brown\"  class=\"choice-1 depth-1\"  >Brown<\/option><option value=\"Black\"  class=\"choice-2 depth-1\"  >Black<\/option><option value=\"White\"  class=\"choice-3 depth-1\"  >White<\/option><option value=\"Blonde\"  class=\"choice-4 depth-1\"  >Blonde<\/option><option value=\"Red\"  class=\"choice-5 depth-1\"  >Red<\/option><option value=\"Gray\"  class=\"choice-6 depth-1\"  >Gray<\/option><option value=\"Auburn\"  class=\"choice-7 depth-1\"  >Auburn<\/option><option value=\"Other\"  class=\"choice-8 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-74-field_30-description\" class=\"wpforms-field-description\">Black\r\nBrown\r\nWhite\r\nBlonde\r\nRed\r\nGray\r\nAuburn\r\nOther<\/div><\/div><div id=\"wpforms-74-field_29-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_29\">What is your relationship status?<\/label><select id=\"wpforms-74-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\"><option value=\"Spouse\"  class=\"choice-1 depth-1\"  >Spouse<\/option><option value=\"Friend\"  class=\"choice-2 depth-1\"  >Friend<\/option><option value=\"Single\"  class=\"choice-3 depth-1\"  >Single<\/option><option value=\"Other\"  class=\"choice-4 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-74-field_29-description\" class=\"wpforms-field-description\">Who do you live with? Spouse\r\nFriend\r\nSingle\r\nOther <\/div><\/div><div id=\"wpforms-74-field_15-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_15\">Do you drink?<\/label><select id=\"wpforms-74-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Occasionally\"  class=\"choice-4 depth-1\"  >Occasionally<\/option><\/select><\/div><div id=\"wpforms-74-field_35-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_35\">Do you smoke? <\/label><select id=\"wpforms-74-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Occasionally\"  class=\"choice-4 depth-1\"  >Occasionally<\/option><\/select><\/div><div id=\"wpforms-74-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_38\">What is your highest level of education?<\/label><input type=\"text\" id=\"wpforms-74-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-74-field_38-error\" ><\/div><div id=\"wpforms-74-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_39\">What is your current occupation?<\/label><input type=\"text\" id=\"wpforms-74-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-74-field_39-error\" ><\/div><div id=\"wpforms-74-field_33-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_33\">Have you donated your eggs previously?<\/label><select id=\"wpforms-74-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\"><option value=\"Yes\"  class=\"choice-5 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-8 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-74-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_9\">If yes, how many cycles?<\/label><input type=\"text\" id=\"wpforms-74-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-74-field_9-error\" ><\/div><div id=\"wpforms-74-field_42-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_42\">Have you ever been told you are infertile?<\/label><select id=\"wpforms-74-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_43-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_43\">Is there any history of infertility in your family?<\/label><select id=\"wpforms-74-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_40\">Are there any known genetic diseases or conditions that run in your family?<\/label><input type=\"text\" id=\"wpforms-74-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-74-field_40-error\" ><\/div><div id=\"wpforms-74-field_44-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_44\">Have you tested positive for chlamydia or gonorrhea in the past year?<\/label><select id=\"wpforms-74-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_46-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_46\">Have you ever used or injected any recreational drugs or illegal drugs? (Cocaine, marijuana, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinations, tranquilizers, PCP, steroids, or others.)<\/label><select id=\"wpforms-74-field_46\" class=\"wpforms-field-medium\" name=\"wpforms[fields][46]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_45\">If yes, which drugs, and when were they last used?<\/label><input type=\"text\" id=\"wpforms-74-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-74-field_45-error\" ><\/div><div id=\"wpforms-74-field_26-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_26\">Are you currently taking any medications?<\/label><select id=\"wpforms-74-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_47\">If yes, please provide the name and indication.<\/label><input type=\"text\" id=\"wpforms-74-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-74-field_47-error\" ><\/div><div id=\"wpforms-74-field_48-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_48\">Have you ever been seen by a psychologist, psychiatrist, social worker, counselor, or any other medical health professional for any reason?<\/label><select id=\"wpforms-74-field_48\" class=\"wpforms-field-medium\" name=\"wpforms[fields][48]\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_49\">If yes, for how long and what reason?<\/label><input type=\"text\" id=\"wpforms-74-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-74-field_49-error\" ><\/div><div id=\"wpforms-74-field_13-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_13\">Have you had a tattoo or piercing in which sterile instruments were not used?<\/label><select id=\"wpforms-74-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\"><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-74-field_14-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_14\">Do you accept travel\/or taking airplane to have Egg Pick-up domestically?<\/label><select id=\"wpforms-74-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Unknown\"  class=\"choice-3 depth-1\"  >Unknown<\/option><\/select><\/div><div id=\"wpforms-74-field_60-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_60\">Do you accept travel\/ or taking airplane to have Egg Pick-up internationally? <\/label><select id=\"wpforms-74-field_60\" class=\"wpforms-field-medium\" name=\"wpforms[fields][60]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><option value=\"Unknown\"  class=\"choice-3 depth-1\"  >Unknown<\/option><\/select><\/div><div id=\"wpforms-74-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_20\">Describe your favorite hobbies and interests:<\/label><textarea id=\"wpforms-74-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-74-field_20-error\" ><\/textarea><\/div><div id=\"wpforms-74-field_22-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_22\">Describe your personality and characteristics :<\/label><textarea id=\"wpforms-74-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-74-field_22-error\" ><\/textarea><\/div><div id=\"wpforms-74-field_61-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_61\">Upload your unedited photo (max 2 files)<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"61\"\n\t\tdata-form-id=\"74\"\n\t\tdata-input-name=\"wpforms_74_61\"\n\t\tdata-extensions=\"png,gif,jpg,jpeg\"\n\t\tdata-max-size=\"1048576\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2147483648\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"1048576\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-74-field_61\"\n\t\tname=\"wpforms_74_61\" \t\tvalue=\"\">\n<div id=\"wpforms-74-field_61-description\" class=\"wpforms-field-description\">You can upload your unedited photos with .png, .gif, .jpg, .jpeg.\r\n <\/div><\/div><div id=\"wpforms-74-field_62-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-74-field_62\">Upload your file.  (max 1 files)<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"62\"\n\t\tdata-form-id=\"74\"\n\t\tdata-input-name=\"wpforms_74_62\"\n\t\tdata-extensions=\"doc,pdf\"\n\t\tdata-max-size=\"1048576\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2147483648\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"1048576\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-74-field_62\"\n\t\tname=\"wpforms_74_62\" \t\tvalue=\"\">\n<div id=\"wpforms-74-field_62-description\" class=\"wpforms-field-description\">You can upload your fires..\r\n.page, .doc , .pdf<\/div><\/div><\/div><!-- .wpforms-field-container --><div 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