www.steptember.org.au
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urlscan Pro
54.79.84.248
Public Scan
Submitted URL: https://steptemberau.cmail19.com/t/j-l-euuukhd-dkdjyduiur-y/
Effective URL: https://www.steptember.org.au/register/au?utm_source=email&utm_medium=campaign-monitor&utm_campaign=2023-steptember&utm_term=a...
Submission: On August 17 via manual from AU — Scanned from AU
Effective URL: https://www.steptember.org.au/register/au?utm_source=email&utm_medium=campaign-monitor&utm_campaign=2023-steptember&utm_term=a...
Submission: On August 17 via manual from AU — Scanned from AU
Form analysis 2 forms found in the DOM
POST https://www.steptember.org.au/register/personaldetails/au/default
<form id="RegisterLoginForm" class="form-horizontal funraisin-form" action="https://www.steptember.org.au/register/personaldetails/au/default" method="post" novalidate="novalidate">
<input type="hidden" name="login" value="Y">
<input type="hidden" name="CSRFToken" value="2402ff373a50320c4b60ff4563d374a0">
<input type="text" name="botrap" value="" style="display:none;">
<section class="section mt10">
<div class="container">
<h3 class="text-center">Already have an Account with us?</h3>
<p class="text-center"> If you have an account with us already please login below. </p>
<div class="row">
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5">Email Address *</label>
<div class="col-sm-12">
<input class="form-control" type="text" name="login_email" id="login_email_address">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5">Password *</label>
<div class="col-sm-12">
<input class="form-control" type="password" name="login_pass" id="login_pass" autocomplete="off">
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="text-center">
<button type="submit" class="btn btn-primary btn-xl"><span>Login</span></button>
</div>
</div>
<div class="form-group">
<div class="text-center">
<a href="/login/nopass" class="lightbox">Forgotten your password?</a>
</div>
</div>
</div>
</section>
</form>POST https://www.steptember.org.au/register/personaldetails/au/default
<form action="https://www.steptember.org.au/register/personaldetails/au/default" method="post" id="RegistrationForm" class="funraisin-form form-horizontal" novalidate="novalidate">
<input type="hidden" name="mandatory" value="m_fname,m_lname,m_email,m_email{email}">
<input type="hidden" name="m_photo" id="m_photo" value="">
<input type="hidden" name="m_coverphoto" id="m_coverphoto" value="">
<input type="hidden" name="cropitimage" id="cropitimage" value="">
<input type="hidden" name="orgcropitimage" id="orgcropitimage" value="">
<input type="hidden" name="cropitcoverimage" id="cropitcoverimage" value="">
<input type="hidden" name="CSRFToken" value="2402ff373a50320c4b60ff4563d374a0">
<input type="hidden" name="register" value="Y">
<input type="text" name="botrap" value="" style="display:none;">
<input type="hidden" name="join_org_id" id="join_org_id" value="">
<input type="hidden" name="is_public" value="Y">
<section class="section pb0 joinOrgSection hidden" style="display: block;">
<div class="container">
<div class="row">
<label class="col-sm-12">Search for your organisation or school</label>
</div>
<div class="row pt20 pl15 pr15" id="JoinOrg">
<div id="JoinTeamSearch" class="form-group ">
<div class="col-sm-12">
<input autocomplete="new-password" class="form-control ui-autocomplete-input" type="text" name="kw_org_search" id="kw_org_search" placeholder="Start typing in your organisation or school name"
aria-label="Start typing in your organisation or school name" value="">
</div>
<div class="col-sm-12">
<p style="font-size:15px;padding-top:10px">Can't find your organisation? Create an organisation <a href="https://www.steptember.org.au/register/au/adult-create-org"><u>here</u></a></p>
<p style="font-size: 15px;padding-top:10px">If you have a promo code from your organisation make sure you have it ready, you will need it during the payment step</p>
</div>
</div>
<div class="form-group pb10 hidden" id="ind_units">
<label class="col-sm-12 pt10 pb5" for="customfield[department]"> Which department are you participating in? * </label>
<div class="col-sm-6">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="BusinessUnits" title="Nothing selected"><span
class="filter-option pull-left">Nothing selected</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text"></span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
</ul>
</div><select name="" class="form-control selectpicker" id="BusinessUnits" aria-required="true" tabindex="-98">
<option value=""></option>
</select>
</div>
</div>
</div>
<script>
$(document).ready(function() {
$('#BusinessUnits').attr('name', '');
$('#ind_units').addClass('hidden');
// looks up a team as they type above
$("#kw_org_search").autocomplete({
source: "/register/orglookup?event_id=13",
minLength: 2,
select: function(event, ui) {
$("#kw_org_search").val(ui.item.label);
$("#join_org_id").val(ui.item.org_id);
// $('.create-org').visibleOut();
$('#orgblog,#orgaddress').hide();
$('#RegistrationForm button[type=submit]').html('Join us');
$('#orgpreview').load('/funraisin/generateorgpreview/' + ui.item.org_id);
$('#BusinessUnits').attr('name', '');
$('#ind_units').addClass('hidden');
$.ajax({
url: '/customcode/getbusinessunits/' + ui.item.org_id,
dataType: 'json',
success: function(data) {
if (data != '' && data != '<option value=""></option>' && data != '<option value="0">0</option>') {
if (data.toString() === '<option value="0">0</option>') {
$('#ind_units').addClass('hidden');
} else {
$('#ind_units').removeClass('hidden');
}
$('#BusinessUnits').attr('name', 'customfield[department]');
$('#BusinessUnits').html(data);
$('#BusinessUnits').prepend('<option value="">Nothing selected');
$('#BusinessUnits option:first-child').prop('selected', true);
$('.selectpicker').selectpicker('refresh');
if ($.isFunction($.fn.rules)) {
$('#BusinessUnits').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
$('#ind_units').removeClass('hidden');
}
}
});
}
});
$("#kw_org_search").attr('autocomplete', 'new-password');
$('#kw_org_search').keyup(function() {
if ($(this).val() == '') {
$('#orgblog,#orgaddress').show();
// $('.create-org').visibleIn();
$('#RegistrationForm button[type=submit]').html('Next');
}
});
});
</script>
</div>
<div id="orgpreview"></div>
<script>
$(document).ready(function() {
$('body').on('click', '.cancel-join-org', function() {
$("#join_org_id").val(-1);
$('#JoinOrgDetails').remove();
$('#JoinOrgSearch').removeClass('hidden');
$('#orgblog,#orgaddress').show();
// $('.create-org').visibleIn();
$('#RegistrationForm button[type=submit]').html('Next');
$('#orgpreview').html('');
$("#kw_org_search").val('');
$('#kw_org_select').trigger('change');
});
});
</script>
</div>
</section>
<!-- this here -->
<section class="section personalDetailsSection">
<div class="container vertical-align-top pt40">
<h3 class="col-md-12 fieldsHeading">Your personal details</h3>
<div class="col-md-2 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5">Title *</label>
<div class="col-sm-12">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="m_title" title="Please select"><span
class="filter-option pull-left">Please select</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">Please select</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mx</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mr</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Mrs</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Miss</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Ms</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="6"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dr</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="7"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Prof</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Sir</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="9"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Dame</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="10"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Assoc Prof</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select name="m_title" id="m_title" class="form-control selectpicker" tabindex="-98">
<option value="">Please select</option>
<option value="Mx">Mx</option>
<option value="Mr">Mr</option>
<option value="Mrs">Mrs</option>
<option value="Miss">Miss</option>
<option value="Ms">Ms</option>
<option value="Dr">Dr</option>
<option value="Prof">Prof</option>
<option value="Sir">Sir</option>
<option value="Dame">Dame</option>
<option value="Assoc Prof">Assoc Prof</option>
</select>
</div>
</div>
</div>
</div>
<script>
$("#m_title").selectpicker("render");
</script>
<div class="clear"></div>
<div class="col-md-4 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="m_fname">First Name *</label>
<div class="col-sm-12">
<input type="text" class="form-control" autocomplete="given-name" name="m_fname" id="m_fname" value="">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="m_lname">Last Name *</label>
<div class="col-sm-12">
<input type="text" class="form-control" autocomplete="family-name" name="m_lname" id="m_lname" value="">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="m_email">Email Address *</label>
<div class="col-sm-12">
<input type="text" class="form-control" autocomplete="email" name="m_email" id="m_email" value="">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="m_pass">Password *</label>
<div class="col-sm-12">
<input type="password" class="form-control" name="m_pass" id="m_pass" value="" autocomplete="off">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="row form-group">
<label class="col-sm-12 pt10 pb5" for="m_phone_mobile">Mobile *</label>
<div class="col-xs-4">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle form-control" data-toggle="dropdown" role="button" data-id="m_phone_mobile_suffix" title="+61"><span
class="filter-option pull-left">+61</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+61</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+0</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1242</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="4"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1246</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="5"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1264</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="6"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1268</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="7"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1345</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1441</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="9"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1473</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="10"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1649</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="11"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1664</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="12"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1670</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="13"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1671</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="14"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1684</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="15"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1758</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="16"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1767</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="17"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1784</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="18"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1787</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="19"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1809</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="20"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1868</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="21"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1869</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="22"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+1876</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="23"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+20</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="24"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+212</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="25"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+213</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="26"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+216</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="27"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+220</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="28"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+221</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="29"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+222</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="30"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+223</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="31"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+224</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="32"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+225</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="33"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+226</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="34"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+227</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="35"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+228</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="36"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+229</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="37"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+230</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="38"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+231</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="39"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+232</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="40"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+233</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="41"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+234</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="42"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+235</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="43"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+236</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="44"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+237</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="45"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+238</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="46"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+239</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="47"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+240</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
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<li data-original-index="163"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+683</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="164"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+684</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="165"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+686</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="166"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+687</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="167"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+688</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="168"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+689</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="169"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+690</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="170"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+691</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="171"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+692</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="172"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+7</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="173"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+70</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="174"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+7370</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="175"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+81</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="176"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+82</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="177"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+84</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="178"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+852</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="179"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+855</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="180"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+856</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="181"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+86</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="182"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+880</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="183"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+886</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="184"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+90</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="185"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+91</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="186"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+92</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="187"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+93</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="188"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+94</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="189"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+95</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="190"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+960</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="191"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+961</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="192"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+962</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="193"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+964</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="194"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+965</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="195"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+966</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="196"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+967</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="197"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+968</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="198"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+971</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="199"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+972</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="200"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+973</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="201"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+974</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="202"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+975</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="203"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+976</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="204"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+977</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="205"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+992</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="206"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+994</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="207"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+995</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="208"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+996</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="209"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">+998</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select class="selectpicker form-control" name="m_phone_mobile_suffix" id="m_phone_mobile_suffix" tabindex="-98">
<option value="+61">+61</option>
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<option value="+1">+1</option>
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<option value="+998">+998</option>
</select>
</div>
</div>
<div class="col-xs-8">
<input type="text" class="form-control phone-group" name="m_phone_mobile" id="m_phone_mobile" value="">
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label for="m_address_country2" class="col-sm-12 pt10 pb5">Country</label>
<div class="col-sm-12">
<select name="m_address_country" id="m_address_country2" class="form-control">
<option selected="true" value="Australia">Australia</option>
<option value="United States">United States</option>
<option value="United Kingdom">United Kingdom</option>
<option value="">---------------------</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia" selected="selected">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Caribbean Netherlands ">Caribbean Netherlands </option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of">Congo, Democratic Republic of</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard and McDonald Islands">Heard and McDonald Islands</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Korea">North Korea</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine, State of">Palestine, State of</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Réunion">Réunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Saint-Martin (France)">Saint-Martin (France)</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Korea">South Korea</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="St. Pierre and Miquelon">St. Pierre and Miquelon</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="The Netherlands">The Netherlands</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican">Vatican</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands (British)">Virgin Islands (British)</option>
<option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
<option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="Åland Islands">Åland Islands</option>
</select>
</div>
</div>
</div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="m_address_pcode">Postcode (Australia only) </label>
<div class="col-sm-12">
<input type="number" class="form-control" name="m_address_pcode" id="m_address_pcode" value="" maxlength="4">
</div>
</div>
</div>
<div class="clear"></div>
<div class="col-md-6 col-sm-12">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="custom_over_18">What year were you born? * <span class="fa fa-info-circle text-left" data-toggle="tooltip"
data-original-title="If you are under 18 you must be appropriately supervised by an adult. You must have permission from a parent or guardian before beginning your fundraising activity." aria-hidden="true"></span></label>
<div class="col-sm-3 pr0 hidden">
<input type="text" class="form-control" name="m_dob_d" id="m_dob_d" value="01" placeholder="dd" minlength="2" maxlength="2" autocomplete="bday-day">
</div>
<div class="col-sm-3 pr0 hidden">
<input type="text" class="form-control" name="m_dob_m" id="m_dob_m" value="01" placeholder="mm" minlength="2" maxlength="2" autocomplete="bday-month">
</div>
<div class="col-sm-5 pr0">
<select name="customfield[m_dob_y]" id="m_dob_y" class="form-control">
<option value="" disabled="" selected="">yyyy</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select>
</div>
</div>
</div>
<input type="hidden" name="customfield[over_18]" id="over_18" value="No">
<script>
$(function() {
$('[name="customfield[m_dob_y]"]').change(function() {
if (parseFloat($(this).val()) <= 2003) {
$('[name="customfield[over_18]"]').val('Yes');
} else {
$('[name="customfield[over_18]"]').val('No');
}
})
$('#noconsent').change(function() {
if ($('#noconsent').is(':checked')) {
$('[name="customfield[over_18]"]').val('Yes');
} else {
$('[name="customfield[over_18]"]').val('No');
}
})
})
</script>
<div class="guardian_details hidden">
<div class="row">
<div class="pb40" aria-live="polite">
<div class="col-md-10">
<h3>Permission to participate</h3>
<p>All people under the age of 18 will require a parent or guardian to complete the form below before proceeding.</p>
<script>
$(function() {
$('#m_dob_y').change(function() {
if ($(this).val() == '2004') {
$('.noconsent').removeClass('hidden')
} else {
$('.noconsent').addClass('hidden')
}
})
if ($('.noconsentneeded').hasClass('hidden')) {
$('[name="customfield[parental_name]"]').rules("remove");
$('[name="customfield[parental_permission]"]').rules("remove");
} else {
if ($.isFunction($.fn.rules)) {
$('[name="customfield[parental_name]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
$('[name="customfield[parental_permission]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
}
$('#noconsent').change(function() {
$('.noconsentneeded').toggleClass('hidden')
if ($('.noconsentneeded').hasClass('hidden')) {
$('[name="customfield[parental_name]"]').rules("remove");
$('[name="customfield[parental_permission]"]').rules("remove");
} else {
if ($.isFunction($.fn.rules)) {
$('[name="customfield[parental_name]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
$('[name="customfield[parental_permission]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
}
});
})
</script>
<label class="noconsent hidden">
<input type="checkbox" name="customfield[noconsent]" id="noconsent" class="form-control" style="width: 13px; height: 13px;display: inline-block"> I am 18 and therefore do not require parental consent. </label>
</div>
<div class="col-md-6 col-sm-12 noconsentneeded">
<div class="form-group">
<label class="col-sm-12 pt10 pb5" for="parental_name">Parent / guardian Name *</label>
<div class="col-sm-12">
<input type="text" class="form-control" name="customfield[parental_name]" id="parental_name" value="" aria-required="true">
</div>
</div>
</div>
<div class="clear"></div>
<div class="col-md-12 noconsentneeded">
<div class="checkBoxTabOption">
<input type="checkbox" class="parental_permission_checkbox" id="parental_permission_checkbox" name="customfield[parental_permission]" value="Y" aria-required="true"> I provide permission for my child to participate in STEPtember. *
</div>
</div>
<div class="clear"></div>
</div>
</div>
</div>
<script>
$(function() {
$("#m_dob_y").change(function() {
var year = $('#m_dob_y').val();
var month = $('#m_dob_m').val()
var day = $('#m_dob_d').val();
if (day !== '' && month !== '' && year !== '') {
//Get dob from input
var dateString = year + '-' + month + '-' + day;
var date = new Date(dateString);
//Get current date
var currentDate = new Date();
//Get difference between user input and current date in milliseconds
var dateDiff = currentDate.getTime() - date.getTime();
//Convert milliseconds to year
var ageDate = new Date(dateDiff);
//Get the absolute value of below operation
var age = Math.abs(ageDate.getUTCFullYear() - 1970);
if (age <= 17) {
$(".guardian_details").each(function() {
$(this).removeClass("hidden");
$(this).find('input').each(function() {
$(this).rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
});
});
$('.18old').addClass('hidden');
} else if (age == 18) {
$('.18old').removeClass('hidden');
$('#im18').prop('checked', false);
$(".guardian_details").each(function() {
$(this).removeClass("hidden");
});
} else {
$(".guardian_details").each(function() {
if (!$(this).hasClass("hidden")) {
$(this).addClass("hidden");
$(this).find('input').each(function() {
$(this).rules('remove', 'required');
});
}
});
}
return age >= 18;
}
});
$('#im18').click(function() {
if ($(this).is(':checked')) {
$('.guardian_fname, .guardian_lname, .guardian_phone, .guardian_email').addClass('hidden');
$('#guardian_fname, #guardian_lname, #guardian_phone, #guardian_email').val('');
} else {
$('.guardian_fname, .guardian_lname, .guardian_phone, .guardian_email').removeClass('hidden');
}
});
});
$(window).on("load", function() {
$("#m_dob_y").change();
});
</script>
<script>
$('#over_18 select').on('change', function() {
var over18Val = $(this).val();
if (over18Val == 'N') {
$('.parental').removeClass('hidden');
$('html, body').animate({
scrollTop: parseInt($('.parental').offset().top) - 150
}, 1000);
$('form').attr('action', 'https://www.steptember.org.au/register/au/default');
if ($.isFunction($.fn.rules)) {
$("#parental_permission").rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_name ").rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_permission_checkbox ").rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
} else if (over18Val == 'Y') {
$('form').attr('action', 'https://www.steptember.org.au/register/au/default');
$('.parental').addClass('hidden');
if ($.isFunction($.fn.rules)) {
$("#parental_permission").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_name ").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_permission_checkbox ").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
} else {
$('.parental').addClass('hidden');
if ($.isFunction($.fn.rules)) {
$("#parental_permission").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_name ").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
if ($.isFunction($.fn.rules)) {
$("#parental_permission_checkbox ").rules("add", {
required: false,
messages: {
required: "This is a required field"
}
});
}
}
});
</script>
<div class="clear"></div>
<input type="hidden" name="m_optin_text" value="<p>Would you like to receive updates from Cerebral Palsy Alliance?</p>">
<div class="clearfix"></div>
<div class="height-10"></div>
<div class="col-sm-12">
<div class="form-group">
<div class="col-xs-8" style="font-size:88%;">
<p>Would you like to receive updates from Cerebral Palsy Alliance?</p>
</div>
<div class="col-xs-4 text-center toggle-switch">
<label class="toggle-btn grid-6 form-control m_optin " data-rel="Y">
<input type="radio" name="m_optin" value="Y"> Yes </label>
<label class="toggle-btn grid-6 form-control m_optin " data-rel="N">
<input type="radio" name="m_optin" value="N"> No </label>
</div>
</div>
</div>
<div class="clearfix"></div>
<div class="height-10"></div>
</div>
</section>
<section class="section raiseMoneySection">
<div class="container">
<div class="form-group mb40">
<label class="col-md-12 pb10" for="stepping_org"> Are you STEPping with your organisation or school? * </label>
<div class="col-md-6 col-sm-12">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="stepping_org" title="select option"><span
class="filter-option pull-left">select option</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">select option</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Yes</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">No</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select class="form-control selectpicker" name="customfield[stepping_org]" id="stepping_org" aria-required="true" tabindex="-98">
<option value="">select option</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<script>
$(function() {
if ($.isFunction($.fn.rules)) {
$('[name="customfield[stepping_org]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
})
</script>
</div>
</div>
<div class="form-group raised-funds-block">
<label class="col-md-12 pb10" for="raise_funds_for">How would you like us to use your fundraising dollars?</label>
<p class="col-md-12">I would like to raise money for... *</p>
<div class="col-md-6 col-sm-12">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="raise_funds_for" title="select option"><span
class="filter-option pull-left">select option</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">select option</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Wherever the need is greatest</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2"><a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Research</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">Equipment and services</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select class="form-control selectpicker" name="customfield[raise_funds_for]" id="raise_funds_for" aria-required="true" tabindex="-98">
<option value="">select option</option>
<option value="Wherever the need is greatest">Wherever the need is greatest</option>
<option value="Research">Research</option>
<option value="Equipment and services">Equipment and services</option>
</select>
</div>
</div>
<div class="clear"></div>
</div>
<p class="pb20">If you're not sure, leave it to us - we'll make sure that your fundraising dollars are best used wherever they are most needed.</p>
<script>
$(function() {
if ($.isFunction($.fn.rules)) {
$('[name="customfield[raise_funds_for]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
})
</script>
<div class="clear"></div>
<div class="form-group one-motivator-block">
<label class="col-md-12 pb10" for="one_motivator">What is your number one motivator for joining STEPtember? *</label>
<div class="col-md-6 col-sm-12">
<div class="btn-group bootstrap-select form-control"><button type="button" class="dropdown-toggle bs-placeholder form-control" data-toggle="dropdown" role="button" data-id="one_motivator" title="select option"><span
class="filter-option pull-left">select option</span> <span class="bs-caret"><span class="caret"></span></span></button>
<div class="dropdown-menu open" role="combobox">
<ul class="dropdown-menu inner" role="listbox" aria-expanded="false">
<li data-original-index="0" class="selected">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="true"><span class="text">select option</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="1">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">I live with cerebral palsy</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="2">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">I live with another disability</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="3">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">A friend or family member living with cerebral palsy</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="4">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">A friend or family member living with a disability</span><span class="glyphicon glyphicon-ok check-mark"></span></a>
</li>
<li data-original-index="5">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">In memory of someone with cerebral palsy</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="6">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">A health/fitness challenge for myself</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="7">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">To compete with friends/family</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="8">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">To raise money for charity</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
<li data-original-index="9">
<a tabindex="0" class="" data-tokens="null" role="option" aria-disabled="false" aria-selected="false"><span class="text">To be part of my company challenge</span><span class="glyphicon glyphicon-ok check-mark"></span></a></li>
</ul>
</div><select class="form-control selectpicker" name="customfield[one_motivator]" id="one_motivator" aria-required="true" tabindex="-98">
<option value="">select option</option>
<option value="cerebral_palsy">I live with cerebral palsy</option>
<option value="another_disability">I live with another disability</option>
<option value="family_member_cerebral_palsy">A friend or family member living with cerebral palsy</option>
<option value="family_member">A friend or family member living with a disability</option>
<option value="cerebral_palsy_memory">In memory of someone with cerebral palsy</option>
<option value="fitness_challenge">A health/fitness challenge for myself</option>
<option value="friends_family">To compete with friends/family</option>
<option value="raise_money">To raise money for charity</option>
<option value="company">To be part of my company challenge</option>
</select>
</div>
<label class="other_motivator hidden mt20" for="other_motivator"> Who do you STEP for?<br>
<small style="font-weight: normal">This will appear on the top of your fundraising page.</small>
</label>
<input type="text" class="form-control other_motivator hidden" name="customfield[other_motivator]" id="other_motivator" value="">
<input type="hidden" class="form-control mt20 cfom" name="customfield[one_motivator_new]" value="">
</div>
<div class="clear"></div>
</div>
<script>
$(function() {
$('#one_motivator').change(function() {
let reason = '';
$('.other_motivator').addClass('hidden');
$('.other_motivator').val('');
switch ($(this).val()) {
case 'cerebral_palsy':
reason = 'for cerebral palsy';
break;
case 'cerebral_palsy_memory':
reason = 'for cerebral palsy';
$('.other_motivator').removeClass('hidden');
break;
case 'another_disability':
reason = 'to be the best I can be';
break;
case 'family_member_cerebral_palsy':
reason = 'for cerebral palsy';
$('.other_motivator').removeClass('hidden');
break;
case 'family_member':
reason = 'to be the best I can be';
$('.other_motivator').removeClass('hidden');
break;
case 'fitness_challenge':
reason = 'for the challenge';
break;
case 'friends_family':
reason = 'for cerebral palsy';
break;
case 'raise_money':
reason = 'for cerebral palsy';
break;
case 'company':
reason = 'for';
break;
default:
}
$('.cfom').val(`I STEP ${reason}`);
});
$('#other_motivator').change(function() {
if ($('#one_motivator').val() == 'family_member_cerebral_palsy') {
$('.cfom').val(`I STEP for cerebral palsy for ${$(this).val()}`);
} else if ($('#one_motivator').val() == 'family_member') {
$('.cfom').val(`I STEP to be the best I can be for ${$(this).val()}`);
} else if ($('#one_motivator').val() == 'company') {
$('.cfom').val(`I STEP for ${$(this).val()}`);
}
})
if ($.isFunction($.fn.rules)) {
$('[name="customfield[one_motivator]"]').rules("add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
})
</script>
<!--
<div class="clear"></div>
<div class="form-group">
<label class="col-md-12 pb10" for="motivated_to">What is your number one motivator for joining STEPtember? *</label>
<div class="col-md-6 col-sm-12">
<!-- <select class="form-control selectpicker" name="customfield[motivated_to]"><option value="" selected="selected"></option><option value="Fundraising for a worthwhile cause">Fundraising for a worthwhile cause</option><option value="Doing something for my fitness">Doing something for my fitness</option><option value="Team building within my organisation">Team building within my organisation</option><option value="Other">Other</option></select> -->
<!-- new
<select class="form-control selectpicker motivated_to" name="customfield[motivated_to]" id="motivated_to">
<option value="">select option</option>
<option value="I have cerebral palsy">I have cerebral palsy</option><option value="A friend or family member lives with cerebral palsy">A friend or family member lives with cerebral palsy</option><option value="A health/fitness challenge for myself">A health/fitness challenge for myself</option><option value="To compete with friends/family">To compete with friends/family</option><option value="To raise money for charity">To raise money for charity</option><option value="To be part of my company challenge">To be part of my company challenge</option><option value="Other">Other</option></select>
</div>
</div>
<script>
$(function(){
if ( $.isFunction($.fn.rules) ) {
$( ".motivated_to" ).rules( "add", {
required: true,
messages: {
required: "This is a required field"
}
});
}
})
</script> -->
<div class="clear"></div>
<script>
$('.motivated_to').on('change', function() {
var motivated_to = $(this).val();
if (motivated_to == 'Other') {
$('.motivation_other').removeClass('hidden');
} else {
$('.motivation_other').addClass('hidden');
}
})
</script>
<label class="col-md-12 motivation_other hidden p0 pb10" for="customfield[your_motivation_other]">Other</label>
<div class="col-md-6 col-sm-12 motivation_other hidden pl0">
<input class="form-control" type="text" name="customfield[your_motivation_other]" id="your_motivation_other" value="">
</div>
<div class="clear"></div>
</div>
</section>
<section class="section termsSection">
<div class="container">
<div class="terms-panel">
<div class="top mCustomScrollbar _mCS_1" id="terms-panel">
<div class="mCustomScrollBox mCS-light" id="mCSB_1" style="position:relative; height:100%; overflow:hidden; max-width:100%;">
<div class="mCSB_container mCS_no_scrollbar" style="position:relative; top:0;">
<h3 class="fieldsHeading">Terms & Conditions</h3>
</div>
<div class="mCSB_scrollTools" style="position: absolute; display: none;">
<div class="mCSB_draggerContainer">
<div class="mCSB_dragger" style="position: absolute; top: 0px;" oncontextmenu="return false;">
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</div>
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</div>
<div class="bottom">
<div class="row">
<input type="checkbox" name="agree_site_terms" id="agree_site_terms" value="" aria-label="I have read and agree to the STEPtember <a href='/privacy-policy' target='_blank'>privacy policy</a>" aria-required="true"> I have read and agree to
the STEPtember <a href="/privacy-policy" target="_blank">privacy policy</a> *
</div>
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</div>
</section>
<script>
$("#terms-panel").mCustomScrollbar();
</script>
<div class="text-center pb20">
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Are you STEPping with your organisation or school? *
select option
* select option
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select option Yes No
How would you like us to use your fundraising dollars?
I would like to raise money for... *
select option
* select option
* Wherever the need is greatest
* Research
* Equipment and services
select option Wherever the need is greatestResearchEquipment and services
If you're not sure, leave it to us - we'll make sure that your fundraising
dollars are best used wherever they are most needed.
What is your number one motivator for joining STEPtember? *
select option
* select option
* I live with cerebral palsy
* I live with another disability
* A friend or family member living with cerebral palsy
* A friend or family member living with a disability
* In memory of someone with cerebral palsy
* A health/fitness challenge for myself
* To compete with friends/family
* To raise money for charity
* To be part of my company challenge
select option I live with cerebral palsy I live with another disability A friend
or family member living with cerebral palsy A friend or family member living
with a disability In memory of someone with cerebral palsy A health/fitness
challenge for myself To compete with friends/family To raise money for charity
To be part of my company challenge
Who do you STEP for?
This will appear on the top of your fundraising page.
Other
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© Cerebral Palsy Alliance | Terms and Conditions | Privacy Policy |
Accessibility
Cerebral Palsy Alliance (ACN 000 062 288), previously incorporated as “The
Spastic Centre of New South Wales”, is a public benevolent institution
incorporated as a company limited by guarantee. STEPtember and the STEPtember
logo are trademarks of Cerebral Palsy Alliance. Cerebral Palsy Alliance, as a
Charity, is Tax exempt and a registered Deductible Gift Recipient. All donations
to Cerebral Palsy Alliance over $2.00 are tax deductible.
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