{"id":16,"date":"2024-06-04T02:43:50","date_gmt":"2024-06-04T02:43:50","guid":{"rendered":"https:\/\/eggalliance.com\/membership-checkout\/"},"modified":"2024-06-19T15:52:40","modified_gmt":"2024-06-19T15:52:40","slug":"membership-checkout","status":"publish","type":"page","link":"https:\/\/eggalliance.com\/?page_id=16","title":{"rendered":"Membership Checkout"},"content":{"rendered":"<p>Submit your application to activate your membership before check out!<\/p><div class=\"wp-block-uagb-container uagb-block-b78096e2 alignfull uagb-is-root-container\"><div class=\"uagb-container-inner-blocks-wrap\"><div class=\"wp-block-uagb-container uagb-block-13e6b766\"><div class=\"wp-block-uagb-modal uagb-block-353a86af uagb-modal-wrapper\" data-escpress=\"enable\" data-overlayclick=\"disable\"><div class=\"uagb-spectra-button-wrapper wp-block-button\"><a class=\"uagb-modal-button-link wp-block-button__link uagb-modal-trigger\" href=\"#\" onclick=\"return false;\" target=\"_self\" rel=\"noopener noreferrer\"><span class=\"uagb-modal-content-wrapper\"><span class=\"uagb-inline-editing\">Egg Donor Application Form<\/span><\/span><\/a><\/div><div class=\"uagb-effect-default uagb-modal-popup uagb-block-353a86af\"><div class=\"uagb-modal-popup-wrap\"><div class=\"uagb-modal-popup-content\"><div class=\"wp-block-uagb-info-box uagb-block-82d62a90 uagb-infobox__content-wrap  uagb-infobox-icon-above-title uagb-infobox-image-valign-top\"><div class=\"uagb-ifb-content\"><div class=\"uagb-ifb-icon-wrap\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M0 256C0 114.6 114.6 0 256 0C397.4 0 512 114.6 512 256C512 397.4 397.4 512 256 512C114.6 512 0 397.4 0 256zM371.8 211.8C382.7 200.9 382.7 183.1 371.8 172.2C360.9 161.3 343.1 161.3 332.2 172.2L224 280.4L179.8 236.2C168.9 225.3 151.1 225.3 140.2 236.2C129.3 247.1 129.3 264.9 140.2 275.8L204.2 339.8C215.1 350.7 232.9 350.7 243.8 339.8L371.8 211.8z\"><\/path><\/svg><\/div><div class=\"uagb-ifb-title-wrap\"><h3 class=\"uagb-ifb-title\">Summit Your Application<br><\/h3><\/div><p class=\"uagb-ifb-desc\">Full fill the form below to get our contact and bonus!<\/p><div class=\"uagb-ifb-button-wrapper wp-block-button\"><a href=\"#\" class=\"uagb-infobox-cta-link wp-block-button__link\" target=\"_self\" rel=\"noopener noreferrer\" onclick=\"return false;\"><span class=\"uagb-inline-editing\">Call To Action<\/span><\/a><\/div><\/div><\/div>\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-ff6729f0-75fb-4155-be68-efb6aa90ea58 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%2F16&#038;wpforms_form_id=74\" data-token=\"60dc983bd29ac86151271a3f3e27398e\" data-token-time=\"1776417590\"><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 class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"74\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-74\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eggalliance.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n<\/div><button class=\"uagb-modal-popup-close\" aria-label=\"Close Modal\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 320 512\"><path d=\"M310.6 361.4c12.5 12.5 12.5 32.75 0 45.25C304.4 412.9 296.2 416 288 416s-16.38-3.125-22.62-9.375L160 301.3L54.63 406.6C48.38 412.9 40.19 416 32 416S15.63 412.9 9.375 406.6c-12.5-12.5-12.5-32.75 0-45.25l105.4-105.4L9.375 150.6c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L160 210.8l105.4-105.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-105.4 105.4L310.6 361.4z\"><\/path><\/svg><\/button><\/div><\/div><\/div><\/div>\n\n<div class=\"wp-block-uagb-container uagb-block-4f0d6d9a\"><div class=\"wp-block-uagb-modal uagb-block-c6926c06 uagb-modal-wrapper\" data-escpress=\"enable\" data-overlayclick=\"disable\"><div class=\"uagb-spectra-button-wrapper wp-block-button\"><a class=\"uagb-modal-button-link wp-block-button__link uagb-modal-trigger\" href=\"#\" onclick=\"return false;\" target=\"_self\" rel=\"noopener noreferrer\"><span class=\"uagb-modal-content-wrapper\"><span class=\"uagb-inline-editing\">Egg Recipient Registration Form<\/span><\/span><\/a><\/div><div class=\"uagb-effect-default uagb-modal-popup uagb-block-c6926c06\"><div class=\"uagb-modal-popup-wrap\"><div class=\"uagb-modal-popup-content\"><div class=\"wp-block-uagb-info-box uagb-block-2c9e01fc uagb-infobox__content-wrap  uagb-infobox-icon-above-title uagb-infobox-image-valign-top\"><div class=\"uagb-ifb-content\"><div class=\"uagb-ifb-icon-wrap\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M0 256C0 114.6 114.6 0 256 0C397.4 0 512 114.6 512 256C512 397.4 397.4 512 256 512C114.6 512 0 397.4 0 256zM371.8 211.8C382.7 200.9 382.7 183.1 371.8 172.2C360.9 161.3 343.1 161.3 332.2 172.2L224 280.4L179.8 236.2C168.9 225.3 151.1 225.3 140.2 236.2C129.3 247.1 129.3 264.9 140.2 275.8L204.2 339.8C215.1 350.7 232.9 350.7 243.8 339.8L371.8 211.8z\"><\/path><\/svg><\/div><div class=\"uagb-ifb-title-wrap\"><h3 class=\"uagb-ifb-title\">Summit Your Registration<\/h3><\/div><p class=\"uagb-ifb-desc\"><br>Full fill the form below to get our contact!.<\/p><div class=\"uagb-ifb-button-wrapper wp-block-button\"><a href=\"#\" class=\"uagb-infobox-cta-link wp-block-button__link\" target=\"_self\" rel=\"noopener noreferrer\" onclick=\"return false;\"><span class=\"uagb-inline-editing\">Call To Action<\/span><\/a><\/div><\/div><\/div>\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-9238dd73-c482-4f34-bb7b-a90e6f025a08 wpforms-render-modern\" id=\"wpforms-102\"><form id=\"wpforms-form-102\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"102\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F16\" data-token=\"8ca473d96c43ddc62a165e313e3efc5e\" data-token-time=\"1776417590\"><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-102-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-102-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-102-field_1-error\" required><label for=\"wpforms-102-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-102-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-102-field_1-last-error\" required><label for=\"wpforms-102-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-102-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_27\">Birth Date (MM) <\/label><input type=\"text\" id=\"wpforms-102-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-102-field_27-error\" ><\/div><div id=\"wpforms-102-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_41\">Birth Date (YYYY)<\/label><input type=\"text\" id=\"wpforms-102-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-102-field_41-error\" aria-describedby=\"wpforms-102-field_41-description\" ><div id=\"wpforms-102-field_41-description\" class=\"wpforms-field-description\">19?? ~20??<\/div><\/div><div id=\"wpforms-102-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_3\">Email  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-102-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" aria-errormessage=\"wpforms-102-field_3-error\" required><\/div><div id=\"wpforms-102-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_28\">Telephone Number<\/label><input type=\"text\" id=\"wpforms-102-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-102-field_28-error\" ><\/div><div id=\"wpforms-102-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_50\">Place of Birth<\/label><input type=\"text\" id=\"wpforms-102-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-102-field_50-error\" ><\/div><div id=\"wpforms-102-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-102-field_51\">Are you a United States citizen or permanent resident?<\/label><select id=\"wpforms-102-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-102-field_63-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_63\">If not, what is your nationality?<\/label><input type=\"text\" id=\"wpforms-102-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" aria-errormessage=\"wpforms-102-field_63-error\" ><\/div><div id=\"wpforms-102-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_53\">Ethniciity<\/label><input type=\"text\" id=\"wpforms-102-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-102-field_53-error\" ><\/div><div id=\"wpforms-102-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_7\">Height (cm \/ feet, inches)<\/label><input type=\"text\" id=\"wpforms-102-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-102-field_7-error\" ><\/div><div id=\"wpforms-102-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_11\">Weight (Kg\/Pounds)<\/label><input type=\"text\" id=\"wpforms-102-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-102-field_11-error\" ><\/div><div id=\"wpforms-102-field_66-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_66\">What is your current Gender?<\/label><select id=\"wpforms-102-field_66\" class=\"wpforms-field-medium\" name=\"wpforms[fields][66]\"><option value=\"Female\"  class=\"choice-1 depth-1\"  >Female<\/option><option value=\"Male\"  class=\"choice-2 depth-1\"  >Male<\/option><option value=\"Other\"  class=\"choice-3 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-102-field_66-description\" class=\"wpforms-field-description\">Female Male Other\r\n<\/div><\/div><div id=\"wpforms-102-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-102-field_31\">ABO Blood Types<\/label><select id=\"wpforms-102-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=\"\u4e0d\u77e5\"  class=\"choice-5 depth-1\"  >\u4e0d\u77e5<\/option><\/select><div id=\"wpforms-102-field_31-description\" class=\"wpforms-field-description\">A B AB O \u4e0d\u77e5\r\n<\/div><\/div><div id=\"wpforms-102-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-102-field_32\">Rh Types<\/label><select id=\"wpforms-102-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-102-field_32-description\" class=\"wpforms-field-description\">Positive Negative Unknown\r\n<\/div><\/div><div id=\"wpforms-102-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_54\">Street Address<\/label><input type=\"text\" id=\"wpforms-102-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-102-field_54-error\" ><\/div><div id=\"wpforms-102-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_55\">City<\/label><input type=\"text\" id=\"wpforms-102-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-102-field_55-error\" ><\/div><div id=\"wpforms-102-field_68-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_68\">State<\/label><select id=\"wpforms-102-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\"><option value=\"AL\"  selected='selected' class=\"choice-1 depth-1\"  >AL<\/option><option value=\"AK\"  class=\"choice-9 depth-1\"  >AK<\/option><option value=\"AZ\"  class=\"choice-10 depth-1\"  >AZ<\/option><option value=\"AR\"  class=\"choice-11 depth-1\"  >AR<\/option><option value=\"CA\"  class=\"choice-12 depth-1\"  >CA<\/option><option value=\"CO\"  class=\"choice-13 depth-1\"  >CO<\/option><option value=\"CT\"  class=\"choice-14 depth-1\"  >CT<\/option><option value=\"DE\"  class=\"choice-15 depth-1\"  >DE<\/option><option value=\"FL\"  class=\"choice-16 depth-1\"  >FL<\/option><option value=\"GA\"  class=\"choice-17 depth-1\"  >GA<\/option><option value=\"HI\"  class=\"choice-18 depth-1\"  >HI<\/option><option value=\"ID\"  class=\"choice-19 depth-1\"  >ID<\/option><option value=\"IL\"  class=\"choice-20 depth-1\"  >IL<\/option><option value=\"IN\"  class=\"choice-21 depth-1\"  >IN<\/option><option value=\"IA\"  class=\"choice-22 depth-1\"  >IA<\/option><option value=\"KS\"  class=\"choice-23 depth-1\"  >KS<\/option><option value=\"KY\"  class=\"choice-24 depth-1\"  >KY<\/option><option value=\"LA\"  class=\"choice-25 depth-1\"  >LA<\/option><option value=\"ME\"  class=\"choice-26 depth-1\"  >ME<\/option><option value=\"MD\"  class=\"choice-27 depth-1\"  >MD<\/option><option value=\"MA\"  class=\"choice-28 depth-1\"  >MA<\/option><option value=\"MI\"  class=\"choice-29 depth-1\"  >MI<\/option><option value=\"MN\"  class=\"choice-30 depth-1\"  >MN<\/option><option value=\"MS\"  class=\"choice-31 depth-1\"  >MS<\/option><option value=\"MO\"  class=\"choice-32 depth-1\"  >MO<\/option><option value=\"MT\"  class=\"choice-33 depth-1\"  >MT<\/option><option value=\"NE\"  class=\"choice-34 depth-1\"  >NE<\/option><option value=\"NV\"  class=\"choice-35 depth-1\"  >NV<\/option><option value=\"NH\"  class=\"choice-36 depth-1\"  >NH<\/option><option value=\"NJ\"  class=\"choice-37 depth-1\"  >NJ<\/option><option value=\"NM\"  class=\"choice-38 depth-1\"  >NM<\/option><option value=\"NY\"  class=\"choice-39 depth-1\"  >NY<\/option><option value=\"NC\"  class=\"choice-40 depth-1\"  >NC<\/option><option value=\"ND\"  class=\"choice-41 depth-1\"  >ND<\/option><option value=\"OH\"  class=\"choice-42 depth-1\"  >OH<\/option><option value=\"OK\"  class=\"choice-62 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=\"WY\"  class=\"choice-55 depth-1\"  >WY<\/option><option value=\"AS\"  class=\"choice-56 depth-1\"  >AS<\/option><option value=\"DC\"  class=\"choice-57 depth-1\"  >DC<\/option><option value=\"GU\"  class=\"choice-58 depth-1\"  >GU<\/option><option value=\"MP\"  class=\"choice-59 depth-1\"  >MP<\/option><option value=\"PR\"  class=\"choice-60 depth-1\"  >PR<\/option><option value=\"VI\"  class=\"choice-61 depth-1\"  >VI<\/option><\/select><div id=\"wpforms-102-field_68-description\" class=\"wpforms-field-description\">AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS (American Samoa) DC (District of Columbia) GU (Guam) MP (Northern Mariana Islands) PR (Puerto Rico) VI (U.S. Virgin Islands)<\/div><\/div><div id=\"wpforms-102-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_56\">Zip Code<\/label><input type=\"text\" id=\"wpforms-102-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-102-field_56-error\" ><\/div><div id=\"wpforms-102-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-102-field_59\">Country: United State<\/label><select id=\"wpforms-102-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"Not\"  class=\"choice-9 depth-1\"  >Not<\/option><\/select><\/div><div id=\"wpforms-102-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_57\">Other Country<\/label><input type=\"text\" id=\"wpforms-102-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-102-field_57-error\" ><\/div><div id=\"wpforms-102-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-102-field_5\">Eye Color<\/label><select id=\"wpforms-102-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\"><option value=\"\u68d5\u8272\"  class=\"choice-1 depth-1\"  >\u68d5\u8272<\/option><option value=\"\u85cd\u8272\"  class=\"choice-2 depth-1\"  >\u85cd\u8272<\/option><option value=\"\u9ed1\u8272\"  class=\"choice-3 depth-1\"  >\u9ed1\u8272<\/option><option value=\"\u7da0\u8272\"  class=\"choice-4 depth-1\"  >\u7da0\u8272<\/option><option value=\"\u6de1\u8910\u8272\"  class=\"choice-5 depth-1\"  >\u6de1\u8910\u8272<\/option><option value=\"\u7070\u8272\"  class=\"choice-6 depth-1\"  >\u7070\u8272<\/option><option value=\"\u7425\u73c0\u8272\"  class=\"choice-7 depth-1\"  >\u7425\u73c0\u8272<\/option><option value=\"\u5176\u5b83\"  class=\"choice-9 depth-1\"  >\u5176\u5b83<\/option><\/select><div id=\"wpforms-102-field_5-description\" class=\"wpforms-field-description\">Brown Blue Black Green Hazel Gray Amber Other<\/div><\/div><div id=\"wpforms-102-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-102-field_30\">Hair Color<\/label><select id=\"wpforms-102-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\"><option value=\"\u68d5\u8272\"  class=\"choice-1 depth-1\"  >\u68d5\u8272<\/option><option value=\"\u9ed1\u8272\"  class=\"choice-2 depth-1\"  >\u9ed1\u8272<\/option><option value=\"\u767d\u8272\"  class=\"choice-9 depth-1\"  >\u767d\u8272<\/option><option value=\"\u91d1\u8272\"  class=\"choice-4 depth-1\"  >\u91d1\u8272<\/option><option value=\"\u7d05\u8272\"  class=\"choice-5 depth-1\"  >\u7d05\u8272<\/option><option value=\"\u7070\u8272\"  class=\"choice-6 depth-1\"  >\u7070\u8272<\/option><option value=\"\u8d64\u8910\u8272\"  class=\"choice-7 depth-1\"  >\u8d64\u8910\u8272<\/option><option value=\"Other\"  class=\"choice-8 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-102-field_30-description\" class=\"wpforms-field-description\">Black Brown White Blonde Red Gray Auburn Othe<\/div><\/div><div id=\"wpforms-102-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-102-field_29\">What is your relationship status?<\/label><select id=\"wpforms-102-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-102-field_29-description\" class=\"wpforms-field-description\">Who do you live with? Spouse Friend Single Other<\/div><\/div><div id=\"wpforms-102-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-102-field_14\">Are you willing to accommodate the schedule of a fresh egg donor?<\/label><select id=\"wpforms-102-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-102-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-102-field_60\">Are you open to receiving frozen eggs?<\/label><select id=\"wpforms-102-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-102-field_65-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_65\">Will you require the egg donor to undergo genetic screening for hereditary diseases?<\/label><select id=\"wpforms-102-field_65\" class=\"wpforms-field-medium\" name=\"wpforms[fields][65]\"><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-102-field_22-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_22\">Do you have any other specific traits or conditions you require from the egg donor?<\/label><textarea id=\"wpforms-102-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-102-field_22-error\" ><\/textarea><\/div><div id=\"wpforms-102-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-102-field_15\">Do you drink?<\/label><select id=\"wpforms-102-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 id=\"wpforms-102-field_15-description\" class=\"wpforms-field-description\">Yes No Occasionally<\/div><\/div><div id=\"wpforms-102-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-102-field_35\">Do you smoke?<\/label><select id=\"wpforms-102-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 id=\"wpforms-102-field_35-description\" class=\"wpforms-field-description\">Yes No Occasionally<\/div><\/div><div id=\"wpforms-102-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_38\">What is your highest level of education?<\/label><input type=\"text\" id=\"wpforms-102-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-102-field_38-error\" ><\/div><div id=\"wpforms-102-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_39\">What is your current occupation?<\/label><input type=\"text\" id=\"wpforms-102-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-102-field_39-error\" ><\/div><div id=\"wpforms-102-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-102-field_33\">Had you ever had Surgery\uff1f<\/label><select id=\"wpforms-102-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-102-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_9\">If yes, what surgery you had before\uff1f<\/label><input type=\"text\" id=\"wpforms-102-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-102-field_9-error\" ><\/div><div id=\"wpforms-102-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-102-field_42\">Do you have adenomyosis, myoma, or endometriosis now?<\/label><select id=\"wpforms-102-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\"><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-102-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-102-field_43\">Had you have operation of cervical ionization or history of cervical incompetency ? <\/label><select id=\"wpforms-102-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-102-field_40-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_40\">Had you history of getting cancer\uff1f<\/label><input type=\"text\" id=\"wpforms-102-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-102-field_40-error\" ><\/div><div id=\"wpforms-102-field_67-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_67\">Do you need surrogacy\uff1f<\/label><select id=\"wpforms-102-field_67\" class=\"wpforms-field-medium\" name=\"wpforms[fields][67]\"><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-102-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-102-field_44\">Do you have DM, hypertension, autoimmune disease or other Internal medicine diseases? <\/label><select id=\"wpforms-102-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-102-field_64-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_64\">If yes, what Internal medicine diseases you have?<\/label><input type=\"text\" id=\"wpforms-102-field_64\" class=\"wpforms-field-medium\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-102-field_64-error\" ><\/div><div id=\"wpforms-102-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-102-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-102-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-102-field_45-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_45\">If yes, which drugs, and when were they last used?<\/label><input type=\"text\" id=\"wpforms-102-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" aria-errormessage=\"wpforms-102-field_45-error\" ><\/div><div id=\"wpforms-102-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-102-field_26\">Are you currently taking any medications?<\/label><select id=\"wpforms-102-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-102-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_47\">If yes, please provide the name and indication.<\/label><input type=\"text\" id=\"wpforms-102-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-102-field_47-error\" ><\/div><div id=\"wpforms-102-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-102-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-102-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-102-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-102-field_49\">If yes, for how long and what reason?<\/label><input type=\"text\" id=\"wpforms-102-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-102-field_49-error\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"102\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-102\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eggalliance.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><button class=\"uagb-modal-popup-close\" aria-label=\"Close Modal\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 320 512\"><path d=\"M310.6 361.4c12.5 12.5 12.5 32.75 0 45.25C304.4 412.9 296.2 416 288 416s-16.38-3.125-22.62-9.375L160 301.3L54.63 406.6C48.38 412.9 40.19 416 32 416S15.63 412.9 9.375 406.6c-12.5-12.5-12.5-32.75 0-45.25l105.4-105.4L9.375 150.6c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L160 210.8l105.4-105.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-105.4 105.4L310.6 361.4z\"><\/path><\/svg><\/button><\/div><\/div><\/div><\/div>\n\n<div class=\"wp-block-uagb-modal uagb-block-23edb7ca uagb-modal-wrapper\" data-escpress=\"enable\" data-overlayclick=\"disable\"><div class=\"uagb-spectra-button-wrapper wp-block-button\"><a class=\"uagb-modal-button-link wp-block-button__link uagb-modal-trigger\" href=\"#\" onclick=\"return false;\" target=\"_self\" rel=\"noopener noreferrer\"><span class=\"uagb-modal-content-wrapper\"><span class=\"uagb-inline-editing\">Professional Application Form<\/span><\/span><\/a><\/div><div class=\"uagb-effect-default uagb-modal-popup uagb-block-23edb7ca\"><div class=\"uagb-modal-popup-wrap\"><div class=\"uagb-modal-popup-content\"><div class=\"wp-block-uagb-info-box uagb-block-cfb36ce6 uagb-infobox__content-wrap  uagb-infobox-icon-above-title uagb-infobox-image-valign-top\"><div class=\"uagb-ifb-content\"><div class=\"uagb-ifb-icon-wrap\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M0 256C0 114.6 114.6 0 256 0C397.4 0 512 114.6 512 256C512 397.4 397.4 512 256 512C114.6 512 0 397.4 0 256zM371.8 211.8C382.7 200.9 382.7 183.1 371.8 172.2C360.9 161.3 343.1 161.3 332.2 172.2L224 280.4L179.8 236.2C168.9 225.3 151.1 225.3 140.2 236.2C129.3 247.1 129.3 264.9 140.2 275.8L204.2 339.8C215.1 350.7 232.9 350.7 243.8 339.8L371.8 211.8z\"><\/path><\/svg><\/div><div class=\"uagb-ifb-title-wrap\"><h3 class=\"uagb-ifb-title\"><div class=\"uagb-ifb-title-wrap\" style=\"color: rgb(51, 65, 85); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-pan-x: ; --tw-pan-y: ; --tw-pinch-zoom: ; --tw-scroll-snap-strictness: proximity; --tw-gradient-from-position: ; --tw-gradient-via-position: ; --tw-gradient-to-position: ; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 \/ 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ; --tw-saturate: ; --tw-sepia: ; --tw-drop-shadow: ; --tw-backdrop-blur: ; --tw-backdrop-brightness: ; --tw-backdrop-contrast: ; --tw-backdrop-grayscale: ; --tw-backdrop-hue-rotate: ; --tw-backdrop-invert: ; --tw-backdrop-opacity: ; --tw-backdrop-saturate: ; --tw-backdrop-sepia: ; --tw-contain-size: ; --tw-contain-layout: ; --tw-contain-paint: ; --tw-contain-style: ; width: 525.294128px; caret-color: rgb(51, 65, 85); font-size: 16px; white-space: normal;\"><span role=\"textbox\" aria-multiline=\"true\" aria-label=\"Write a Title\" aria-readonly=\"false\" class=\"block-editor-rich-text__editable uagb-ifb-title rich-text\" data-wp-block-attribute-key=\"288\" style=\"color: rgb(30, 41, 59); margin-right: revert; margin-left: revert; --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-pan-x: ; --tw-pan-y: ; --tw-pinch-zoom: ; --tw-scroll-snap-strictness: proximity; --tw-gradient-from-position: ; --tw-gradient-via-position: ; --tw-gradient-to-position: ; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 \/ 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ; --tw-saturate: ; --tw-sepia: ; --tw-drop-shadow: ; --tw-backdrop-blur: ; --tw-backdrop-brightness: ; --tw-backdrop-contrast: ; --tw-backdrop-grayscale: ; --tw-backdrop-hue-rotate: ; --tw-backdrop-invert: ; --tw-backdrop-opacity: ; --tw-backdrop-saturate: ; --tw-backdrop-sepia: ; --tw-contain-size: ; --tw-contain-layout: ; --tw-contain-paint: ; --tw-contain-style: ; display: block; font-size: 1.5rem; line-height: 1.3em; white-space: pre-wrap; min-width: 1px;\">Summit Your Application<\/span><\/div><p role=\"textbox\" aria-multiline=\"true\" aria-label=\"Write a Description\" aria-readonly=\"false\" class=\"block-editor-rich-text__editable uagb-ifb-desc rich-text\" data-wp-block-attribute-key=\"289\" style=\"color: rgb(51, 65, 85); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-pan-x: ; --tw-pan-y: ; --tw-pinch-zoom: ; --tw-scroll-snap-strictness: proximity; --tw-gradient-from-position: ; --tw-gradient-via-position: ; --tw-gradient-to-position: ; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246 \/ 0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ; --tw-saturate: ; --tw-sepia: ; --tw-drop-shadow: ; --tw-backdrop-blur: ; --tw-backdrop-brightness: ; --tw-backdrop-contrast: ; --tw-backdrop-grayscale: ; --tw-backdrop-hue-rotate: ; --tw-backdrop-invert: ; --tw-backdrop-opacity: ; --tw-backdrop-saturate: ; --tw-backdrop-sepia: ; --tw-contain-size: ; --tw-contain-layout: ; --tw-contain-paint: ; --tw-contain-style: ; font-size: 16px; caret-color: rgb(51, 65, 85); min-width: 1px;\">Full fill the form below to get our contact to activate your professional membership!<\/p><\/h3><\/div><p class=\"uagb-ifb-desc\">Click here to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis pulvinar dapibus.<\/p><div class=\"uagb-ifb-button-wrapper wp-block-button\"><a href=\"#\" class=\"uagb-infobox-cta-link wp-block-button__link\" target=\"_self\" rel=\"noopener noreferrer\" onclick=\"return false;\"><span class=\"uagb-inline-editing\">Call To Action<\/span><\/a><\/div><\/div><\/div>\n\n<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-be4b74a7-234b-4273-bbcc-20cc7cb11efb wpforms-render-modern\" id=\"wpforms-312\"><form id=\"wpforms-form-312\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"312\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F16\" data-token=\"f9e60745655a9dba879d96637156f475\" data-token-time=\"1776417590\"><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-312-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-312-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-312-field_1-error\" required><label for=\"wpforms-312-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-312-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-312-field_1-last-error\" required><label for=\"wpforms-312-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-312-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_3\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-312-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" aria-errormessage=\"wpforms-312-field_3-error\" required><\/div><div id=\"wpforms-312-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_28\">Telephone Number<\/label><input type=\"text\" id=\"wpforms-312-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-312-field_28-error\" ><\/div><div id=\"wpforms-312-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-312-field_32\">Your Professional Position<\/label><select id=\"wpforms-312-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\"><option value=\"Physician\/Professor\"  class=\"choice-1 depth-1\"  >Physician\/Professor<\/option><option value=\"President\/Director\/Supervisor\"  class=\"choice-2 depth-1\"  >President\/Director\/Supervisor<\/option><option value=\"Manager\/Coordinator\"  class=\"choice-7 depth-1\"  >Manager\/Coordinator<\/option><option value=\"Embryologist\/Technician\"  class=\"choice-5 depth-1\"  >Embryologist\/Technician<\/option><option value=\"NP\/Nurse\/Navigator\"  class=\"choice-6 depth-1\"  >NP\/Nurse\/Navigator<\/option><option value=\"Other staff\"  class=\"choice-8 depth-1\"  >Other staff<\/option><\/select><div id=\"wpforms-312-field_32-description\" class=\"wpforms-field-description\">Positive Negative Unknown\r\n<\/div><\/div><div id=\"wpforms-312-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_9\">Name of Your Organization<\/label><input type=\"text\" id=\"wpforms-312-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-312-field_9-error\" ><\/div><div id=\"wpforms-312-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_54\">Street Address<\/label><input type=\"text\" id=\"wpforms-312-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-312-field_54-error\" ><\/div><div id=\"wpforms-312-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_55\">City<\/label><input type=\"text\" id=\"wpforms-312-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-312-field_55-error\" ><\/div><div id=\"wpforms-312-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-312-field_58\">State<\/label><select id=\"wpforms-312-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-312-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-312-field_56-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_56\">Zip Code<\/label><input type=\"text\" id=\"wpforms-312-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-312-field_56-error\" ><\/div><div id=\"wpforms-312-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-312-field_59\">Country: United State<\/label><select id=\"wpforms-312-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-312-field_57-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-312-field_57\">Other Country<\/label><input type=\"text\" id=\"wpforms-312-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-312-field_57-error\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"312\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-312\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eggalliance.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><button class=\"uagb-modal-popup-close\" aria-label=\"Close Modal\"><svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 320 512\"><path d=\"M310.6 361.4c12.5 12.5 12.5 32.75 0 45.25C304.4 412.9 296.2 416 288 416s-16.38-3.125-22.62-9.375L160 301.3L54.63 406.6C48.38 412.9 40.19 416 32 416S15.63 412.9 9.375 406.6c-12.5-12.5-12.5-32.75 0-45.25l105.4-105.4L9.375 150.6c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L160 210.8l105.4-105.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-105.4 105.4L310.6 361.4z\"><\/path><\/svg><\/button><\/div><\/div><\/div>\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\"><div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/eggalliance.com\/?page_id=483\">Other Language Forms <\/a><\/div><\/div><\/div><\/div><p>[pmpro_checkout]<\/p>","protected":false},"excerpt":{"rendered":"<p>Submit your application to activate your membership before check out! [pmpro_checkout]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"pmpro_default_level":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"aioseo_notices":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16"}],"collection":[{"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/eggalliance.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16"}],"version-history":[{"count":13,"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16\/revisions"}],"predecessor-version":[{"id":491,"href":"https:\/\/eggalliance.com\/index.php?rest_route=\/wp\/v2\/pages\/16\/revisions\/491"}],"wp:attachment":[{"href":"https:\/\/eggalliance.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}