www.psychedelicassistedtherapysummit.com
Open in
urlscan Pro
2606:4700::6811:d7f2
Public Scan
Submitted URL: https://fleetmaull.krtra.com/c/kG4XdQAPiflF/NK3jx
Effective URL: https://www.psychedelicassistedtherapysummit.com/?lid=569103&r_done=1
Submission: On February 14 via api from US — Scanned from DE
Effective URL: https://www.psychedelicassistedtherapysummit.com/?lid=569103&r_done=1
Submission: On February 14 via api from US — Scanned from DE
Form analysis 10 forms found in the DOM
POST https://app.kartra.com//process/add_lead/qb5aTniexZ9c
<form action="https://app.kartra.com//process/add_lead/qb5aTniexZ9c" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin unique_class__txiwxmeap form_class_sIx5ycdha6a4 js_kartra_trackable_object form_class_JNgWSIPmoqlF form_class_5F2PR6U0ajdT form_class_JjtDaCgKQPrK form_class_qb5aTniexZ9c" data-optin-id="qb5aTniexZ9c"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
target="_top" method="POST" data-kt-type="optin" data-kt-value="qb5aTniexZ9c" data-kt-owner="Rg3GX6gP" data-asset-id="7">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_i {
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_clabel {
color: !important;
}
.unique_class__txiwxmeap ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_qb5aTniexZ9c btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div>
</form>POST https://app.kartra.com//process/add_lead/eJjsWMzRIaCp
<form action="https://app.kartra.com//process/add_lead/eJjsWMzRIaCp" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="400"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin js_kartra_trackable_object unique_class__5p4c1u0ny form_class_sIx5ycdha6a4 form_class_Bo8wI6almdZa form_class_DwF0mOCahGlF form_class_3mTCdEskFwZa form_class_eJjsWMzRIaCp" data-optin-id="eJjsWMzRIaCp"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
data-kt-type="optin" data-kt-value="eJjsWMzRIaCp" data-kt-owner="Rg3GX6gP" target="_top" method="POST" data-asset-id="9">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_i {
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_clabel {
color: !important;
}
.unique_class__5p4c1u0ny ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_eJjsWMzRIaCp btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 400;">Register for Free!</button>
</div>
</div>
</div><input type="hidden" name="referrer" value="r46oqGsCbIlF"><input type="hidden" name="kuid" value="3d013923-b495-4b27-8e28-3d1fcb0c5ca0">
</form>POST https://app.kartra.com//process/add_lead/qb5aTniexZ9c
<form action="https://app.kartra.com//process/add_lead/qb5aTniexZ9c" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin unique_class__txiwxmeap form_class_sIx5ycdha6a4 js_kartra_trackable_object form_class_JNgWSIPmoqlF form_class_5F2PR6U0ajdT form_class_JjtDaCgKQPrK form_class_qb5aTniexZ9c" data-optin-id="qb5aTniexZ9c"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
target="_top" method="POST" data-kt-type="optin" data-kt-value="qb5aTniexZ9c" data-kt-owner="Rg3GX6gP" data-asset-id="14">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_i {
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_clabel {
color: !important;
}
.unique_class__txiwxmeap ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_qb5aTniexZ9c btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div>
</form>POST https://app.kartra.com//process/add_lead/eJjsWMzRIaCp
<form action="https://app.kartra.com//process/add_lead/eJjsWMzRIaCp" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="400"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin js_kartra_trackable_object unique_class__5p4c1u0ny form_class_sIx5ycdha6a4 form_class_Bo8wI6almdZa form_class_DwF0mOCahGlF form_class_3mTCdEskFwZa form_class_eJjsWMzRIaCp" data-optin-id="eJjsWMzRIaCp"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
data-kt-type="optin" data-kt-value="eJjsWMzRIaCp" data-kt-owner="Rg3GX6gP" target="_top" method="POST" data-asset-id="16">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_i {
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_clabel {
color: !important;
}
.unique_class__5p4c1u0ny ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_eJjsWMzRIaCp btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 400;">Register for Free!</button>
</div>
</div>
</div><input type="hidden" name="referrer" value="r46oqGsCbIlF"><input type="hidden" name="kuid" value="3d013923-b495-4b27-8e28-3d1fcb0c5ca0">
</form>POST https://app.kartra.com//process/add_lead/qb5aTniexZ9c
<form action="https://app.kartra.com//process/add_lead/qb5aTniexZ9c" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin unique_class__txiwxmeap form_class_sIx5ycdha6a4 js_kartra_trackable_object form_class_JNgWSIPmoqlF form_class_5F2PR6U0ajdT form_class_JjtDaCgKQPrK form_class_qb5aTniexZ9c" data-optin-id="qb5aTniexZ9c"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
target="_top" method="POST" data-kt-type="optin" data-kt-value="qb5aTniexZ9c" data-kt-owner="Rg3GX6gP" data-asset-id="8">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_i {
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_clabel {
color: !important;
}
.unique_class__txiwxmeap ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_qb5aTniexZ9c btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div>
</form>POST https://app.kartra.com//process/add_lead/eJjsWMzRIaCp
<form action="https://app.kartra.com//process/add_lead/eJjsWMzRIaCp" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="400"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin js_kartra_trackable_object unique_class__5p4c1u0ny form_class_sIx5ycdha6a4 form_class_Bo8wI6almdZa form_class_DwF0mOCahGlF form_class_3mTCdEskFwZa form_class_eJjsWMzRIaCp" data-optin-id="eJjsWMzRIaCp"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
data-kt-type="optin" data-kt-value="eJjsWMzRIaCp" data-kt-owner="Rg3GX6gP" target="_top" method="POST" data-asset-id="10">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_i {
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_clabel {
color: !important;
}
.unique_class__5p4c1u0ny ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_eJjsWMzRIaCp btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 400;">Register for Free!</button>
</div>
</div>
</div><input type="hidden" name="referrer" value="r46oqGsCbIlF"><input type="hidden" name="kuid" value="3d013923-b495-4b27-8e28-3d1fcb0c5ca0">
</form>POST https://app.kartra.com//process/add_lead/qb5aTniexZ9c
<form action="https://app.kartra.com//process/add_lead/qb5aTniexZ9c" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin unique_class__txiwxmeap form_class_sIx5ycdha6a4 js_kartra_trackable_object form_class_JNgWSIPmoqlF form_class_5F2PR6U0ajdT form_class_JjtDaCgKQPrK form_class_qb5aTniexZ9c" data-optin-id="qb5aTniexZ9c"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
target="_top" method="POST" data-kt-type="optin" data-kt-value="qb5aTniexZ9c" data-kt-owner="Rg3GX6gP" data-asset-id="3">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_i {
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_clabel {
color: !important;
}
.unique_class__txiwxmeap ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_qb5aTniexZ9c btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div>
</form>POST https://app.kartra.com//process/add_lead/eJjsWMzRIaCp
<form action="https://app.kartra.com//process/add_lead/eJjsWMzRIaCp" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin js_kartra_trackable_object unique_class__5p4c1u0ny form_class_sIx5ycdha6a4 form_class_Bo8wI6almdZa form_class_DwF0mOCahGlF form_class_3mTCdEskFwZa form_class_eJjsWMzRIaCp" data-optin-id="eJjsWMzRIaCp"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
data-kt-type="optin" data-kt-value="eJjsWMzRIaCp" data-kt-owner="Rg3GX6gP" target="_top" method="POST" data-asset-id="6">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_i {
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_clabel {
color: !important;
}
.unique_class__5p4c1u0ny ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_eJjsWMzRIaCp btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div><input type="hidden" name="referrer" value="r46oqGsCbIlF"><input type="hidden" name="kuid" value="3d013923-b495-4b27-8e28-3d1fcb0c5ca0">
</form>POST https://app.kartra.com//process/add_lead/qb5aTniexZ9c
<form action="https://app.kartra.com//process/add_lead/qb5aTniexZ9c" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin unique_class__txiwxmeap form_class_sIx5ycdha6a4 js_kartra_trackable_object form_class_JNgWSIPmoqlF form_class_5F2PR6U0ajdT form_class_JjtDaCgKQPrK form_class_qb5aTniexZ9c" data-optin-id="qb5aTniexZ9c"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
target="_top" method="POST" data-kt-type="optin" data-kt-value="qb5aTniexZ9c" data-kt-owner="Rg3GX6gP" data-asset-id="11">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__txiwxmeap .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_i {
color: !important;
}
.unique_class__txiwxmeap .kartra_optin_clabel {
color: !important;
}
.unique_class__txiwxmeap ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__txiwxmeap :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__txiwxmeap input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_qb5aTniexZ9c js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
--><button type="button" class="kartra_gdpr_popover_button js_gdpr_button_popover_trigger js_theme_border">
<i class="kartraico-info_letter js_kartra_popover_trigger js_kartra_popover_gdpr_trigger" data-popover="js_kartra_gdpr_popover"></i>
</button>
</label>
</div>
<div class="js_kartra_gdpr_popover js_kartra_popover kartra_optin_gdpr_terms_offer" style="display: none;">
<div class="kartra_optin_popover">
<div class="kartra_optin_popover-content kartra_optin_popover-content-npadding">
<span class="js_gdpr_terms_text">I confirm that I am at least 16 years of age or older<br>
<br> I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. <br>
<br> I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. <br>
<br> I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be
required to use cookies or similar tracking to provide those products or services.. <br>
<br> I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. <br>
<br> I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be
unable to provide contracted products or services to me, and I can not hold you responsible for that. <br>
<br> Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is
responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the
email address provided.</span>
</div>
<button type="button" class="js_gdpr_popover_close kartra_optin_popover-close js_utility_popover_close">
<i class="kartraico-clear"></i>
</button>
</div>
</div>
</div>
</div><button type="submit" class="kartra_optin_submit_btn kartra_optin_btn_block kartra_optin_btn_giant submit_button_qb5aTniexZ9c btn-rounded btn_shadow_small" disabled="disabled"
style="background-color: rgb(250, 128, 35); color: rgb(255, 255, 255); font-weight: 700;">Register for Free!</button>
</div>
</div>
</div>
</form>POST https://app.kartra.com//process/add_lead/eJjsWMzRIaCp
<form action="https://app.kartra.com//process/add_lead/eJjsWMzRIaCp" data-input-class="kartra_optin_input_giant" data-submit-bg="rgb(250, 128, 35)" data-submit-color="rgb(255, 255, 255)" data-submit-type="Solid" data-submit-bold="700"
data-submit-shadow="btn_shadow_small" data-submit-size="kartra_btn_giant" data-submit-corners="Rounded"
class="filled_optin js_kartra_trackable_object unique_class__5p4c1u0ny form_class_sIx5ycdha6a4 form_class_Bo8wI6almdZa form_class_DwF0mOCahGlF form_class_3mTCdEskFwZa form_class_eJjsWMzRIaCp" data-optin-id="eJjsWMzRIaCp"
data-domain="https://app.kartra.com/" data-field-style="undefined" data-field-bg="" data-field-color="" data-text-color="" data-display-icons="true" data-submit-text="Register for Free!" style="margin-top: 0px; margin-bottom: 0px; display: none;"
data-kt-type="optin" data-kt-value="eJjsWMzRIaCp" data-kt-owner="Rg3GX6gP" target="_top" method="POST" data-asset-id="15">
<div class="kartra_optin_r">
<style>
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_tnc-form button.btn.dropdown-toggle,
div[class*="leads_capture"] .kartra_page_optin_form .unique_class__5p4c1u0ny .kartra_optin_cg button.btn.dropdown-toggle {
background-color: ;
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_i {
color: !important;
}
.unique_class__5p4c1u0ny .kartra_optin_clabel {
color: !important;
}
.unique_class__5p4c1u0ny ::-webkit-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny ::-moz-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-ms-input-placeholder {
color: !important;
opacity: 0.7;
}
.unique_class__5p4c1u0ny :-moz-placeholder {
color: !important;
opacity: 0.7;
}
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=radio]+small,
div[class*="leads_capture"] .kartra_page_optin_form .kartra_optin_wrapper .unique_class__5p4c1u0ny input[type=checkbox]+small {
background-color: ;
}
</style>
<div class="kartra_optin_c1">
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-person"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="First name" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="first_name" data-santitation-type="front_name">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-email"></i>
<div class="kartra_optin_asterisk"></div><input type="text" placeholder="Email" class="required_eJjsWMzRIaCp js_kartra_santitation kartra_optin_ti" name="email" data-santitation-type="email">
</div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_client_id" name="custom_29"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="ga_session_id" name="custom_32"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbp" name="custom_30"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="cookie_fbc" name="custom_31"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_source" name="custom_26"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_medium" name="custom_33"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="utm_campaign" name="custom_34"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_referrer" name="custom_35"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="affiliation" name="custom_41"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="page_location" name="custom_43"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="last_uid" name="custom_44"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="pap_aid" name="custom_45"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="kartra_optin_controls kartra_optin_input_giant kartra_optin_icon"><i class="kartra_optin_i kartraico-edit"></i><input type="text" autocomplete="false" placeholder="user_agent" name="custom_46"
class="js_kartra_santitation kartra_optin_ti" data-santitation-type="normal"></div>
</div>
<div class="kartra_optin_cg">
<div class="js_gdpr_wrapper clearfix kartra_optin_gdpr_wrapper" style="">
<div class="gdpr_communications js_gdpr_communications kartra_optin_cg kartra_optin_gdpr_terms" style="display: none;">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_communications" type="checkbox" class="js_gdpr_communications_check" value="1" checked="checked">
<small></small>
<span class="js_gdpr_label_communications">I would like to receive future communications</span>
</label>
</div>
</div>
<div class="gdpr_terms js_gdpr_terms kartra_optin_cg kartra_optin_gdpr_terms">
<div class="kartra-optin-checkbox">
<label class="kartra_optin_field-label kartra-optin-checkbox">
<input name="gdpr_terms" type="checkbox" class="js_gdpr_terms_check" value="1">
<small></small>
<span class="js_gdpr_label_terms">I agree to the GDPR (Data Protection) Terms & Conditions</span><!--
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Toggle navigation * Speakers * Schedule February 20 - 26, 2024 The All-New 2nd Annual PSYCHEDELIC ASSISTED THERAPY GLOBAL SUMMIT -------------------------------------------------------------------------------- Changing Consciousness, Healing Trauma, Relieving Human Suffering, Sacred Reciprocity, and more... REGISTER NOW FOR FREE! ...and immediately receive 3 powerful video interviews with James Fadiman, Ifetayo Harvey & Dennis McKenna Many of us who have experienced psychedelics feel very much that they are sacred tools. They open spiritual awareness. — Stanislav Grof EXPLORE THE LATEST RESEARCH & DISCOVER THE PROMISE OF PSYCHEDELIC-ASSISTED THERAPY... -------------------------------------------------------------------------------- A free, 7-day online event featuring 60+ world-class experts, including Stanislav Grof, Rosalind Watts, Rick Doblin, Gita Vaid, Andrew Weil, Paul Stamets, Hannah McLane, Bessel van der Kolk, NiCole T. Buchanan, Richard Schwartz, and many more... The 7-day journey begins in... 0 0 5 5 DAYS 1 1 3 3 HOURS 2 2 8 8 MINUTES 2 2 1 2 SECONDS -------------------------------------------------------------------------------- REGISTER NOW FOR FREE! Now including some of the most powerful presentations from our 2022 Summit * Gabor Maté, MD * Belinda Eriacho * William Richards, PhD * Mary Cosimano, PhD * Sara Reed, MS LMFT * Charles Raison, MD * David Nutt, DM * Joe Tafur, MD * Janis Phelps, PhD * Emilio Arbe, MD * Anthony Bossis, PhD * Hanifa Nayo Washington * Daniel Siegel, MD * Phil Wolfson, MD Register Now for Free and Immediately Unlock 3 Powerful Summit Interviews with James Fadiman, Ifetayo Harvey & Dennis McKenna REGISTER NOW FOR FREE! OUR PSYCHEDELIC-ASSISTED THERAPY GLOBAL SUMMIT 1+ Participants 1+ Expert Speakers 1+ Transformational Days WHO IS THIS SUMMIT FOR? -------------------------------------------------------------------------------- Everyone Interested in the Psychedelic Renaissance and the Emerging Field of Psychedelic-Assisted Therapies Including the General Public, Clinicians, Researchers, Clients, Policymakers, and Entrepreneurs. (10 APA CE Credits Available for Licensed Clinicians with purchase of Lifetime Access) EXPLORE: -------------------------------------------------------------------------------- * Indigenous, Eastern & Western Modes of Knowing: Mind, Consciousness, & Spirit * Research, Rescheduling for Clinical Application & Decriminalization * Therapeutic Applications for Specific MH Challenges & Healing Underlying Traumas * Practice: Therapeutic Approaches & Strategies, Dosing & Protocols for Safe Delivery * Before and After Preparation & Integration for Optimal Treatment Effectiveness * Standards, Ethics, & Best Practices for Treatment & Training Therapists * Delivery Infrastructure & Business Model - Diversity, Equity, Inclusion, and Accessibility -------------------------------------------------------------------------------- Global Thought Leaders Learn from a diverse group of 60+ leading contributors, experts, and pioneers in the psychedelic-assisted therapy field. Latest Research & Protocols Update and deepen your knowledge and understanding of psychedelic-assisted therapies, medicine, and healing. Flexible 48-hour Access Enjoy all the inspiring expert interviews posted each day of the Summit at your convenience, any time of day, for 48 hours. Join the Engaged Community Join our private Facebook Group to connect to and engage with your fellow participants during the Summit. SUMMIT MISSION: To provide clinicians, researchers, policy makers, and the general public with up-to-date information on current developments in psychedelic-assisted therapies; To give voice to the diverse practitioners and researchers contributing to the development of evidence-based protocols and training, sound clinical practice, accessible treatment infrastructures, and ethical standards emphasizing diversity, inclusivity, mindfulness, and compassion. What You'll Learn: -------------------------------------------------------------------------------- Possible strategies for integrating session facilitation with existing therapeutic modalities How to implement best practices for pre-session preparation & post-session integration How psychedelic experiences impact our evolving understanding of mind and consciousness within the larger matrix of interconnectedness and interbeing How we can best honor the origins of psychedelic medicine, the context of sacred reciprocity, and different world views & ways of knowing Learn about new breakthroughs and advances that are providing hope for people suffering from trauma, addiction, anxiety, and depression Strategies for creating accessible treatment infrastructures and business models that assure diversity, equity, and inclusion. How the field is progressing with research, clinical trials, and efforts to reschedule psychedelic medicines for clinical use How to ensure standards, ethics, and best practices for P.A.T. delivery and therapist and/or facilitator training How the various therapeutic applications of different psychedelic medicines like ketamine, MDMA, psilocybin, mescaline, DMT, and LSD can potentially provide healing and support for anxiety, depression, addictions, traumas, PTSD, ADHD, end-of-life anxiety, and more... How to facilitate the ideal set & setting for session facilitation with cultural competency and the latest developments in dosing and protocols with different psychedelic medicines The 7-day journey begins in... -------------------------------------------------------------------------------- 0 0 5 5 DAYS 1 1 3 3 HOURS 2 2 8 8 MINUTES 2 2 1 2 SECONDS REGISTER NOW FOR FREE! Share this event with friends and colleagues! Share Tweet Share SUMMIT PRESENTERS 60+ Leading Experts to Guide You GITA VAID, MD -------------------------------------------------------------------------------- Psychiatrist practicing ketamine-assisted therapy, Co-founder of the Center for Natural Intelligence, and Director of Psychedelic Awareness at The Chopra Foundation STANISLAV GROF, MD -------------------------------------------------------------------------------- Acclaimed Psychiatrist, Developer of Holotropic Breathwork, Co-Founder and Chief theoretician of Transpersonal Psychology, and Founder of the International Transpersonal Association (ITA) ROSALIND WATTS, PHD -------------------------------------------------------------------------------- Clinical Psychologist and Founder of ACER Integration, one of the 50 Most Influential People in Psychedelics and top 16 Women Shaping the Future of Psychedelics DEEPAK CHOPRA, MD -------------------------------------------------------------------------------- Clinical Professor at UCSD, Author of over 90 books, Founder of Chopra Global and Chopra Foundation, Partnering with MindMed for Clinical Research & Education on the Future of Psychedelic Medicine ANDREW WEIL, MD -------------------------------------------------------------------------------- Leader, Pioneer, & Educator in the fields of Integrative Health and Medicinal Plants, Founder and Director of the Andrew Weil Center for Integrative Medicine, Bestselling Author MONNICA WILLIAMS, PHD -------------------------------------------------------------------------------- Clinical psychologist, Associate Professor in the School of Psychology, Clinical Director of the Behavioral Wellness Clinic, Associate editor of The Behavior Therapist and New Ideas in Psychology GABOR MATÉ, MD (2022) -------------------------------------------------------------------------------- Physician, Renowned Expert on Addiction and Trauma, Best Selling Author, including The Myth of Normal: Trauma, Illness, & Healing in a Toxic Culture DIANA QUINN, ND -------------------------------------------------------------------------------- Naturopathic Doctor, Co-Founder Psychedelic Liberation Collective, Training Director at Alma Institute, Cohort Integration Leader at Naropa University BELINDA ERIACHO (2022) -------------------------------------------------------------------------------- Dine’ (Navajo) and Zuni lineage, Board Member of the Church of the Eagle and the Condor, Program Advisor for Naropa University, and Native American Advisor for SoundMind RICK DOBLIN, PHD -------------------------------------------------------------------------------- Researcher, Advocate, Founder and Executive Director of the Multidisciplinary Association for Psychedelic Studies (MAPS), Author of Manifesting Minds HANNAH McLANE, MD -------------------------------------------------------------------------------- Physician, Psychoanalyst, Entrepreneur, and Founder of SoundMind Institute, a Psychedelic Training & Research Institute PAUL STAMETS -------------------------------------------------------------------------------- Mycologist and Industry Leader in Fungi, Speaker, Bestselling Author, Medical Researcher, Entrepreneur RICHARD SCHWARTZ, PHD -------------------------------------------------------------------------------- Psychologist, Founder of Internal Family Systems (IFS), Author, No Bad Parts, Internal Family Systems Therapy BRIGITTE GROF, PHD -------------------------------------------------------------------------------- Co-creater of the Grof® Legacy Training, Licensed Psychotherapist, Artist, and certified Holotropic Breathwork Practitioner BESSEL VAN DER KOLK, MD -------------------------------------------------------------------------------- Psychiatrist, Author, Body Keeps the Score, Leading Trauma Expert and Educator, Researcher in MDMA therapy for trauma NICOLE T. BUCHANAN, PHD -------------------------------------------------------------------------------- Associate Professor of Psychology at Michigan State, Trainee in MDMA-assisted psychotherapy, Speaker, Writer ANNIE MITHOEFER, BSN -------------------------------------------------------------------------------- Registered Nurse, Clinical Investigator for MDMA/PTSD Studies MICHAEL MITHOEFER, MD -------------------------------------------------------------------------------- Senior Medical Director for Medical Affairs, Training and Supervision for MAPS. MATTHEW JOHNSON, PHD -------------------------------------------------------------------------------- Professor of Psychiatry and Behavioral Sciences at Johns Hopkins, one of the world’s most published scientists on the human effects of psychedelics, President of the International Society for Research on Psychedelics LICIA SKY -------------------------------------------------------------------------------- Co-Founder and CEO of the Trauma Research Foundation WILLIAM RICHARDS, PHD (2022) -------------------------------------------------------------------------------- Pioneering Researcher in Psychedelics and Psychotherapy, Clinical Psychologist John Hopkins School of Medicine, and Author of Sacred Knowledge: Psychedelics and Religious Experiences DERAN YOUNG, LCSW -------------------------------------------------------------------------------- Licensed Therapist, Founder of Black Therapists Rock, Contributor to New York Times Bestseller, You Are Your Best Thing DAVID NUTT, DM (2022) -------------------------------------------------------------------------------- Psychiatrist, Author, Researcher on psychopharmacology, neuroscience and psychedelics, and Host of The Drug Science Podcast. ANJA LOIZAGA-VELDER, PHD -------------------------------------------------------------------------------- Co-founder of the Nierika Institute for Intercultural Medicine, an NGO dedicated to the preservation of indigenous traditions with sacred plant medicines MARY COSIMANO, PHD (2022) -------------------------------------------------------------------------------- Director of Guide Services at Johns Hopkins Center for Psychedelic and Consciousness Research, Researcher, and Teacher of Psychedelic-Assisted Therapies and Research BEN SESSA, MD -------------------------------------------------------------------------------- Psychiatrist, Writer, Researcher of Psychedelic Drugs, and Author of The Psychedelic Renaissance SARA REED, MS LMFT (2022) -------------------------------------------------------------------------------- Creative Executive for Minds iHealth Solutions and Therapist Supervisor, Practitioner in psychedelic-assisted therapy CHARLES RAISON, MD (2022) -------------------------------------------------------------------------------- Psychiatrist, Professor of Psychiatry, Researcher and Co-author of “The New Mind-Body Science of Depression” JOE TAFUR, MD (2022) -------------------------------------------------------------------------------- Integrative Family Physician, Curandero, Author of The Fellowship of the River: A Medical Doctor's Exploration into Traditional Amazonian Plant Medicine JANIS PHELPS, PHD (2022) -------------------------------------------------------------------------------- Founder and Director of the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies EMILIO ARBE, MD (2022) -------------------------------------------------------------------------------- Chief Medical Officer, specialized in the development of psychedelic-assisted psychotherapies DAEESS 1DREA, MD -------------------------------------------------------------------------------- Integrative Physician, Trauma Expert, Author of Top Ten Traits of Highly Resilient People SUNNY STRASBURG, LMFT -------------------------------------------------------------------------------- Certified Psychedelic Psychotherapist trained in Internal Family Systems, Clinical Director at TRIPP PsyAssist, EMDR-certified trauma specialist, Consultant, and Writer DANIEL SIEGEL, MD (2022) -------------------------------------------------------------------------------- UCLA Clinical Professor of Psychiatry, Executive Director of Mindsight Institute, Bestselling Author of Brainstorm, Mindsight, & Aware HANIFA NAYO WASHINGTON (2022) -------------------------------------------------------------------------------- Co-Founder and Chief of Strategy for Fireside Project, a non-profit creating systemic change in the field of psychedelics PHIL WOLFSON, MD (2022) -------------------------------------------------------------------------------- Psychiatrist, Founder of Ketamine Assisted Psychotherapy, President & CEO of Ketamine Research Foundation, Author, Researcher KWASI ADUSEI, DNP, PMHNP -------------------------------------------------------------------------------- Psychiatric Nurse Practitioner, Co-Founder of the Psychedelic Society of Western New York CASSANDRA VIETEN, PHD -------------------------------------------------------------------------------- Licensed clinical psychologist, mind-body medicine researcher, author, consultant, and internationally recognized public speaker STEVEN C. HAYES, PHD -------------------------------------------------------------------------------- Professor of Psychology, ACT Developer, Bestselling Author of Get Out of Your Head and Into Your Life PREETI SIMRAN SETHI, MBA -------------------------------------------------------------------------------- 2023 Ferriss-UC Berkeley Psychedelic Journalism Fellow, Carter Center Mental Health Journalism Fellow, Founder of the Asian Psychedelic Collective, and Author ERICA ZELFAND, ND -------------------------------------------------------------------------------- CEO of Right to Heal, Naturopathic Physician, Lead Educator at Inner Trek, and Psychedelic Facilitator DARRON T. SMITH, PHD -------------------------------------------------------------------------------- Clinician, Scholar, Researcher and Educator of evidence-based solutions for people with mental illness, applying neuroscience and psychedelic research RONALD SIEGEL, PSYD -------------------------------------------------------------------------------- Psychology Professor, Clinician, Educator, and Author of The Mindfulness Solution: Everyday Practices for Everyday Problems BRIAN RICHARDS, PSYD -------------------------------------------------------------------------------- Clinical Psychologist and psilocybin expert, on the Board of Psychedelic Medicine and Therapies JOSEPH McCOWAN, PSYD -------------------------------------------------------------------------------- Licensed Clinical Psychologist, Researcher, Co-therapist, and Supervisor in the MAPS-sponsored Phase 3 clinical trials of MDMA-assisted therapy for PTSD CLANCY CAVNAR, PSYD -------------------------------------------------------------------------------- Licensed Clinical Psychologist, Research Associate of the Nucleus for Interdisciplinary Studies of Psychoactives (NEIP), and Associate Editor at Chacruna TORSTEN PASSIE, MD -------------------------------------------------------------------------------- Psychiatrist, Professor, and a Leading International Authority on Altered States of Consciousness. CHARLOTTE JAMES -------------------------------------------------------------------------------- Founder of the Psychedelic Liberation Training, Educator and Community Wellness Advocate MICHAEL ALPERT, MD -------------------------------------------------------------------------------- Board-Certified Psychiatrist, Medical Director at the Quincy Asian Resources Initiative, and Ketamine-Assisted Therapy Therapist VICTOR CABRAL, MSW, LSW -------------------------------------------------------------------------------- Director of Policy & Regulatory Affairs at Fluence, Psychotherapist, Consultant, Speaker, and Filmmaker HATTIE WELLS -------------------------------------------------------------------------------- Psychedelic Practitioner, Ethnobotanist and Co-Director of Breaking Convention CHRISTOPHER TIMMERMANN, PHD -------------------------------------------------------------------------------- Neuroscientist, Leading Neuropsychopharmacology and Psychedelics Researcher at Imperial College London ALBERT GARCIA-ROMEU, PHD -------------------------------------------------------------------------------- Founding member of the Johns Hopkins Center for Psychedelic and Consciousness Research ANTHONY BOSSIS, PHD (2022) -------------------------------------------------------------------------------- Clinical Psychologist, Researcher, and Clinical Assistant Professor of Psychiatry at NYU School of Medicine INGMAR GORMAN, PHD -------------------------------------------------------------------------------- Chief Executive Officer and Lead Trainer at Fluence and Clinical Psychologist CHRISTOPHER GERMER, PHD -------------------------------------------------------------------------------- Harvard Psychologist, Co-Developer of Mindful Self-Compassion (MSC), Author, The Mindful Path to Self-Compassion CHEN LIZRA -------------------------------------------------------------------------------- Founder of the Power of Somatic Intelligence, an organization dedicated to teaching the wisdom of the body, TED speaker, and Somatic Intelligence Coach AUSTIN PERLMUTTER, MD -------------------------------------------------------------------------------- Board Certified Internal Medicine Physician, Managing Director at Big Bold Health, NYT Bestselling Author, published researcher, and international educator RYAN WESTRUM, PHD -------------------------------------------------------------------------------- Registered Integration Therapist for MAPS, Author of The Psychedelics Integration Handbook, Founder of Healing Souls LEWIS MEHL-MADRONA, MD -------------------------------------------------------------------------------- Associate Professor, Trained in Family Medicine, Psychiatry, And Clinical Psychology, and Prolific Writer FLEET MAULL, PHD -------------------------------------------------------------------------------- Summit Host, Dharma Teacher, Mindset Coach, Social Entrepreneur, Founder of Heart Mind Institute and Prison Mindfulness Institute, Author of Radical Responsibility PETER CORBETT, LCSW -------------------------------------------------------------------------------- Psychotherapist, Co-director of Ketamine Psychotherapy Associates, and MAPS certified therapist for psychedelic research studies PATRICK FISHER, PHD -------------------------------------------------------------------------------- Associate Professor at the University of Copenhagen in Denmark and Senior Researcher at the Neurobiology Research Unit BIA LABATE, PHD -------------------------------------------------------------------------------- Executive Director of the Chacruna Institute, Anthropologist, and Advisor at the Veteran Mental Health Leadership Coalition REGISTER NOW FOR FREE! ...and immediately receive 3 powerful video interviews with James Fadiman, Ifetayo Harvey & Dennis McKenna PRODUCED BY SUMMIT PARTNERS SUPPORTFAQ support@heartmind.co +1 (508) 613-2095 © Heart Mind Institute. All Rights Reserved. × Before You Go... Don't miss out on immediate access to these 3 FREE VIDEOS! Register NOW for FREE and get: 3 powerful video interviews with James Fadiman, Ifetayo Harvey & Dennis McKenna × Register for the Free Psychedelic-Assisted Therapy Global Summit PLEASE INDICATE IF YOU ARE A MENTAL HEALTH CARE OR MEDICAL PROFESSIONAL. NO YES I would like to receive future communications I agree to the GDPR (Data Protection) Terms & Conditions I confirm that I am at least 16 years of age or older I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. 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You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! I would like to receive future communications I agree to the GDPR (Data Protection) Terms & Conditions I confirm that I am at least 16 years of age or older I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services.. I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! By signing up, you agree to join the Heart Mind Institute LLC email community and receive relevant communications and offers from us. Your email address will NEVER be shared or sold. By signing up you agree to Heart Mind Institute’s Privacy Policy. You can easily unsubscribe at any time. Powered by KARTRA × Register for the Free Psychedelic-Assisted Therapy Global Summit PLEASE INDICATE IF YOU ARE A MENTAL HEALTH CARE OR MEDICAL PROFESSIONAL. NO YES I would like to receive future communications I agree to the GDPR (Data Protection) Terms & Conditions I confirm that I am at least 16 years of age or older I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services.. I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. 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I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services.. I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! By signing up, you agree to join the Heart Mind Institute LLC email community and receive relevant communications and offers from us. Your email address will NEVER be shared or sold. By signing up you agree to Heart Mind Institute’s Privacy Policy. You can easily unsubscribe at any time. Powered by KARTRA × Register for the Free Psychedelic-Assisted Therapy Global Summit PLEASE INDICATE IF YOU ARE A MENTAL HEALTH CARE OR MEDICAL PROFESSIONAL. 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You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! 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By signing up, you agree to join the Heart Mind Institute LLC email community and receive relevant communications and offers from us. Your email address will NEVER be shared or sold. By signing up you agree to Heart Mind Institute’s Privacy Policy. You can easily unsubscribe at any time. Powered by KARTRA × Register for the Free Psychedelic-Assisted Therapy Global Summit PLEASE INDICATE IF YOU ARE A MENTAL HEALTH CARE OR MEDICAL PROFESSIONAL. NO YES I would like to receive future communications I agree to the GDPR (Data Protection) Terms & Conditions I confirm that I am at least 16 years of age or older I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services.. I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! I would like to receive future communications I agree to the GDPR (Data Protection) Terms & Conditions I confirm that I am at least 16 years of age or older I have read and accept any EULA, Terms and Conditions, Acceptable Use Policy, and/or Data Processing Addendum which has been provided to me in connection with the software, products and/or services. I have been fully informed and consent to the collection and use of my personal data for any purpose in connection with the software, products and/or services. I understand that certain data, including personal data, must be collected or processed in order for you to provide any products or services I have requested or contracted for. I understand that in some cases it may be required to use cookies or similar tracking to provide those products or services.. I understand that I have the right to request access annually to any personal data you have obtained or collected regarding me. You have agreed to provide me with a record of my personal data in a readable format. I also understand that I can revoke my consent and that I have the right to be forgotten. If I revoke my consent you will stop collecting or processing my personal data. I understand that if I revoke my consent, you may be unable to provide contracted products or services to me, and I can not hold you responsible for that. Likewise, if I properly request to be forgotten, you will delete the data you have for me, or make it inaccessible. I also understand that if there is a dispute regarding my personal data, I can contact someone who is responsible for handling data-related concerns. If we are unable to resolve any issue, you will provide an independent service to arbitrate a resolution. If I have any questions regarding my rights or privacy, I can contact the email address provided. Register for Free! By signing up, you agree to join the Heart Mind Institute LLC email community and receive relevant communications and offers from us. Your email address will NEVER be shared or sold. By signing up you agree to Heart Mind Institute’s Privacy Policy. You can easily unsubscribe at any time. Powered by KARTRA Cookies We use cookies to improve our service, track analytics, remember preferences, etc. By using our site, you consent to these cookies. Privacy policy Cookie policy Accept all cookies Only essential cookies Save