{"id":430,"date":"2023-05-31T01:01:23","date_gmt":"2023-05-31T01:01:23","guid":{"rendered":"http:\/\/appaphatespeech.org\/report\/"},"modified":"2023-06-27T06:10:21","modified_gmt":"2023-06-27T06:10:21","slug":"report","status":"publish","type":"page","link":"http:\/\/appaphatespeech.org\/mya\/report\/","title":{"rendered":"\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1016\u103c\u1005\u103a\u101b\u1015\u103a \u1005\u102f\u1006\u1031\u102c\u1004\u103a\u1038\u1019\u103e\u102f\u1015\u102f\u1036\u1005\u1036"},"content":{"rendered":"<script type=\"text\/javascript\">var 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gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><legend class='gfield_label gform-field-label'  >\u1041\u104b \u101e\u1004\u103a\u101e\u100a\u103a \u1019\u100a\u103a\u101e\u100a\u103a\u1037\u200c\u200c\u1014\u1031\u101b\u102c\u1010\u103d\u1004\u103a \u1014\u1031\u1011\u102d\u102f\u1004\u103a\u1014\u1031\u1015\u102b\u101e\u101c\u1032\u104b<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_8'>\n\t\t\t<div class='gchoice gchoice_2_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='\u1019\u103c\u1014\u103a\u1019\u102c\u1014\u102d\u102f\u1004\u103a\u1004\u1036'  id='choice_2_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>\u1019\u103c\u1014\u103a\u1019\u102c\u1014\u102d\u102f\u1004\u103a\u1004\u1036<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036'  id='choice_2_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036'  id='choice_2_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_2' id='label_2_8_2' class='gform-field-label gform-field-label--type-inline'>\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='\u1019\u103c\u1014\u103a\u1019\u102c\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u104a \u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u104a (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036 \u1019\u101f\u102f\u1010\u103a\u101e\u100a\u1037\u103a\u1014\u1031\u101b\u102c'  id='choice_2_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_3' id='label_2_8_3' class='gform-field-label gform-field-label--type-inline'>\u1019\u103c\u1014\u103a\u1019\u102c\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u104a 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gform-field-label--type-inline'>\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1021\u1010\u103d\u1004\u103a\u1038\u1010\u103d\u1004\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_174_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_174' type='radio' value='\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1015\u103c\u1004\u103a\u1015\u1010\u103d\u1004\u103a'  id='choice_2_174_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_174_1' id='label_2_174_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1015\u103c\u1004\u103a\u1015\u1010\u103d\u1004\u103a<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_175\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_175\"><legend class='gfield_label gform-field-label'  >\u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1019\u100a\u103a\u101e\u100a\u103a\u1037\u200c\u200c\u1014\u1031\u101b\u102c\u1010\u103d\u1004\u103a \u1016\u103c\u1005\u103a\u1015\u103d\u102c\u1038\u1001\u1032\u1037\u101e\u1014\u100a\u103a\u1038\u104b<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_175'>\n\t\t\t<div class='gchoice gchoice_2_175_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1021\u1010\u103d\u1004\u103a\u1038\u1010\u103d\u1004\u103a'  id='choice_2_175_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_175_0' id='label_2_175_0' class='gform-field-label gform-field-label--type-inline'>\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1021\u1010\u103d\u1004\u103a\u1038\u1010\u103d\u1004\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_175_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_175' type='radio' value='\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1015\u103c\u1004\u103a\u1015\u1010\u103d\u1004\u103a'  id='choice_2_175_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_175_1' id='label_2_175_1' class='gform-field-label gform-field-label--type-inline'>\u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u1015\u103c\u1004\u103a\u1015\u1010\u103d\u1004\u103a<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_177\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_177\"><legend class='gfield_label gform-field-label'  >2.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_177'>\n\t\t\t<div class='gchoice gchoice_2_177_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_177' type='radio' value='\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u101c\u102d\u102f\u1037 \u101a\u102f\u1036\u1000\u103c\u100a\u103a\u101b\u1010\u1032\u1037 \u1010\u1001\u102f\u1001\u102f\u1000\u102d\u102f \u1021\u103d\u1014\u103a\u101c\u102d\u102f\u1004\u103a\u1038\u1019\u103e\u102c \u1010\u103d\u1031\u1037\u101c\u102d\u102f\u1000\u103a\u1010\u101a\u103a\u104b'  id='choice_2_177_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_177_0' id='label_2_177_0' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u101c\u102d\u102f\u1037 \u101a\u102f\u1036\u1000\u103c\u100a\u103a\u101b\u1010\u1032\u1037 \u1010\u1001\u102f\u1001\u102f\u1000\u102d\u102f \u1021\u103d\u1014\u103a\u101c\u102d\u102f\u1004\u103a\u1038\u1019\u103e\u102c \u1010\u103d\u1031\u1037\u101c\u102d\u102f\u1000\u103a\u1010\u101a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_177_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_177' type='radio' value='\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u101c\u102d\u102f\u1037 \u101a\u102f\u1036\u1000\u103c\u100a\u103a\u101b\u1010\u1032\u1037 \u1010\u1001\u102f\u1001\u102f\u1000\u102d\u102f \u1021\u1015\u103c\u1004\u103a\u1019\u103e\u102c \u1000\u102d\u102f\u101a\u103a\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102f\u1036\u101c\u102d\u102f\u1000\u103a\u1010\u101a\u103a\u104b'  id='choice_2_177_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_177_1' id='label_2_177_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u101c\u102d\u102f\u1037 \u101a\u102f\u1036\u1000\u103c\u100a\u103a\u101b\u1010\u1032\u1037 \u1010\u1001\u102f\u1001\u102f\u1000\u102d\u102f \u1021\u1015\u103c\u1004\u103a\u1019\u103e\u102c \u1000\u102d\u102f\u101a\u103a\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102f\u1036\u101c\u102d\u102f\u1000\u103a\u1010\u101a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_176\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_176\"><legend class='gfield_label gform-field-label'  >\u101e\u1004\u103a\u101e\u100a\u103a \u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1000\u102d\u102f \u1021\u103d\u1014\u103a\u101c\u102d\u102f\u1004\u103a\u1038\u1019\u103e\u102c \u1010\u103d\u1031\u1037\u101c\u102d\u102f\u1000\u103a\u101e\u100a\u103a\u101f\u102f \u1016\u1031\u102c\u103a\u1015\u103c\u1011\u102c\u1038\u101e\u100a\u103a\u104b \u1021\u1006\u102d\u102f\u1015\u102b \u1021\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b\u102c\u101e\u100a\u103a \u1019\u100a\u103a\u101e\u100a\u1037\u103a \u1006\u102d\u102f\u101b\u103e\u101a\u103a\u1019\u102e\u1012\u102e\u101a\u102c\u1000\u102d\u102f \u1021\u101e\u102f\u1036\u1038\u1015\u103c\u102f\u1011\u102c\u1038\u1015\u102b\u101e\u1014\u100a\u103a\u1038\u104b <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_176'>\n\t\t\t<div class='gchoice gchoice_2_176_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Facebook'  id='choice_2_176_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_0' id='label_2_176_0' class='gform-field-label gform-field-label--type-inline'>Facebook<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Twitter'  id='choice_2_176_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_1' id='label_2_176_1' class='gform-field-label gform-field-label--type-inline'>Twitter<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='WhatsApp'  id='choice_2_176_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_2' id='label_2_176_2' class='gform-field-label gform-field-label--type-inline'>WhatsApp<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='YouTube'  id='choice_2_176_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_3' id='label_2_176_3' class='gform-field-label gform-field-label--type-inline'>YouTube<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Tik Tok'  id='choice_2_176_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_4' id='label_2_176_4' class='gform-field-label gform-field-label--type-inline'>Tik Tok<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Snap Chat'  id='choice_2_176_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_5' id='label_2_176_5' class='gform-field-label gform-field-label--type-inline'>Snap Chat<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='Instagram'  id='choice_2_176_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_6' id='label_2_176_6' class='gform-field-label gform-field-label--type-inline'>Instagram<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_176_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_176' type='radio' value='gf_other_choice'  id='choice_2_176_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_176_7' id='label_2_176_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_176_other' class='gchoice_other_control' name='input_176_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_169\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_169\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1043\u104b \u1021\u1006\u102d\u102f\u1015\u102b \u1015\u103c\u1031\u102c\u1006\u102d\u102f\u1019\u103e\u102f\u101e\u100a\u103a \u101c\u1030\u1010\u1005\u103a\u1025\u102e\u1038\u1010\u1005\u103a\u101a\u1031\u102c\u1000\u103a (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u101c\u1030\u1021\u102f\u1015\u103a\u1005\u102f\u1021\u1015\u1031\u102b\u103a \u1021\u1031\u102c\u1000\u103a\u1015\u102b\u1021\u1001\u103c\u1031\u1001\u1036\u1021\u1001\u103b\u1000\u103a\u1019\u103b\u102c\u1038\u1015\u1031\u102b\u103a\u1010\u103d\u1004\u103a\u1019\u1030\u1010\u100a\u103a\u104d \u1015\u1005\u103a\u1019\u103e\u1010\u103a\u1011\u102c\u1038\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_169'><div class='gchoice gchoice_2_169_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.1' type='checkbox'  value='\u101c\u1030\u1019\u103b\u102d\u102f\u1038\/\u1010\u102d\u102f\u1004\u103a\u1038\u101b\u1004\u103a\u1038\u101e\u102c\u1038\u1016\u103c\u1005\u103a\u1019\u103e\u102f'  id='choice_2_169_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_1' id='label_2_169_1' class='gform-field-label gform-field-label--type-inline'>\u101c\u1030\u1019\u103b\u102d\u102f\u1038\/\u1010\u102d\u102f\u1004\u103a\u1038\u101b\u1004\u103a\u1038\u101e\u102c\u1038\u1016\u103c\u1005\u103a\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.2' type='checkbox'  value='\u1000\u102d\u102f\u1038\u1000\u103d\u101a\u103a\u1019\u103e\u102f'  id='choice_2_169_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_2' id='label_2_169_2' class='gform-field-label gform-field-label--type-inline'>\u1000\u102d\u102f\u1038\u1000\u103d\u101a\u103a\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.3' type='checkbox'  value='\u1000\u103b\u102c\u1038\u1019\u1016\u103c\u1005\u103a\u1010\u100a\u103a\u1019\u103e\u102f'  id='choice_2_169_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_3' id='label_2_169_3' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u102c\u1038\u1019\u1016\u103c\u1005\u103a\u1010\u100a\u103a\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.4' type='checkbox'  value='\u101c\u102d\u1004\u103a\u1005\u102d\u1010\u103a\u1010\u102d\u1019\u103a\u1038\u100a\u103d\u1010\u103a\u1019\u103e\u102f'  id='choice_2_169_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_4' id='label_2_169_4' class='gform-field-label gform-field-label--type-inline'>\u101c\u102d\u1004\u103a\u1005\u102d\u1010\u103a\u1010\u102d\u1019\u103a\u1038\u100a\u103d\u1010\u103a\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.5' type='checkbox'  value='\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u101b\u1031\u1038\u1014\u103e\u102e\u1038\u1014\u103d\u101a\u103a\u1019\u103e\u102f'  id='choice_2_169_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_5' id='label_2_169_5' class='gform-field-label gform-field-label--type-inline'>\u1014\u102d\u102f\u1004\u103a\u1004\u1036\u101b\u1031\u1038\u1014\u103e\u102e\u1038\u1014\u103d\u101a\u103a\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.6' type='checkbox'  value='\u1019\u101e\u1014\u103a\u1005\u103d\u1019\u103a\u1038\u1019\u103e\u102f'  id='choice_2_169_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_6' id='label_2_169_6' class='gform-field-label gform-field-label--type-inline'>\u1019\u101e\u1014\u103a\u1005\u103d\u1019\u103a\u1038\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.7' type='checkbox'  value='\u1021\u101e\u102c\u1038\u1021\u101b\u1031\u102c\u1004\u103a'  id='choice_2_169_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_7' id='label_2_169_7' class='gform-field-label gform-field-label--type-inline'>\u1021\u101e\u102c\u1038\u1021\u101b\u1031\u102c\u1004\u103a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.8' type='checkbox'  value='\u101c\u1030\u1010\u1014\u103a\u1038\u1005\u102c\u1038\u1001\u103d\u1032\u1001\u103c\u102c\u1038\u1019\u103e\u102f'  id='choice_2_169_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_8' id='label_2_169_8' class='gform-field-label gform-field-label--type-inline'>\u101c\u1030\u1010\u1014\u103a\u1038\u1005\u102c\u1038\u1001\u103d\u1032\u1001\u103c\u102c\u1038\u1019\u103e\u102f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.9' type='checkbox'  value='\u101b\u103d\u103e\u1031\u1037\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u1014\u1031\u1011\u102d\u102f\u1004\u103a\u1019\u103e\u102f\u1021\u1001\u103c\u1031\u1021\u1014\u1031'  id='choice_2_169_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_9' id='label_2_169_9' class='gform-field-label gform-field-label--type-inline'>\u101b\u103d\u103e\u1031\u1037\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u1014\u1031\u1011\u102d\u102f\u1004\u103a\u1019\u103e\u102f\u1021\u1001\u103c\u1031\u1021\u1014\u1031<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_169_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_169.11' type='checkbox'  value='\u1021\u1001\u103c\u102c\u1038'  id='choice_2_169_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_169_11' id='label_2_169_11' class='gform-field-label gform-field-label--type-inline'>\u1021\u1001\u103c\u102c\u1038<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_168\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_168\"><label class='gfield_label gform-field-label' for='input_2_168' >\u1021\u1001\u103c\u102c\u1038<\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_2_168' type='text' value='' class='large'  aria-describedby=\"gfield_description_2_168\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_2_168'>\u1021\u1006\u102d\u102f\u1015\u102b \u1015\u103c\u1031\u102c\u1006\u102d\u102f\u1019\u103e\u102f\u101e\u100a\u103a \u1021\u1011\u1000\u103a\u1010\u103d\u1004\u103a \u1016\u1031\u102c\u103a\u1015\u103c\u1011\u102c\u1038\u101e\u1031\u102c \u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1019\u103e\u102f\u1019\u103b\u102c\u1038\u1010\u103d\u1004\u103a \u1019\u1015\u102b\u101c\u103b\u103e\u1004\u103a \u1019\u100a\u103a\u101e\u100a\u103a\u1016\u103c\u1005\u103a\u101e\u1014\u100a\u103a\u1038\u104b \u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u101e\u100a\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f \u1016\u1031\u102c\u103a\u1015\u103c\u1015\u102b\u104b  <\/div><\/div><fieldset id=\"field_2_32\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_32\"><legend class='gfield_label gform-field-label'  >\u1044\u104b \u101e\u1004\u1037\u103a\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1019\u100a\u103a\u101e\u102d\u102f\u1037\u101e\u1031\u102c \u101e\u1000\u103a\u101e\u1031\u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f \u1015\u1031\u1038\u1015\u102d\u102f\u1037\u1014\u102d\u102f\u1004\u103a\u1019\u100a\u103a\u1014\u100a\u103a\u1038\u104b (\u1021\u1000\u101a\u103a\u104d \u101c\u102d\u102f\u1021\u1015\u103a\u1015\u102b\u1000 \u1014\u1031\u102c\u1000\u103a\u1015\u102d\u102f\u1004\u103a\u1038\u1010\u103d\u1004\u103a \u1015\u1031\u1038\u1015\u102d\u102f\u1037\u1014\u102d\u102f\u1004\u103a\u101e\u100a\u103a\u104b) <\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_32'>\n\t\t\t<div class='gchoice gchoice_2_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Screen shot \/ \u1013\u102c\u1010\u103a\u1015\u102f\u1036'  id='choice_2_32_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_2_32\"   \/>\n\t\t\t\t\t<label for='choice_2_32_0' id='label_2_32_0' class='gform-field-label gform-field-label--type-inline'>Screen shot \/ \u1013\u102c\u1010\u103a\u1015\u102f\u1036<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='\u1021\u101e\u1036\u101e\u103d\u1004\u103a\u1038\u1011\u102c\u1038\u101e\u100a\u1037\u103a\u1016\u102d\u102f\u1004\u103a'  id='choice_2_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_1' id='label_2_32_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u101e\u1036\u101e\u103d\u1004\u103a\u1038\u1011\u102c\u1038\u101e\u100a\u1037\u103a\u1016\u102d\u102f\u1004\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='\u101b\u1031\u1038\u1019\u103e\u1010\u103a\u1011\u102c\u1038\u101e\u1031\u102c \u1011\u103d\u1000\u103a\u1006\u102d\u102f\u1001\u103b\u1000\u103a'  id='choice_2_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_2' id='label_2_32_2' class='gform-field-label gform-field-label--type-inline'>\u101b\u1031\u1038\u1019\u103e\u1010\u103a\u1011\u102c\u1038\u101e\u1031\u102c \u1011\u103d\u1000\u103a\u1006\u102d\u102f\u1001\u103b\u1000\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='\u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u1005\u102c\u1019\u103b\u102c\u1038'  id='choice_2_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_3' id='label_2_32_3' class='gform-field-label gform-field-label--type-inline'>\u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u1005\u102c\u1019\u103b\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='\u1014\u103e\u102f\u1010\u103a\u1011\u103d\u1000\u103a\u1005\u1000\u102c\u1038'  id='choice_2_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_4' id='label_2_32_4' class='gform-field-label gform-field-label--type-inline'>\u1014\u103e\u102f\u1010\u103a\u1011\u103d\u1000\u103a\u1005\u1000\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='\u1021\u1001\u103c\u102c\u1038\u104b'  id='choice_2_32_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_5' id='label_2_32_5' class='gform-field-label gform-field-label--type-inline'>\u1021\u1001\u103c\u102c\u1038\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_2_32'>\u1021\u1000\u101a\u103a\u104d \u1021\u1011\u1000\u103a\u1015\u102b\u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1019\u103e\u102f\u1019\u103b\u102c\u1038\u1014\u103e\u1004\u103a\u1037 \u1019\u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u1015\u102b\u1000 \u2018\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037\u2019 (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) 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type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_148' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_148' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_3_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_2_33\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_33\"><legend class='gfield_label gform-field-label'  >\u1045\u104b \u101a\u1001\u102f\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1010\u103d\u1004\u103a \u101e\u1004\u103a\u104f \u1021\u1001\u1014\u103a\u1038\u1000\u100f\u1039\u100d\u1019\u103e\u102c \u1019\u100a\u103a\u101e\u100a\u103a\u1014\u100a\u103a\u1038\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_33'>\n\t\t\t<div class='gchoice gchoice_2_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u1001\u1036\u101b\u101e\u1030'  id='choice_2_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_33_0' id='label_2_33_0' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u1001\u1036\u101b\u101e\u1030<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='\u1019\u103b\u1000\u103a\u1019\u103c\u1004\u103a\u101e\u1000\u103a\u101e\u1031'  id='choice_2_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_33_1' id='label_2_33_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u103b\u1000\u103a\u1019\u103c\u1004\u103a\u101e\u1000\u103a\u101e\u1031<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_166\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_166\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1046\u104b \u101e\u1004\u1037\u103a\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1019\u100a\u103a\u101e\u102d\u102f\u1037\u101e\u1031\u102c \u101b\u101c\u102c\u1012\u103a\u1019\u103b\u102d\u102f\u1038\u1000\u102d\u102f \u1019\u103b\u103e\u1031\u102c\u103a\u101c\u1004\u1037\u103a\u1015\u102b\u101e\u101c\u1032\u104b<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_166'><div class='gchoice gchoice_2_166_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.1' type='checkbox'  value='\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1014\u103e\u1004\u1037\u103a \u1001\u103d\u1032\u1001\u103c\u102c\u1038\u1006\u1000\u103a\u1006\u1036\u1019\u103e\u102f \u1021\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1000\u102d\u102f \u1015\u102d\u102f\u1019\u102d\u102f\u1014\u102c\u1038\u101c\u100a\u103a\u101e\u1018\u1031\u102c\u1015\u1031\u102b\u1000\u103a\u101c\u102c\u101b\u1014\u103a\u104b'  id='choice_2_166_1'   aria-describedby=\"gfield_description_2_166\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_1' id='label_2_166_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1014\u103e\u1004\u1037\u103a \u1001\u103d\u1032\u1001\u103c\u102c\u1038\u1006\u1000\u103a\u1006\u1036\u1019\u103e\u102f \u1021\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1000\u102d\u102f \u1015\u102d\u102f\u1019\u102d\u102f\u1014\u102c\u1038\u101c\u100a\u103a\u101e\u1018\u1031\u102c\u1015\u1031\u102b\u1000\u103a\u101c\u102c\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.2' type='checkbox'  value='\u1019\u100a\u103a\u101e\u102d\u102f\u1037\u101e\u1031\u102c \u1010\u101b\u102c\u1038\u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1021\u101b\u1031\u1038\u101a\u1030\u101b\u1019\u100a\u103a\u1000\u102d\u102f \u1015\u102d\u102f\u1019\u102d\u102f\u1014\u102c\u1038\u101c\u100a\u103a\u101e\u1018\u1031\u102c\u1015\u1031\u102b\u1000\u103a\u101c\u102c\u101b\u1014\u103a\u104b'  id='choice_2_166_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_2' id='label_2_166_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u100a\u103a\u101e\u102d\u102f\u1037\u101e\u1031\u102c \u1010\u101b\u102c\u1038\u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1021\u101b\u1031\u1038\u101a\u1030\u101b\u1019\u100a\u103a\u1000\u102d\u102f \u1015\u102d\u102f\u1019\u102d\u102f\u1014\u102c\u1038\u101c\u100a\u103a\u101e\u1018\u1031\u102c\u1015\u1031\u102b\u1000\u103a\u101c\u102c\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.3' type='checkbox'  value='\u1015\u103c\u1031\u102c\u1006\u102d\u102f\u101e\u1030\u1014\u103e\u1004\u1037\u103a \u1015\u100b\u102d\u1015\u1000\u1039\u1001\u1006\u103d\u1031\u1038\u1014\u103d\u1031\u1038\u1016\u103c\u1031\u101b\u103e\u1004\u103a\u1038\u1001\u103c\u1004\u103a\u1038\u1014\u100a\u103a\u1038 \u1016\u103c\u1004\u1037\u103a \u1006\u103d\u1031\u1038\u1014\u103d\u1031\u1038\u101b\u1014\u103a\u104b'  id='choice_2_166_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_3' id='label_2_166_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1031\u102c\u1006\u102d\u102f\u101e\u1030\u1014\u103e\u1004\u1037\u103a \u1015\u100b\u102d\u1015\u1000\u1039\u1001\u1006\u103d\u1031\u1038\u1014\u103d\u1031\u1038\u1016\u103c\u1031\u101b\u103e\u1004\u103a\u1038\u1001\u103c\u1004\u103a\u1038\u1014\u100a\u103a\u1038 \u1016\u103c\u1004\u1037\u103a \u1006\u103d\u1031\u1038\u1014\u103d\u1031\u1038\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.4' type='checkbox'  value='\u1016\u103c\u1005\u103a\u1015\u103b\u1000\u103a\u1001\u1032\u1037\u101e\u100a\u103a\u1037 \u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1014\u103e\u1004\u103a\u1037 \u1015\u1010\u103a\u101e\u1000\u103a\u104d \u1021\u101e\u102d\u1015\u100a\u102c\u1010\u102d\u102f\u1038\u1015\u103d\u102c\u1038\u101b\u1014\u103a\u104b'  id='choice_2_166_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_4' id='label_2_166_4' class='gform-field-label gform-field-label--type-inline'>\u1016\u103c\u1005\u103a\u1015\u103b\u1000\u103a\u1001\u1032\u1037\u101e\u100a\u103a\u1037 \u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1014\u103e\u1004\u103a\u1037 \u1015\u1010\u103a\u101e\u1000\u103a\u104d \u1021\u101e\u102d\u1015\u100a\u102c\u1010\u102d\u102f\u1038\u1015\u103d\u102c\u1038\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.5' type='checkbox'  value='\u1014\u1031\u102c\u1004\u103a\u1000\u102c\u101c\u1010\u103d\u1004\u103a \u1016\u103c\u1005\u103a\u1015\u1031\u102b\u103a\u101c\u102c\u1014\u102d\u102f\u1004\u103a\u101e\u100a\u1037\u103a \u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1000\u102d\u102f \u1000\u102c\u1000\u103d\u101a\u103a\u1010\u102c\u1038\u1006\u102e\u1038\u101b\u1014\u103a\u104b'  id='choice_2_166_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_5' id='label_2_166_5' class='gform-field-label gform-field-label--type-inline'>\u1014\u1031\u102c\u1004\u103a\u1000\u102c\u101c\u1010\u103d\u1004\u103a \u1016\u103c\u1005\u103a\u1015\u1031\u102b\u103a\u101c\u102c\u1014\u102d\u102f\u1004\u103a\u101e\u100a\u1037\u103a \u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038\u1000\u102d\u102f \u1000\u102c\u1000\u103d\u101a\u103a\u1010\u102c\u1038\u1006\u102e\u1038\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.6' type='checkbox'  value='\u1024\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u102d\u102f \u1000\u1019\u1039\u1018\u102c\u1037\u1000\u102f\u101c\u101e\u1019\u1002\u1039\u1002\u1011\u1036 \u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u101b\u1014\u103a\u104b'  id='choice_2_166_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_6' id='label_2_166_6' class='gform-field-label gform-field-label--type-inline'>\u1024\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u102d\u102f \u1000\u1019\u1039\u1018\u102c\u1037\u1000\u102f\u101c\u101e\u1019\u1002\u1039\u1002\u1011\u1036 \u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u101b\u1014\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_166_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_166.7' type='checkbox'  value='\u1021\u1001\u103c\u102c\u1038\u104b'  id='choice_2_166_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_166_7' id='label_2_166_7' class='gform-field-label gform-field-label--type-inline'>\u1021\u1001\u103c\u102c\u1038\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_2_166'>\u1021\u1000\u101a\u103a\u104d \u1021\u1011\u1000\u103a\u1015\u102b\u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1019\u103e\u102f\u1019\u103b\u102c\u1038\u1014\u103e\u1004\u103a\u1037 \u1019\u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u1015\u102b\u1000 \u2018\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037\u2019 (\u101e\u102d\u102f\u1037) \u2018\u1021\u1001\u103c\u102c\u1038\u2019 \u1000\u102d\u102f \u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1015\u103c\u102f\u104d \u1014\u103e\u102d\u1015\u103a \u1015\u103c\u102e\u1038 \u1021\u1031\u102c\u1000\u103a\u1010\u103d\u1004\u103a \u1016\u1031\u102c\u103a\u1015\u103c\u1011\u102c\u1038\u101e\u1031\u102c \u1005\u102c\u101b\u1031\u1038\u101b\u1014\u103a \u1014\u1031\u101b\u102c\u1010\u103d\u1004\u103a \u1021\u101e\u1031\u1038\u1005\u102d\u1010\u103a \u1016\u103c\u100a\u1037\u103a\u101e\u103d\u1004\u103a\u1038\u101b\u1031\u1038\u101e\u102c\u1038\u1015\u102b\u104b <\/div><\/fieldset><div id=\"field_2_167\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_167\"><label class='gfield_label gform-field-label' for='input_2_167' >\u1021\u1001\u103c\u102c\u1038\u104b<\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_2_167' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_60\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_60\"><legend class='gfield_label gform-field-label'  >\u1047\u104b \u101e\u1004\u103a\u101e\u100a\u103a \u101b\u1032\u1000\u102d\u102f \u1021\u1014\u1039\u1010\u101b\u102c\u101a\u103a\u1000\u1004\u103a\u1038\u1005\u103d\u102c \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u101e\u101c\u102c\u1038\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_60'>\n\t\t\t<div class='gchoice gchoice_2_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_60_0' id='label_2_60_0' class='gform-field-label gform-field-label--type-inline'>\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u1019\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u104b'  id='choice_2_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_60_1' id='label_2_60_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b'  id='choice_2_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_60_2' id='label_2_60_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_63\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_63\"><legend class='gfield_label gform-field-label'  >\u1048\u104b \u1024\u1021\u101b\u102c\u101e\u100a\u103a \u1021\u1005\u102d\u102f\u1038\u101b\u104f \u1005\u103d\u1000\u103a\u1016\u1000\u103a\u1019\u103e\u102f \u101c\u102d\u102f\u1021\u1015\u103a\u101e\u1031\u102c \u1015\u103c\u103f\u1014\u102c\u1010\u1005\u103a\u1001\u102f \u1016\u103c\u1005\u103a\u1015\u102b\u1000 \u101e\u1004\u103a\u101e\u100a\u103a \u104e\u1004\u103a\u1038\u1010\u102d\u102f\u1037\u1011\u1036 \u1006\u1000\u103a\u101e\u103d\u101a\u103a \u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u101c\u102c\u1038\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_63'>\n\t\t\t<div class='gchoice gchoice_2_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b'  id='choice_2_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_63_0' id='label_2_63_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u101e\u1031\u101b\u1031\u1038\u101b\u103e\u1004\u103a\u101b\u1031\u1038 \u1021\u1001\u103c\u1031\u1021\u1014\u1031\u1016\u103c\u1005\u103a\u1019\u103e\u101e\u102c\u101c\u103b\u103e\u1004\u103a \u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u104b'  id='choice_2_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_63_1' id='label_2_63_1' class='gform-field-label gform-field-label--type-inline'>\u101e\u1031\u101b\u1031\u1038\u101b\u103e\u1004\u103a\u101b\u1031\u1038 \u1021\u1001\u103c\u1031\u1021\u1014\u1031\u1016\u103c\u1005\u103a\u1019\u103e\u101e\u102c\u101c\u103b\u103e\u1004\u103a \u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_63_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u1019\u103e\u102c \u1019\u101e\u1031\u1001\u103b\u102c\u1015\u102b\u104b'  id='choice_2_63_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_63_2' id='label_2_63_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u1019\u103e\u102c \u1019\u101e\u1031\u1001\u103b\u102c\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_63_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u104b'  id='choice_2_63_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_63_3' id='label_2_63_3' class='gform-field-label gform-field-label--type-inline'>\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_222' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_222' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_4_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_220\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_220\"><h3>\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1010\u102d\u102f\u1037\u104f \u1021\u103d\u1014\u103a\u101c\u102d\u102f\u1004\u103a\u1038\u1015\u102f\u1036\u1005\u1036\u1000\u102d\u102f \u1021\u101e\u102f\u1036\u1038\u1015\u103c\u102f\u104d \u1021\u1019\u102f\u1014\u103a\u1038\u1005\u1000\u102c\u1038 \u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u102d\u102f \u101e\u1010\u1004\u103a\u1038\u1015\u102d\u102f\u1037\u101e\u100a\u1037\u103a\u1021\u1010\u103d\u1000\u103a \u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1010\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b<\/h3>\n\u1024\u1015\u102f\u1036\u1005\u1036\u101b\u103e\u102d \u1014\u1031\u102c\u1000\u103a\u1021\u1015\u102d\u102f\u1004\u103a\u1038\u1019\u103b\u102c\u1038\u1019\u103e\u102c \u1005\u102d\u1010\u103a\u1000\u103c\u102d\u102f\u1000\u103a\u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1014\u102d\u102f\u1004\u103a\u1015\u103c\u102e\u1038 \u104e\u1004\u103a\u1038\u1010\u102d\u102f\u1037\u1000\u102d\u102f \u1000\u103b\u1031\u102c\u103a\u104d\u101c\u100a\u103a\u1038 \u101e\u1004\u103a\u1037\u1005\u102d\u1010\u103a\u1000\u103c\u102d\u102f\u1000\u103a \u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1016\u103c\u1031\u1006\u102d\u102f\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b \u101e\u102d\u102f\u1037\u101e\u1031\u102c\u103a\u104a \u101e\u1004\u103a\u101e\u100a\u103a \u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1014\u103e\u1004\u1037\u103a\u1015\u1010\u103a\u101e\u1000\u103a\u101e\u100a\u1037\u103a \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f \u1015\u102d\u102f\u1019\u102d\u102f\u1011\u100a\u103a\u1037\u101e\u103d\u1004\u103a\u1038\u101c\u102d\u102f\u1015\u102b\u1000 \u104e\u1004\u103a\u1038\u1010\u102d\u102f\u1037\u1000\u102d\u102f \u1016\u103c\u100a\u1037\u103a\u1005\u103d\u1000\u103a\u101b\u1014\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1010\u102d\u102f\u1037 \u1021\u1000\u103c\u1036\u1015\u103c\u102f\u101c\u102d\u102f\u1015\u102b\u101e\u100a\u103a\u104b <\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_75' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_75' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_5_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_149\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_149\"><h3>\u101e\u1004\u103a\u1037\u1021\u1000\u103c\u1031\u102c\u1004\u103a\u1038<\/h3>\u101e\u1004\u103a\u1037\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1005\u102d\u1010\u103a\u101e\u1000\u103a\u1010\u1031\u102c\u1004\u103a\u1037\u101e\u1000\u103a\u101e\u102c\u1016\u103c\u1005\u103a\u1015\u102b\u1000 \u1000\u102d\u102f\u101a\u103a\u101b\u1031\u1038\u1000\u102d\u102f\u101a\u103a\u1010\u102c\u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1021\u1001\u103b\u102d\u102f\u1037\u1000\u102d\u102f \u1019\u103b\u103e\u101d\u1031\u1015\u1031\u1038\u1015\u102b\u104b (\u1016\u1031\u102c\u103a\u1015\u103c\u1011\u102c\u1038\u101e\u1031\u102c \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f \u1021\u1019\u100a\u103a\u101d\u103e\u1000\u103a\u1011\u102c\u1038\u1019\u100a\u103a\u1016\u103c\u1005\u103a\u1015\u103c\u102e\u1038 \u101c\u102f\u1036\u1001\u103c\u102f\u1036\u1005\u103d\u102c\u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1011\u102c\u1038\u1019\u100a\u103a\u101c\u100a\u103a\u1038\u1016\u103c\u1005\u103a\u101e\u100a\u103a)\u104b<\/div><fieldset id=\"field_2_35\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_35\"><legend class='gfield_label gform-field-label'  >\u1049\u104b \u1000\u103b\u102c\u1038\u1019\u1016\u103c\u1005\u103a\u1010\u100a\u103a\u1019\u103e\u102f\u1019\u103e\u102c<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_35'>\n\t\t\t<div class='gchoice gchoice_2_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038'  id='choice_2_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_0' id='label_2_35_0' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038'  id='choice_2_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_1' id='label_2_35_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='\u1021\u1001\u103c\u102c\u1038\u104b'  id='choice_2_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_2' id='label_2_35_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1001\u103c\u102c\u1038\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_223\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_223\"><label class='gfield_label gform-field-label' for='input_2_223' >\u1049.\u1041\u104b \u1021\u101e\u1000\u103a\u1019\u103e\u102c<\/label><div class='ginput_container ginput_container_select'><select name='input_223' id='input_2_223' class='large gfield_select'     aria-invalid=\"false\" ><option value='\u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1015\u103c\u102f\u104d \u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1015\u102b\u104b' >\u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1015\u103c\u102f\u104d \u101b\u103d\u1031\u1038\u1001\u103b\u101a\u103a\u1015\u102b\u104b<\/option><option value='\u1041\u1042 \u1014\u103e\u1005\u103a\u1019\u103e \u1041\u1047 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1041\u1042 \u1014\u103e\u1005\u103a\u1019\u103e \u1041\u1047 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1041\u1048 \u1014\u103e\u1005\u103a\u1019\u103e \u1042\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1041\u1048 \u1014\u103e\u1005\u103a\u1019\u103e \u1042\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1042\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1043\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1042\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1043\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1043\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1044\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1043\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1044\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1044\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1045\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1044\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1045\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1045\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1046\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b' >\u1045\u1045 \u1014\u103e\u1005\u103a\u1019\u103e \u1046\u1044 \u1014\u103e\u1005\u103a\u1021\u1011\u102d\u104b<\/option><option value='\u1046\u1045 \u1014\u103e\u1005\u103a\u1014\u103e\u1004\u103a\u1037 \u1021\u1011\u1000\u103a\u104b' >\u1046\u1045 \u1014\u103e\u1005\u103a\u1014\u103e\u1004\u103a\u1037 \u1021\u1011\u1000\u103a\u104b<\/option><\/select><\/div><\/div><div id=\"field_2_151\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_151\">\u1021\u1031\u102c\u1000\u103a\u1015\u102b\u1019\u1031\u1038\u1001\u103d\u1014\u103a\u1038\u1019\u103b\u102c\u1038\u1000\u102d\u102f\u1016\u103c\u1031\u1006\u102d\u102f\u101b\u1014\u103a \u101e\u1004\u1037\u103a\u1021\u1016\u103c\u1031\u1000\u102d\u102f \u101b\u102d\u102f\u1038\u101b\u103e\u1004\u103a\u1038\u1005\u103d\u102c\u1016\u103c\u100a\u1037\u103a\u1005\u103d\u1000\u103a\u1015\u102b\u104a (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u1000 &#8216;N\/A&#8217; \u101f\u102f\u101b\u1031\u1038\u101e\u102c\u1038\u1015\u102b\u104b<\/div><div id=\"field_2_43\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_43\"><label class='gfield_label gform-field-label' for='input_2_43' >\u1049.\u1042\u104b \u1010\u102d\u102f\u1004\u103a\u1038\u101b\u1004\u103a\u1038\u101e\u102c\u1038\u1019\u103e\u102c<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_46\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\"><label class='gfield_label gform-field-label' for='input_2_46' >\u1049.\u1043\u104b \u101c\u102d\u1004\u103a\u1005\u102d\u1010\u103a\u1010\u102d\u1019\u103a\u1038\u100a\u103d\u1010\u103a\u1019\u103e\u102f\u101c\u1000\u1039\u1001\u100f\u102c\u1019\u103e\u102c<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_150\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_150\"><label class='gfield_label gform-field-label' for='input_2_150' >\u1049.\u1044\u104b \u1000\u102d\u102f\u1038\u1000\u103d\u101a\u103a\u101a\u102f\u1036\u1000\u103c\u100a\u103a\u1019\u103e\u102f\/\u1018\u102c\u101e\u102c\u1019\u103e\u102c<\/label><div class='ginput_container ginput_container_text'><input name='input_150' id='input_2_150' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_34' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_34' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"6\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"6\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_6_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_154\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_154\"><h3>\u1018\u101a\u103a\u101c\u102d\u102f\u1001\u1036\u1005\u102c\u1038\u101b\u101e\u101c\u1032\u104b <\/h3>\n\u101e\u1004\u103a\u1037\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1005\u102d\u1010\u103a\u101e\u1000\u103a\u1010\u1031\u102c\u1004\u103a\u1037\u101e\u1000\u103a\u101e\u102c\u1016\u103c\u1005\u103a\u1015\u102b\u1000 \u101e\u1004\u103a\u1019\u100a\u103a\u101e\u102d\u102f\u1037\u1019\u100a\u103a\u1015\u102f\u1036 \u1001\u1036\u1005\u102c\u1038\u101b\u101e\u100a\u103a\u1000\u102d\u102f \u1019\u103b\u103e\u101d\u1031\u1015\u1031\u1038\u1015\u102b\u104b<\/div><fieldset id=\"field_2_52\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_52\"><legend class='gfield_label gform-field-label'  >\u1041\u1040\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1021\u102d\u1015\u103a\u1005\u1000\u103a\u1001\u103c\u1004\u103a\u1038\u1000\u102d\u102f \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u101e\u100a\u103a (\u1015\u102d\u102f\u1019\u102d\u102f\u1021\u102d\u1015\u103a\u1005\u1000\u103a\u1001\u103c\u1004\u103a\u1038 (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1021\u102d\u1015\u103a\u1001\u103b\u102d\u1014\u103a\u101c\u103b\u1031\u102c\u1037\u1014\u100a\u103a\u1038\u1001\u103c\u1004\u103a\u1038)<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_52'>\n\t\t\t<div class='gchoice gchoice_2_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='\u101c\u102f\u1036\u1038\u101d\u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u1019\u101b\u103e\u102d\u1015\u102b\u104b'  id='choice_2_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_0' id='label_2_52_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u101d\u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u1019\u101b\u103e\u102d\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_1' id='label_2_52_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_52_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_2' id='label_2_52_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_52_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_52_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_3' id='label_2_52_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_53\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_53\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1041\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1005\u102c\u1038\u101e\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u1021\u101c\u1031\u1037\u1021\u1011\u1000 \u1021\u1015\u1031\u102b\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u101e\u100a\u103a\u104b (\u1015\u102d\u102f\u1019\u102d\u102f\u1005\u102c\u1038\u101e\u102f\u1036\u1038\u1001\u103c\u1004\u103a\u1038 (\u101e\u102d\u102f\u1037) \u1005\u102c\u1038\u101e\u102f\u1036\u1038\u1019\u103e\u102f\u101c\u103b\u1031\u102c\u1037\u1014\u100a\u103a\u1038\u1001\u103c\u1004\u103a\u1038)<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_53'>\n\t\t\t<div class='gchoice gchoice_2_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='\u101c\u102f\u1036\u1038\u101d\u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u1019\u101b\u103e\u102d\u1015\u102b\u104b'  id='choice_2_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_0' id='label_2_53_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u101d\u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u1019\u101b\u103e\u102d\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_1' id='label_2_53_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_53_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_53_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_2' id='label_2_53_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_53_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_53_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_53_3' id='label_2_53_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_54\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_54\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1042\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1021\u102c\u1038 \u1021\u102d\u1019\u103a\u1015\u103c\u1004\u103a\u1015\u101e\u102d\u102f\u1037 \u1011\u103d\u1000\u103a\u1001\u103d\u102c\u1001\u103c\u1004\u103a\u1038\u1021\u1015\u1031\u102b\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_54'>\n\t\t\t<div class='gchoice gchoice_2_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b'  id='choice_2_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_54_0' id='label_2_54_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_54_1' id='label_2_54_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_54_2' id='label_2_54_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_54_3' id='label_2_54_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_55\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_55\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1043\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1021\u102c\u1038 \u1021\u102d\u1019\u103a\u1010\u103d\u1004\u103a\u1038\u1014\u1031\u1011\u102d\u102f\u1004\u103a\u1005\u1025\u103a \u101c\u102f\u1036\u1001\u103c\u102f\u1036\u1019\u103e\u102f\u1001\u1036\u1005\u102c\u1038\u101b\u1001\u103c\u1004\u103a\u1038\u1021\u1015\u1031\u102b\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_55'>\n\t\t\t<div class='gchoice gchoice_2_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b'  id='choice_2_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_55_0' id='label_2_55_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_55_1' id='label_2_55_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_55_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_55_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_55_2' id='label_2_55_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_55_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_55_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_55_3' id='label_2_55_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_56\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_56\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1044\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1019\u1030\u1038\u101a\u1005\u103a\u1005\u1031\u1010\u1010\u103a\u101e\u1031\u102c\u1021\u101b\u102c\u1019\u103b\u102c\u1038 \u101e\u102f\u1036\u1038\u1005\u103d\u1032\u1019\u103e\u102f\u1021\u1015\u1031\u102b\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_56'>\n\t\t\t<div class='gchoice gchoice_2_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b'  id='choice_2_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_0' id='label_2_56_0' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1038\u1040\u1021\u1000\u1030\u1021\u100a\u102e\u1010\u1031\u102c\u1004\u103a\u1038\u1019\u100a\u103a \u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_1' id='label_2_56_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u100a\u103a\u1038\u1004\u101a\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f \u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_56_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_2' id='label_2_56_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1010\u1014\u103a\u1021\u101e\u1004\u1037\u103a \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_56_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_3' id='label_2_56_3' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1004\u103a\u1038\u1011\u1014\u103a\u1005\u103d\u102c \u101e\u1000\u103a\u101b\u1031\u102c\u1000\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u1019\u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u1015\u102b\u104b'  id='choice_2_56_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_4' id='label_2_56_4' class='gform-field-label gform-field-label--type-inline'>\u1019\u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_57\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_57\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1045\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u103c\u1031\u102c\u1004\u1037\u103a \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u1001\u1036\u101b\u101e\u1030 (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1021\u101e\u102d\u102f\u1004\u103a\u1038\u1021\u1040\u102d\u102f\u1004\u103a\u1038\u104f \u101c\u102f\u1036\u1001\u103c\u102f\u1036\u101b\u1031\u1038\u1014\u103e\u1004\u1037\u103a\u1015\u1010\u103a\u101e\u1000\u103a\u1015\u103c\u102e\u1038 \u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_57'>\n\t\t\t<div class='gchoice gchoice_2_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_57_0' id='label_2_57_0' class='gform-field-label gform-field-label--type-inline'>\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u1019\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u104b'  id='choice_2_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_57_1' id='label_2_57_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_57_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b'  id='choice_2_57_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_57_2' id='label_2_57_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_58\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_58\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1046\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u103c\u1031\u102c\u1004\u1037\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u101e\u100a\u103a \u1021\u103d\u1014\u103a\u101c\u102d\u102f\u1004\u103a\u1038\u101e\u102f\u1036\u1038\u1005\u103d\u1032\u1001\u103c\u1004\u103a\u1038\u1014\u103e\u1004\u1037\u103a \u1015\u1010\u103a\u101e\u1000\u103a\u1015\u103c\u102e\u1038 \u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u1019\u103e\u102f\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_58'>\n\t\t\t<div class='gchoice gchoice_2_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_58_0' id='label_2_58_0' class='gform-field-label gform-field-label--type-inline'>\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u1019\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u104b'  id='choice_2_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_58_1' id='label_2_58_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u101b\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_58_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b'  id='choice_2_58_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_58_2' id='label_2_58_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_59\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_59\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1047\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u103c\u1031\u102c\u1004\u1037\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1014\u1031\u1037\u1005\u1025\u103a\u1018\u101d\u1016\u103c\u1010\u103a\u101e\u1014\u103a\u1038\u1019\u103e\u102f\u1014\u103e\u1004\u1037\u103a \u1015\u1010\u103a\u101e\u1000\u103a\u1015\u103c\u102e\u1038 \u1015\u103c\u1031\u102c\u1004\u103a\u1038\u101c\u1032\u101e\u103d\u102c\u1038\u1015\u102b\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_59'>\n\t\t\t<div class='gchoice gchoice_2_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u101c\u1032\u101e\u103d\u102c\u1038\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_0' id='label_2_59_0' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u101c\u1032\u101e\u103d\u102c\u1038\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u101c\u1032\u1019\u101e\u103d\u102c\u1038\u1015\u102b\u104b'  id='choice_2_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_1' id='label_2_59_1' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1031\u102c\u1004\u103a\u1038\u101c\u1032\u1019\u101e\u103d\u102c\u1038\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_59_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b'  id='choice_2_59_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_2' id='label_2_59_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_61\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_61\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1048\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u103c\u1031\u102c\u1004\u1037\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u101e\u100a\u103a \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u101f\u102f \u101a\u102f\u1036\u1000\u103c\u100a\u103a\u101e\u100a\u1037\u103a \u1021\u1005\u102f\u1021\u1016\u103d\u1032\u1037\u1019\u103e \u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1026\u1038\u1014\u103e\u1004\u103a\u1037 \u1005\u1000\u102c\u1038\u1015\u103c\u1031\u102c\u1001\u103c\u1004\u103a\u1038 (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1010\u103d\u1031\u1037\u1006\u102f\u1036\u1001\u103c\u1004\u103a\u1038\u1000\u102d\u102f \u101b\u103e\u1031\u102c\u1004\u103a\u1000\u103c\u1025\u103a\u1015\u102b\u101e\u100a\u103a\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_61'>\n\t\t\t<div class='gchoice gchoice_2_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u101b\u103e\u1031\u102c\u1004\u103a\u1000\u103c\u1025\u103a\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_61_0' id='label_2_61_0' class='gform-field-label gform-field-label--type-inline'>\u101b\u103e\u1031\u102c\u1004\u103a\u1000\u103c\u1025\u103a\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u1019\u101b\u103e\u1031\u102c\u1004\u103a\u1000\u103c\u1025\u103a\u1015\u102b\u104b'  id='choice_2_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_61_1' id='label_2_61_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u101b\u103e\u1031\u102c\u1004\u103a\u1000\u103c\u1025\u103a\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_61_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b'  id='choice_2_61_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_61_2' id='label_2_61_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u1016\u1031\u102c\u103a\u1015\u103c\u101c\u102d\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_64\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_64\"><legend class='gfield_label gform-field-label'  >\u1041\u1040.\u1049\u104b \u101a\u1001\u102f\u1021\u1016\u103c\u1005\u103a\u1021\u1015\u103b\u1000\u103a\u1000\u103c\u1031\u102c\u1004\u1037\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u101e\u100a\u103a<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_64'>\n\t\t\t<div class='gchoice gchoice_2_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='\u1021\u1006\u1004\u103a\u1015\u103c\u1031\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_64_0' id='label_2_64_0' class='gform-field-label gform-field-label--type-inline'>\u1021\u1006\u1004\u103a\u1015\u103c\u1031\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='\u1005\u102d\u1010\u103a\u1010\u102d\u102f\u1012\u1031\u102b\u101e\u1011\u103d\u1000\u103a\u101b\u101e\u100a\u103a\u104b'  id='choice_2_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_64_1' id='label_2_64_1' class='gform-field-label gform-field-label--type-inline'>\u1005\u102d\u1010\u103a\u1010\u102d\u102f\u1012\u1031\u102b\u101e\u1011\u103d\u1000\u103a\u101b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='\u1005\u102d\u1010\u103a\u1019\u1000\u1031\u102c\u1004\u103a\u1038\u1016\u103c\u1005\u103a\u101e\u100a\u103a\u104b'  id='choice_2_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_64_2' id='label_2_64_2' class='gform-field-label gform-field-label--type-inline'>\u1005\u102d\u1010\u103a\u1019\u1000\u1031\u102c\u1004\u103a\u1038\u1016\u103c\u1005\u103a\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='\u1021\u101c\u103d\u1014\u103a\u1021\u1019\u1004\u103a\u1038\u1005\u102d\u1010\u103a\u1019\u1000\u1031\u102c\u1004\u103a\u1038\u1016\u103c\u1005\u103a\u1015\u103c\u102e\u1038 \u1019\u102d\u1019\u102d\u1000\u102d\u102f\u101a\u103a\u1000\u102d\u102f (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1021\u1001\u103c\u102c\u1038\u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1025\u102e\u1038\u1000\u102d\u102f \u1011\u102d\u1001\u102d\u102f\u1000\u103a\u1014\u102c\u1000\u103b\u1004\u103a\u1019\u103e\u102f\u1016\u103c\u1005\u103a\u1005\u1031\u101e\u100a\u103a\u104b'  id='choice_2_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_64_3' id='label_2_64_3' class='gform-field-label gform-field-label--type-inline'>\u1021\u101c\u103d\u1014\u103a\u1021\u1019\u1004\u103a\u1038\u1005\u102d\u1010\u103a\u1019\u1000\u1031\u102c\u1004\u103a\u1038\u1016\u103c\u1005\u103a\u1015\u103c\u102e\u1038 \u1019\u102d\u1019\u102d\u1000\u102d\u102f\u101a\u103a\u1000\u102d\u102f (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1021\u1001\u103c\u102c\u1038\u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1025\u102e\u1038\u1000\u102d\u102f \u1011\u102d\u1001\u102d\u102f\u1000\u103a\u1014\u102c\u1000\u103b\u1004\u103a\u1019\u103e\u102f\u1016\u103c\u1005\u103a\u1005\u1031\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_159\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_159\"><b>\u101e\u1004\u103a\u101e\u100a\u103a\u1021\u101c\u103d\u1014\u103a\u1021\u1019\u1004\u103a\u1038\u1005\u102d\u1010\u103a\u1019\u1000\u1031\u102c\u1004\u103a\u1038\u1016\u103c\u1005\u103a\u1015\u103c\u102e\u1038 \u1019\u102d\u1019\u102d\u1000\u102d\u102f\u101a\u103a\u1000\u102d\u102f (\u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a) \u1021\u1001\u103c\u102c\u1038\u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1025\u102e\u1038\u1000\u102d\u102f \u1011\u102d\u1001\u102d\u102f\u1000\u103a\u1014\u102c\u1000\u103b\u1004\u103a\u1019\u103e\u102f\u1016\u103c\u1005\u103a\u1005\u1031\u101c\u103b\u103e\u1004\u103a<\/b>\n<ol type=\"1\">\n<li>\u1019\u103c\u1014\u103a\u1019\u102c\u1014\u102d\u102f\u1004\u103a\u1004\u1036- \u1014\u103e\u1005\u103a\u101e\u102d\u1019\u1037\u103a\u1006\u103d\u1031\u1038\u1014\u103d\u1031\u1038\u1019\u103e\u102f\u1000\u102d\u102f\u1006\u1031\u102c\u1004\u103a\u101b\u103d\u1000\u103a\u1015\u1031\u1038\u101e\u100a\u1037\u103a \u201c Call Me Today\u201d \u1000\u102d\u102f \u101b\u102f\u1036\u1038\u1016\u103d\u1004\u1037\u103a\u101b\u1000\u103a (\u1010\u1014\u1004\u103a\u1039\u101c\u102c \u1019\u103e \u101e\u1031\u102c\u1000\u103c\u102c)\u1010\u103d\u1004\u103a \u100a\u1014\u1031 (\u1045)\u1014\u102c\u101b\u102e\u1019\u103e (\u1041\u1041)\u1014\u102c\u101b\u102e\u1021\u1010\u103d\u1004\u103a\u1038 <b>09 782 383 145<\/b> \u101e\u102d\u102f\u1037 \u1006\u1000\u103a\u101e\u103d\u101a\u103a\u1014\u102d\u102f\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b <\/li>\n\n<li>\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036- Beyond Borders emergency \u1016\u102f\u1014\u103a\u1038 \u1014\u103e\u1004\u103a\u1037 WhatsApp hotline &#8211; <b>012 3739419<\/b><\/li>\n\n<li>\u2022 \u1011\u102d\u102f\u1004\u103a\u1038\u1014\u102d\u102f\u1004\u103a\u1004\u1036- Samaritans emergency hotline &#8211; <b>02 713-6793<\/b><\/li><\/ol><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_51' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"7\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"7\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_7_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_7' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_7' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_224\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_224\"><h3>\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u1021\u1000\u103c\u1031\u102c\u1004\u103a\u1038<\/h3><\/div><fieldset id=\"field_2_227\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_227\"><legend class='gfield_label gform-field-label'  >\u1041\u1041\u104b \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u1000\u102d\u102f \u101e\u1004\u103a\u101e\u102d\u1015\u102b\u101e\u101c\u102c\u1038\u104b<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_227'>\n\t\t\t<div class='gchoice gchoice_2_227_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_227' type='radio' value='\u101e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_227_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_227_0' id='label_2_227_0' class='gform-field-label gform-field-label--type-inline'>\u101e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_227_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_227' type='radio' value='\u1019\u101e\u102d\u1015\u102b\u104b'  id='choice_2_227_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_227_1' id='label_2_227_1' class='gform-field-label gform-field-label--type-inline'>\u1019\u101e\u102d\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_228\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_228\"><legend class='gfield_label gform-field-label'  >\u1041\u1041.\u1041\u104b \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u101e\u100a\u103a 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value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038 - \u101c\u1030\u101c\u1010\u103a'  id='choice_2_228_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_228_1' id='label_2_228_1' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038 &#8211; \u101c\u1030\u101c\u1010\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_228_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_228' type='radio' value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038 - \u101c\u1030\u1000\u103c\u102e\u1038'  id='choice_2_228_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_228_2' id='label_2_228_2' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u102c\u1038 &#8211; \u101c\u1030\u1000\u103c\u102e\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_228_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_228' type='radio' value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038 - \u101c\u1030\u1004\u101a\u103a'  id='choice_2_228_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_228_3' id='label_2_228_3' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038 &#8211; \u101c\u1030\u1004\u101a\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_228_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_228' type='radio' value='\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038 - \u101c\u1030\u101c\u1010\u103a'  id='choice_2_228_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_228_4' id='label_2_228_4' class='gform-field-label gform-field-label--type-inline'>\u1021\u1019\u103b\u102d\u102f\u1038\u101e\u1019\u102e\u1038 &#8211; 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class='gchoice gchoice_2_230_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='\u1001\u101b\u102e\u1038\u101e\u103d\u102c\u1038'  id='choice_2_230_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_8' id='label_2_230_8' class='gform-field-label gform-field-label--type-inline'>\u1001\u101b\u102e\u1038\u101e\u103d\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_230_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='\u101c\u102f\u1036\u1001\u103c\u102f\u1036\u101b\u1031\u1038\u1021\u1019\u103e\u102f\u1011\u1019\u103a\u1038'  id='choice_2_230_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_9' id='label_2_230_9' class='gform-field-label gform-field-label--type-inline'>\u101c\u102f\u1036\u1001\u103c\u102f\u1036\u101b\u1031\u1038\u1021\u1019\u103e\u102f\u1011\u1019\u103a\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_230_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='\u101b\u1032\/\u1005\u1005\u103a\u1010\u1015\u103a'  id='choice_2_230_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_10' id='label_2_230_10' class='gform-field-label gform-field-label--type-inline'>\u101b\u1032\/\u1005\u1005\u103a\u1010\u1015\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_230_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='\u101e\u1010\u1004\u103a\u1038\u1005\u102c\u1006\u101b\u102c'  id='choice_2_230_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_11' id='label_2_230_11' class='gform-field-label gform-field-label--type-inline'>\u101e\u1010\u1004\u103a\u1038\u1005\u102c\u1006\u101b\u102c<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_230_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='\u1006\u1000\u103a\u1006\u1036\u101b\u1031\u1038\u1019\u101b\u103e\u102d\u1015\u102b\u104b'  id='choice_2_230_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_12' id='label_2_230_12' class='gform-field-label gform-field-label--type-inline'>\u1006\u1000\u103a\u1006\u1036\u101b\u1031\u1038\u1019\u101b\u103e\u102d\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_230_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='gf_other_choice'  id='choice_2_230_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_230_13' id='label_2_230_13' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_230_other' class='gchoice_other_control' name='input_230_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_229\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_229\"><legend class='gfield_label gform-field-label'  >\u1041\u1041.\u1043\u104b \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u104f \u101c\u1030\u1019\u103b\u102d\u102f\u1038\u1019\u103e\u102c<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_229'>\n\t\t\t<div class='gchoice gchoice_2_229_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u101b\u102d\u102f\u101f\u1004\u103a\u1002\u103b\u102c'  id='choice_2_229_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_0' id='label_2_229_0' class='gform-field-label gform-field-label--type-inline'>\u101b\u102d\u102f\u101f\u1004\u103a\u1002\u103b\u102c<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u1018\u1004\u103a\u1039\u1002\u101c\u102c\u1038\u1012\u1031\u1037\u101b\u103e\u103a'  id='choice_2_229_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_1' id='label_2_229_1' class='gform-field-label gform-field-label--type-inline'>\u1018\u1004\u103a\u1039\u1002\u101c\u102c\u1038\u1012\u1031\u1037\u101b\u103e\u103a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038'  id='choice_2_229_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_2' id='label_2_229_2' class='gform-field-label gform-field-label--type-inline'>\u1019\u101c\u1031\u1038\u101b\u103e\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u1011\u102d\u102f\u1004\u103a\u1038'  id='choice_2_229_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_3' id='label_2_229_3' class='gform-field-label gform-field-label--type-inline'>\u1011\u102d\u102f\u1004\u103a\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u1019\u103c\u1014\u103a\u1019\u102c'  id='choice_2_229_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_4' id='label_2_229_4' class='gform-field-label gform-field-label--type-inline'>\u1019\u103c\u1014\u103a\u1019\u102c<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='\u1021\u1014\u1031\u102c\u1000\u103a\u1010\u102d\u102f\u1004\u103a\u1038\u101e\u102c\u1038'  id='choice_2_229_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_5' id='label_2_229_5' class='gform-field-label gform-field-label--type-inline'>\u1021\u1014\u1031\u102c\u1000\u103a\u1010\u102d\u102f\u1004\u103a\u1038\u101e\u102c\u1038<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_229_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_229' type='radio' value='gf_other_choice'  id='choice_2_229_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_229_6' id='label_2_229_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_229_other' class='gchoice_other_control' name='input_229_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_81\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_81\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1041\u1041.\u1044\u104b \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u101e\u100a\u103a \u1019\u100a\u103a\u101e\u1030\u1037\u1000\u102d\u102f \u1014\u102c\u1000\u103b\u1004\u103a\u1021\u1031\u102c\u1004\u103a\u101c\u102f\u1015\u103a\u101e\u1014\u100a\u103a\u1038\u104b \u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1015\u103c\u102f\u104d \u101e\u1000\u103a\u1006\u102d\u102f\u1004\u103a\u101e\u1031\u102c \u1021\u102c\u1038\u101c\u102f\u1036\u1038\u1000\u102d\u102f \u101b\u103d\u1031\u1038\u1015\u102b- <\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_81'><div class='gchoice gchoice_2_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1015\u102f\u1002\u1039\u1002\u102d\u102f\u101c\u103a\u101b\u1031\u1038\u1021\u101b \u1010\u102d\u102f\u1000\u103a\u1001\u102d\u102f\u1000\u103a\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_81_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_81_1' id='label_2_81_1' class='gform-field-label gform-field-label--type-inline'>They wanted to hurt me personally\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1015\u102f\u1002\u1039\u1002\u102d\u102f\u101c\u103a\u101b\u1031\u1038\u1021\u101b \u1010\u102d\u102f\u1000\u103a\u1001\u102d\u102f\u1000\u103a\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_81_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.2' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1001\u103c\u102c\u1038\u101e\u1030\u1010\u1005\u103a\u1026\u1038\u1000\u102d\u102f \u1010\u102d\u102f\u1000\u103a\u1001\u102d\u102f\u1000\u103a\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_81_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_81_2' id='label_2_81_2' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1001\u103c\u102c\u1038\u101e\u1030\u1010\u1005\u103a\u1026\u1038\u1000\u102d\u102f \u1010\u102d\u102f\u1000\u103a\u1001\u102d\u102f\u1000\u103a\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_184\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_184\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u101e\u100a\u103a \u101e\u1004\u103a\u1037\u1000\u102d\u102f \u1019\u100a\u103a\u101e\u100a\u103a\u1037\u1014\u100a\u103a\u1038\u1014\u103e\u1004\u103a\u1037 \u1014\u102c\u1000\u103b\u1004\u103a\u1021\u1031\u102c\u1004\u103a\u101c\u102f\u1015\u103a\u101e\u1014\u100a\u103a\u1038\u104b<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_184'><div class='gchoice gchoice_2_184_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_184.1' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1000\u103c\u1031\u102c\u1000\u103a\u1021\u1031\u102c\u1004\u103a \u101c\u102f\u1015\u103a\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b'  id='choice_2_184_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_184_1' id='label_2_184_1' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1000\u103c\u1031\u102c\u1000\u103a\u1021\u1031\u102c\u1004\u103a \u101c\u102f\u1015\u103a\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_184_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_184.2' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1010\u1005\u103a\u1001\u102f\u1001\u102f\u101c\u102f\u1015\u103a\u1001\u102d\u102f\u1004\u103a\u1038\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b'  id='choice_2_184_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_184_2' id='label_2_184_2' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1000\u102d\u102f \u1010\u1005\u103a\u1001\u102f\u1001\u102f\u101c\u102f\u1015\u103a\u1001\u102d\u102f\u1004\u103a\u1038\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_184_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_184.3' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1010\u1005\u103a\u1001\u102f\u1001\u102f\u101c\u102f\u1015\u103a\u1019\u101b\u1021\u1031\u102c\u1004\u103a \u1010\u102c\u1038\u1006\u102e\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_184_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_184_3' id='label_2_184_3' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1010\u1005\u103a\u1001\u102f\u1001\u102f\u101c\u102f\u1015\u103a\u1019\u101b\u1021\u1031\u102c\u1004\u103a \u1010\u102c\u1038\u1006\u102e\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_185\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_185\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u101e\u100a\u103a \u1021\u1001\u103c\u102c\u1038\u101e\u1030\u1010\u1005\u103a\u1026\u1038\u1000\u102d\u102f \u1019\u100a\u103a\u101e\u100a\u103a\u1037\u1014\u100a\u103a\u1038\u1014\u103e\u1004\u103a\u1037 \u1014\u102c\u1000\u103b\u1004\u103a\u1021\u1031\u102c\u1004\u103a\u101c\u102f\u1015\u103a\u101e\u1014\u100a\u103a\u1038\u104b<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_185'><div class='gchoice gchoice_2_185_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.1' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1000\u102d\u102f \u1000\u103c\u1031\u102c\u1000\u103a\u1021\u1031\u102c\u1004\u103a\u101c\u102f\u1015\u103a\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b'  id='choice_2_185_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_185_1' id='label_2_185_1' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1000\u102d\u102f \u1000\u103c\u1031\u102c\u1000\u103a\u1021\u1031\u102c\u1004\u103a\u101c\u102f\u1015\u103a\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_185_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.2' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1000\u102d\u102f \u1025\u1015\u1012\u1031\u1014\u103e\u1004\u1037\u103a \u1019\u101c\u103d\u1010\u103a\u1000\u1004\u103a\u1038\u101e\u1031\u102c\u1021\u101b\u102c\u1010\u1005\u103a\u1001\u102f\u1001\u102f \u101c\u102f\u1015\u103a\u1005\u1031\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b'  id='choice_2_185_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_185_2' id='label_2_185_2' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1000\u102d\u102f \u1025\u1015\u1012\u1031\u1014\u103e\u1004\u1037\u103a \u1019\u101c\u103d\u1010\u103a\u1000\u1004\u103a\u1038\u101e\u1031\u102c\u1021\u101b\u102c\u1010\u1005\u103a\u1001\u102f\u1001\u102f \u101c\u102f\u1015\u103a\u1005\u1031\u1001\u103b\u1004\u103a\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_185_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.3' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1001\u102f \u1019\u1015\u103c\u102f\u101c\u102f\u1015\u103a\u1014\u102d\u102f\u1004\u103a\u1021\u1031\u102c\u1004\u103a \u1010\u102c\u1038\u1006\u102e\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_185_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_185_3' id='label_2_185_3' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u102c\u101a\u1000\u1036\u101b\u103e\u1004\u103a\u1021\u1014\u1031\u1016\u103c\u1004\u1037\u103a \u1025\u1015\u1012\u1031\u1000\u103c\u1031\u102c\u1004\u103a\u1038\u1021\u101b \u1010\u1005\u103a\u1005\u102f\u1036\u1010\u1005\u103a\u1001\u102f \u1019\u1015\u103c\u102f\u101c\u102f\u1015\u103a\u1014\u102d\u102f\u1004\u103a\u1021\u1031\u102c\u1004\u103a \u1010\u102c\u1038\u1006\u102e\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_83\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_83\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >\u1041\u1041.\u1045\u104b \u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u101e\u1030\u104f \u101b\u100a\u103a\u101b\u103d\u101a\u103a\u1001\u103b\u1000\u103a\u1000\u102d\u102f \u101e\u1004\u103a\u1019\u100a\u103a\u101e\u102d\u102f\u1037\u1011\u1004\u103a\u101e\u1014\u100a\u103a\u1038\u104b<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_83'><div class='gchoice gchoice_2_83_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.1' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u1010\u1031\u102c\u1037\u103a\u1000\u102d\u102f \u1005\u1031\u102c\u103a\u1000\u102c\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u1010\u101a\u103a\u104b'  id='choice_2_83_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_83_1' id='label_2_83_1' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u1010\u1031\u102c\u1037\u103a\u1000\u102d\u102f \u1005\u1031\u102c\u103a\u1000\u102c\u1038\u1001\u103b\u1004\u103a\u1000\u103c\u1010\u101a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_83_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.2' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u1010\u1031\u102c\u1037\u103a\u1000\u102d\u102f \u101b\u1014\u103a\u1005\u101e\u100a\u103a\u104b'  id='choice_2_83_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_83_2' id='label_2_83_2' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u1000 \u1000\u103b\u103d\u1014\u103a\u1010\u1031\u102c\u1037\u103a\u1000\u102d\u102f \u101b\u1014\u103a\u1005\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_83_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.3' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1000\u103c\u1019\u103a\u1038\u1016\u1000\u103a\u1019\u103e\u102f\u1000\u102d\u102f \u101b\u100a\u103a\u101b\u103d\u101a\u103a\u1001\u103b\u1000\u103a\u101b\u103e\u102d\u101b\u103e\u102d \u101c\u103e\u102f\u1036\u1037\u1006\u1031\u102c\u103a\u101c\u102d\u102f\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_83_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_83_3' id='label_2_83_3' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1000\u103c\u1019\u103a\u1038\u1016\u1000\u103a\u1019\u103e\u102f\u1000\u102d\u102f \u101b\u100a\u103a\u101b\u103d\u101a\u103a\u1001\u103b\u1000\u103a\u101b\u103e\u102d\u101b\u103e\u102d \u101c\u103e\u102f\u1036\u1037\u1006\u1031\u102c\u103a\u101c\u102d\u102f\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_83_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.4' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1019\u103b\u102c\u1038\u101e\u1030\u1004\u103e\u102c \u1021\u1000\u103c\u1031\u102c\u1000\u103a\u1010\u101b\u102c\u1038 \u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a \u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u1015\u1030\u1015\u1014\u103a\u1019\u103e\u102f\u1000\u102d\u102f \u101c\u102d\u102f\u101c\u102c\u1038\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_83_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_83_4' id='label_2_83_4' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u1021\u1019\u103b\u102c\u1038\u101e\u1030\u1004\u103e\u102c \u1021\u1000\u103c\u1031\u102c\u1000\u103a\u1010\u101b\u102c\u1038 \u101e\u102d\u102f\u1037\u1019\u101f\u102f\u1010\u103a \u1005\u102d\u102f\u1038\u101b\u102d\u1019\u103a\u1015\u1030\u1015\u1014\u103a\u1019\u103e\u102f\u1000\u102d\u102f \u101c\u102d\u102f\u101c\u102c\u1038\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_83_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.5' type='checkbox'  value='\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u101c\u1030\u1021\u102f\u1015\u103a\u1005\u102f\u1010\u1005\u103a\u1005\u102f\u1019\u103e \u1021\u1001\u103c\u102c\u1038\u101c\u1030\u1021\u102f\u1015\u103a\u1005\u102f\u1010\u1005\u103a\u1005\u102f\u1021\u1015\u1031\u102b\u103a \u1015\u103c\u1005\u103a\u1019\u103e\u102f\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u1005\u1031\u101c\u102d\u102f\u1000\u103c\u101e\u100a\u103a\u104b'  id='choice_2_83_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_83_5' id='label_2_83_5' class='gform-field-label gform-field-label--type-inline'>\u101e\u1030\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u101c\u1030\u1021\u102f\u1015\u103a\u1005\u102f\u1010\u1005\u103a\u1005\u102f\u1019\u103e \u1021\u1001\u103c\u102c\u1038\u101c\u1030\u1021\u102f\u1015\u103a\u1005\u102f\u1010\u1005\u103a\u1005\u102f\u1021\u1015\u1031\u102b\u103a \u1015\u103c\u1005\u103a\u1019\u103e\u102f\u1000\u103b\u1030\u1038\u101c\u103d\u1014\u103a\u1005\u1031\u101c\u102d\u102f\u1000\u103c\u101e\u100a\u103a\u104b<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_225' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"6\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"6\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_225' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"8\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"8\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_8_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_8' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_8' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_226\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_226\"><h3>\u1014\u1031\u102c\u1000\u103a\u1006\u102f\u1036\u1038\u1021\u1006\u1004\u1037\u103a\u1019\u103b\u102c\u1038<\/h3><\/div><fieldset id=\"field_2_66\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_66\"><legend class='gfield_label gform-field-label'  >\u1041\u1042\u104b \u1012\u102e\u1015\u102f\u1036\u1005\u1036\u1000\u102d\u102f \u1016\u103c\u100a\u1037\u103a\u1015\u103c\u102e\u1038\u101e\u100a\u1037\u103a\u1021\u1001\u102b \u101e\u1004\u103a\u101d\u1004\u103a\u101b\u1031\u102c\u1000\u103a\u1011\u100a\u1037\u103a\u101e\u103d\u1004\u103a\u1038\u1001\u1032\u1037\u101e\u1031\u102c \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u101e\u100a\u103a APPAP Country Team \u101e\u102d\u102f\u1037 \u1015\u1031\u1038\u1015\u102d\u102f\u1037\u1015\u103c\u102e\u1038\u1016\u103c\u1005\u103a\u1015\u102b\u101c\u102d\u1019\u1037\u103a\u1019\u100a\u103a\u104b \u101e\u1004\u103a \u1001\u103d\u1004\u1037\u103a\u1015\u103c\u102f\u1001\u103b\u1000\u103a\u1019\u1015\u1031\u1038\u101c\u103b\u103e\u1004\u103a APPAP \u1019\u103e \u1021\u1001\u103c\u102c\u1038\u1019\u100a\u103a\u101e\u1030\u1037\u1000\u102d\u102f\u1019\u103e \u1015\u103c\u1014\u103a\u101c\u100a\u103a\u1019\u103b\u103e\u101d\u1031\u1019\u100a\u103a\u1019\u101f\u102f\u1010\u103a\u1015\u102b\u104b \u101e\u1004\u103a\u104f\u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f APPAP \u1021\u102c\u1038 \u1019\u103b\u103e\u101d\u1031\u101b\u101e\u100a\u103a\u1000\u102d\u102f \u101e\u1000\u103a\u1010\u1031\u102c\u1004\u1037\u103a\u101e\u1000\u103a\u101e\u102c\u1016\u103c\u1005\u103a\u1015\u102b\u101e\u101c\u102c\u1038\u104b  <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_66'>\n\t\t\t<div class='gchoice gchoice_2_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Complaints'  id='choice_2_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_66_0' id='label_2_66_0' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1021\u102c\u1038 \u101c\u1030\u1019\u103e\u102f\u1000\u103d\u1014\u103a\u101a\u1000\u103a\u1005\u102c\u1019\u103b\u1000\u103a\u1014\u103e\u102c\u1019\u103b\u102c\u1038\u1010\u103d\u1004\u103a \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u101b\u102c\u1010\u103d\u1004\u103a\u101e\u1031\u102c\u103a\u101c\u100a\u103a\u1038\u1000\u1031\u102c\u1004\u103a\u1038\u104a \u1000\u1019\u1039\u1018\u102c\u1037\u1000\u102f\u101c\u101e\u1019\u1002\u1039\u1002\u101e\u102d\u102f\u1037 \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u101b\u102c\u1010\u103d\u1004\u103a\u101e\u1031\u102c\u103a\u101c\u100a\u103a\u1038\u1000\u1031\u102c\u1004\u103a\u1038 \u1021\u101e\u102f\u1036\u1038\u1015\u103c\u102f\u101b\u1014\u103a\u1001\u103d\u1004\u1037\u103a\u1015\u103c\u102f\u1015\u102b\u101e\u100a\u103a\u104b \u101e\u102d\u102f\u1037\u101e\u1031\u102c\u103a \u101c\u1030\u1011\u102f\u1021\u1000\u103c\u102c\u1038\u1016\u103c\u1014\u1037\u103a\u101d\u1031\u101e\u100a\u1037\u103a \u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u1005\u102c\u1019\u103b\u102c\u1038\u1021\u1010\u103d\u1000\u103a\u1019\u1030 \u1001\u103d\u1004\u1037\u103a\u1019\u1015\u103c\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Reports, Complaints'  id='choice_2_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_66_1' id='label_2_66_1' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1021\u102c\u1038 \u101c\u1030\u1019\u103e\u102f\u1000\u103d\u1014\u103a\u101a\u1000\u103a\u1005\u102c\u1019\u103b\u1000\u103a\u1014\u103e\u102c\u1019\u103b\u102c\u1038\u1010\u103d\u1004\u103a \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u101b\u102c\u1010\u103d\u1004\u103a\u101e\u1031\u102c\u103a\u101c\u100a\u103a\u1038\u1000\u1031\u102c\u1004\u103a\u1038\u104a \u1000\u1019\u1039\u1018\u102c\u1037\u1000\u102f\u101c\u101e\u1019\u1002\u1039\u1002\u101e\u102d\u102f\u1037 \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u101b\u102c\u1010\u103d\u1004\u103a\u101e\u1031\u102c\u103a\u101c\u100a\u103a\u1038\u1000\u1031\u102c\u1004\u103a\u1038 \u1021\u101e\u102f\u1036\u1038\u1015\u103c\u102f\u101b\u1014\u103a\u1001\u103d\u1004\u1037\u103a\u1015\u103c\u102f\u1015\u102b\u101e\u100a\u103a\u104b \u101c\u1030\u1011\u102f\u1021\u1000\u103c\u102c\u1038\u1016\u103c\u1014\u1037\u103a\u101d\u1031\u101e\u100a\u1037\u103a \u1021\u1005\u102e\u101b\u1004\u103a\u1001\u1036\u1005\u102c\u1019\u103b\u102c\u1038\u1010\u103d\u1004\u103a\u101c\u100a\u103a\u1038 \u1021\u101e\u102f\u1036\u1036\u1038\u1015\u103c\u102f\u101b\u1014\u103a \u1001\u103d\u1004\u1037\u103a\u1015\u103c\u102f\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_66_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='\u1019\u101b\u103e\u102d\u1015\u102b\u104b'  id='choice_2_66_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_66_2' id='label_2_66_2' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1000\u102d\u102f APPAP \u1019\u103e \u1021\u1001\u103c\u102c\u1038\u1019\u100a\u103a\u101e\u1030\u1010\u1005\u103a\u1026\u1038\u1010\u1005\u103a\u101a\u1031\u102c\u1000\u103a\u1011\u1036\u101e\u102d\u102f\u1037 \u1019\u103b\u103e\u101d\u1031\u1001\u103c\u1004\u103a\u1038\u1000\u102d\u102f \u1001\u103d\u1004\u1037\u103a\u1019\u1015\u103c\u102f\u1015\u102b\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_68\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_68\"><legend class='gfield_label gform-field-label'  >\u1041\u1043\u104b \u101a\u1001\u102f \u1005\u1005\u103a\u1010\u1019\u103a\u1038\u1021\u102c\u1038 \u1016\u103c\u100a\u1037\u103a\u1005\u103d\u1000\u103a\u1015\u1031\u1038\u1001\u103c\u1004\u103a\u1038\u1000\u102d\u102f \u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1010\u1004\u103a\u1015\u102b\u101e\u100a\u103a\u104b \u101e\u1004\u103a\u104f \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1019\u103e\u102f\u1014\u103e\u1004\u1037\u103a \u1015\u1010\u103a\u101e\u1010\u103a\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u1000\u103a\u1021\u1000\u1031\u102c\u1004\u103a\u1021\u1011\u100a\u103a\u1016\u1031\u102c\u103a\u1006\u1031\u102c\u1004\u103a\u101b\u103d\u1000\u103a\u101e\u103d\u102c\u1038\u1019\u100a\u103a\u1016\u103c\u1005\u103a\u1000\u103c\u1031\u102c\u1004\u103a\u1038 \u1000\u1010\u102d\u1015\u103c\u102f\u1015\u102b\u101e\u100a\u103a\u104b <\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_68'>\n\t\t\t<div class='gchoice gchoice_2_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='\u1015\u103c\u1014\u103a\u101c\u100a\u103a\u1000\u102f\u1005\u102c\u1038\u1019\u103e\u102f\u101b\u101b\u103e\u102d\u101b\u1014\u103a \u1000\u102d\u102f\u101a\u103a\u1010\u102d\u102f\u1004\u103a\u101c\u102f\u1015\u103a\u1006\u1031\u102c\u1004\u103a\u101c\u102d\u102f\u1005\u102d\u1010\u103a\u101e\u102c\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_68_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_68_0' id='label_2_68_0' class='gform-field-label gform-field-label--type-inline'>\u1015\u103c\u1014\u103a\u101c\u100a\u103a\u1000\u102f\u1005\u102c\u1038\u1019\u103e\u102f\u101b\u101b\u103e\u102d\u101b\u1014\u103a \u1000\u102d\u102f\u101a\u103a\u1010\u102d\u102f\u1004\u103a\u101c\u102f\u1015\u103a\u1006\u1031\u102c\u1004\u103a\u101c\u102d\u102f\u1005\u102d\u1010\u103a\u101e\u102c\u101b\u103e\u102d\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1019\u103e\u102f\u1000\u102d\u102f APPAP \u1000 \u1000\u1030\u100a\u102e\u1006\u1031\u102c\u1004\u103a\u101b\u103d\u1000\u103a\u1015\u1031\u1038\u1005\u1031\u101c\u102d\u102f\u1015\u102b\u101e\u100a\u103a\u104b'  id='choice_2_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_68_1' id='label_2_68_1' class='gform-field-label gform-field-label--type-inline'>\u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u104f \u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1019\u103e\u102f\u1000\u102d\u102f APPAP \u1000 \u1000\u1030\u100a\u102e\u1006\u1031\u102c\u1004\u103a\u101b\u103d\u1000\u103a\u1015\u1031\u1038\u1005\u1031\u101c\u102d\u102f\u1015\u102b\u101e\u100a\u103a\u104b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_65' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u1014\u1031\u102c\u1000\u103a\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"7\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"7\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_65' class='gform_next_button gform-theme-button button' value='\u101b\u103e\u1031\u1037\u101e\u102d\u102f\u1037'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"9\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"9\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_2_9_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;} jQuery(\"#gform_save_2\").val(1); jQuery(\"#gform_2\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> \u101e\u102d\u1019\u103a\u1038\u1006\u100a\u103a\u1038\u1015\u103c\u102e\u1038 \u1006\u1000\u103a\u101c\u102f\u1015\u103a\u1015\u102b\u104b<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_9' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_9' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_69\"  class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_69\"><label class='gfield_label gform-field-label' for='input_2_69' >\u1014\u1031\u102c\u1000\u103a\u1011\u1015\u103a\u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1019\u103b\u102c\u1038\u1021\u1010\u103d\u1000\u103a \u1000\u103b\u103d\u1014\u103a\u102f\u1015\u103a\u1010\u102d\u102f\u1037\u101e\u100a\u103a \u101e\u1004\u1037\u103a\u1011\u1036 \u1006\u1000\u103a\u101e\u103d\u101a\u103a\u1015\u102b\u1019\u100a\u103a\u104a \u1000\u103b\u1031\u1038\u1007\u1030\u1038\u1015\u103c\u102f\u104d \u101e\u1004\u103a\u104f \u1006\u1000\u103a\u101e\u103d\u101a\u103a\u101b\u1014\u103a\u1021\u1001\u103b\u1000\u103a\u1021\u101c\u1000\u103a\u1000\u102d\u102f \u1021\u1031\u102c\u1000\u103a\u1015\u102b\u1010\u103d\u1004\u103a \u1011\u100a\u1037\u103a\u101e\u103d\u1004\u103a\u1038\u1015\u102b-<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_2_69' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_70\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_70\"><legend class='gfield_label gform-field-label'  >\u101e\u1004\u1037\u103a\u1010\u102d\u102f\u1004\u103a\u1000\u103c\u102c\u1038\u1001\u103b\u1000\u103a\u1014\u103e\u1004\u1037\u103a\u1015\u1010\u103a\u101e\u1000\u103a\u104d 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