lets.go.prweekus.com
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147.154.51.122
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URL:
https://lets.go.prweekus.com/prweek-pc?elqTrackId=ceae8822a4d34f3f8e3a5febe63372da&elq=ba554ea6892845af9145916dea125b90&elqai...
Submission: On February 21 via manual from US — Scanned from DE
Submission: On February 21 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: PC_PRW — POST https://s3096123.t.eloqua.com/e/f2
<form method="post" name="PC_PRW" action="https://s3096123.t.eloqua.com/e/f2" onsubmit="return handleFormSubmit(this)" id="form22" class="elq-form">
<input value="PC_PRW" type="hidden" name="elqFormName">
<input value="3096123" type="hidden" name="elqSiteId">
<input name="elqCampaignId" type="hidden" value="3449">
<div class="container">
<div class="row">
<div>
<div class="connect__body">
<p><br><b>Take control of your email communication preferences and choose to receive only the emails that matter most to you.</b><br> You can choose to edit your profile below and select the email communications you want to receive. You can
easily uncheck any boxes for the communications you no longer want to receive. Once completed, please submit and your preferences will be updated.<br> </p>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement0" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe271">First Name <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="firstName" id="fe271" value="" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement1" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe272">Last Name <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="lastName" id="fe272" value="" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement0" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe306">Title <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="title" id="fe306" value="" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement1" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe286">Company <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="company" id="fe286" value="" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement0" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe291">State or Province </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe291" name="stateProv" style="width:100%;" data-value="">
<option value="">Please Select... </option>
<option value="AK">Alaska </option>
<option value="AL">Alabama </option>
<option value="AR">Arkansas </option>
<option value="AS">American Samoa </option>
<option value="AZ">Arizona </option>
<option value="CA">California </option>
<option value="CO">Colorado </option>
<option value="CT">Connecticut </option>
<option value="DC">D.C. </option>
<option value="DE">Delaware </option>
<option value="FL">Florida </option>
<!-- <option value="FM">Micronesia
</option> -->
<option value="GA">Georgia </option>
<option value="GU">Guam </option>
<option value="HI">Hawaii </option>
<option value="IA">Iowa </option>
<option value="ID">Idaho </option>
<option value="IL">Illinois </option>
<option value="IN">Indiana </option>
<option value="KS">Kansas </option>
<option value="KY">Kentucky </option>
<option value="LA">Louisiana </option>
<option value="MA">Massachusetts </option>
<option value="MD">Maryland </option>
<option value="ME">Maine </option>
<option value="MH">Marshall Islands </option>
<option value="MI">Michigan </option>
<option value="MN">Minnesota </option>
<option value="MO">Missouri </option>
<option value="MP">Marianas </option>
<option value="MS">Mississippi </option>
<option value="MT">Montana </option>
<option value="NC">North Carolina </option>
<option value="ND">North Dakota </option>
<option value="NE">Nebraska </option>
<option value="NH">New Hampshire </option>
<option value="NJ">New Jersey </option>
<option value="NM">New Mexico </option>
<option value="NV">Nevada </option>
<option value="NY">New York </option>
<option value="OH">Ohio </option>
<option value="OK">Oklahoma </option>
<option value="OR">Oregon </option>
<option value="PA">Pennsylvania </option>
<option value="PR">Puerto Rico </option>
<option value="PW">Palau </option>
<option value="RI">Rhode Island </option>
<option value="SC">South Carolina </option>
<option value="SD">South Dakota </option>
<option value="TN">Tennessee </option>
<option value="TX">Texas </option>
<option value="UT">Utah </option>
<option value="VA">Virginia </option>
<option value="VI">Virgin Islands </option>
<option value="VT">Vermont </option>
<option value="WA">Washington </option>
<option value="WI">Wisconsin </option>
<option value="WV">West Virginia </option>
<option value="WY">Wyoming </option>
<option value="AA">Military Americas </option>
<option value="AE">Military Europe/ME/Canada </option>
<option value="AP">Military Pacific </option>
<option value="AB">Alberta </option>
<option value="MB">Manitoba </option>
<option value="BC">British Columbia </option>
<option value="NB">New Brunswick </option>
<option value="NL">Newfoundland and Labrador </option>
<option value="NS">Nova Scotia </option>
<option value="NT">Northwest Territories </option>
<option value="NU">Nunavut </option>
<option value="ON">Ontario </option>
<option value="PE">Prince Edward Island </option>
<option value="QC">Quebec </option>
<option value="SK">Saskatchewan </option>
<option value="YT">Yukon Territory </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement0" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe293">Country <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe293" name="country" style="width:100%;" data-value="">
<option value="">-- Please Select -- </option>
<option value="US">United States </option>
<option value="CA">Canada </option>
<option value="GB">United Kingdom </option>
<option value="XX">Other </option>
<!--
<option value="IN">India
</option>
<option value="NL">Netherlands
</option>
<option value="AU">Australia
</option>
<option value="ZA">South Africa
</option>
<option value="FR">France
</option>
<option value="DE">Germany
</option>
<option value="SG">Singapore
</option>
<option value="SE">Sweden
</option>
<option value="BR">Brazil
</option>
<option value="">--------------
</option>
<option value="AF">Afghanistan
</option>
<option value="AX">Åland Islands
</option>
<option value="AL">Albania
</option>
<option value="DZ">Algeria
</option>
<option value="AS">American Samoa
</option>
<option value="AD">Andorra
</option>
<option value="AO">Angola
</option>
<option value="AI">Anguilla
</option>
<option value="AQ">Antarctica
</option>
<option value="AG">Antigua and Barbuda
</option>
<option value="AR">Argentina
</option>
<option value="AM">Armenia
</option>
<option value="AW">Aruba
</option>
<option value="AU">Australia
</option>
<option value="AT">Austria
</option>
<option value="AZ">Azerbaijan
</option>
<option value="BS">Bahamas
</option>
<option value="BH">Bahrain
</option>
<option value="BD">Bangladesh
</option>
<option value="BB">Barbados
</option>
<option value="BY">Belarus
</option>
<option value="BE">Belgium
</option>
<option value="BZ">Belize
</option>
<option value="BJ">Benin
</option>
<option value="BM">Bermuda
</option>
<option value="BT">Bhutan
</option>
<option value="BO">Bolivia
</option>
<option value="BA">Bosnia and Herzegovina
</option>
<option value="BW">Botswana
</option>
<option value="BV">Bouvet Island
</option>
<option value="BR">Brazil
</option>
<option value="IO">Brit/Indian Ocean Terr.
</option>
<option value="BN">Brunei Darussalam
</option>
<option value="BG">Bulgaria
</option>
<option value="BF">Burkina Faso
</option>
<option value="BI">Burundi
</option>
<option value="KH">Cambodia
</option>
<option value="CM">Cameroon
</option>
<option value="CA">Canada
</option>
<option value="CV">Cape Verde
</option>
<option value="KY">Cayman Islands
</option>
<option value="CF">Central African Republic
</option>
<option value="TD">Chad
</option>
<option value="CL">Chile
</option>
<option value="CN">China
</option>
<option value="CX">Christmas Island
</option>
<option value="CC">Cocos (Keeling) Islands
</option>
<option value="CO">Colombia
</option>
<option value="KM">Comoros
</option>
<option value="CG">Congo
</option>
<option value="CD">Congo, The Dem. Republic Of
</option>
<option value="CK">Cook Islands
</option>
<option value="CR">Costa Rica
</option>
<option value="CI">Côte d'Ivoire
</option>
<option value="HR">Croatia
</option>
<option value="CU">Cuba
</option>
<option value="CY">Cyprus
</option>
<option value="CZ">Czech Republic
</option>
<option value="DK">Denmark
</option>
<option value="DJ">Djibouti
</option>
<option value="DM">Dominica
</option>
<option value="DO">Dominican Republic
</option>
<option value="EC">Ecuador
</option>
<option value="EG">Egypt
</option>
<option value="SV">El Salvador
</option>
<option value="GQ">Equatorial Guinea
</option>
<option value="ER">Eritrea
</option>
<option value="EE">Estonia
</option>
<option value="ET">Ethiopia
</option>
<option value="FK">Falkland Islands
</option>
<option value="FO">Faroe Islands
</option>
<option value="FJ">Fiji
</option>
<option value="FI">Finland
</option>
<option value="FR">France
</option>
<option value="GF">French Guiana
</option>
<option value="PF">French Polynesia
</option>
<option value="TF">French Southern Terr.
</option>
<option value="GA">Gabon
</option>
<option value="GM">Gambia
</option>
<option value="GE">Georgia
</option>
<option value="DE">Germany
</option>
<option value="GH">Ghana
</option>
<option value="GI">Gibraltar
</option>
<option value="GB">United Kingdom
</option>
<option value="GR">Greece
</option>
<option value="GL">Greenland
</option>
<option value="GD">Grenada
</option>
<option value="GP">Guadeloupe
</option>
<option value="GU">Guam
</option>
<option value="GT">Guatemala
</option>
<option value="GN">Guinea
</option>
<option value="GW">Guinea-Bissau
</option>
<option value="GY">Guyana
</option>
<option value="HT">Haiti
</option>
<option value="HM">Heard/McDonald Isls.
</option>
<option value="HN">Honduras
</option>
<option value="HK">Hong Kong
</option>
<option value="HU">Hungary
</option>
<option value="IS">Iceland
</option>
<option value="IN">India
</option>
<option value="ID">Indonesia
</option>
<option value="IR">Iran
</option>
<option value="IQ">Iraq
</option>
<option value="IE">Ireland
</option>
<option value="IL">Israel
</option>
<option value="IT">Italy
</option>
<option value="JM">Jamaica
</option>
<option value="JP">Japan
</option>
<option value="JO">Jordan
</option>
<option value="KZ">Kazakhstan
</option>
<option value="KE">Kenya
</option>
<option value="KI">Kiribati
</option>
<option value="KP">Korea (North)
</option>
<option value="KR">Korea (South)
</option>
<option value="KW">Kuwait
</option>
<option value="KG">Kyrgyzstan
</option>
<option value="LA">Laos
</option>
<option value="LV">Latvia
</option>
<option value="LB">Lebanon
</option>
<option value="LS">Lesotho
</option>
<option value="LR">Liberia
</option>
<option value="LY">Libya
</option>
<option value="LI">Liechtenstein
</option>
<option value="LT">Lithuania
</option>
<option value="LU">Luxembourg
</option>
<option value="MO">Macau
</option>
<option value="MK">Macedonia
</option>
<option value="MG">Madagascar
</option>
<option value="MW">Malawi
</option>
<option value="MY">Malaysia
</option>
<option value="MV">Maldives
</option>
<option value="ML">Mali
</option>
<option value="MT">Malta
</option>
<option value="MH">Marshall Islands
</option>
<option value="MQ">Martinique
</option>
<option value="MR">Mauritania
</option>
<option value="MU">Mauritius
</option>
<option value="YT">Mayotte
</option>
<option value="MX">Mexico
</option>
<option value="FM">Micronesia
</option>
<option value="MD">Moldova
</option>
<option value="MC">Monaco
</option>
<option value="MN">Mongolia
</option>
<option value="MS">Montserrat
</option>
<option value="MA">Morocco
</option>
<option value="MZ">Mozambique
</option>
<option value="MM">Myanmar
</option>
<option value="MP">N. Mariana Isls.
</option>
<option value="NA">Namibia
</option>
<option value="NR">Nauru
</option>
<option value="NP">Nepal
</option>
<option value="NL">Netherlands
</option>
<option value="AN">Netherlands Antilles
</option>
<option value="NC">New Caledonia
</option>
<option value="NZ">New Zealand
</option>
<option value="NI">Nicaragua
</option>
<option value="NE">Niger
</option>
<option value="NG">Nigeria
</option>
<option value="NU">Niue
</option>
<option value="NF">Norfolk Island
</option>
<option value="NO">Norway
</option>
<option value="OM">Oman
</option>
<option value="PK">Pakistan
</option>
<option value="PW">Palau
</option>
<option value="PS">Palestinian Territory, Occupied
</option>
<option value="PA">Panama
</option>
<option value="PG">Papua New Guinea
</option>
<option value="PY">Paraguay
</option>
<option value="PE">Peru
</option>
<option value="PH">Philippines
</option>
<option value="PN">Pitcairn
</option>
<option value="PL">Poland
</option>
<option value="PT">Portugal
</option>
<option value="PR">Puerto Rico
</option>
<option value="QA">Qatar
</option>
<option value="RE">Reunion
</option>
<option value="RO">Romania
</option>
<option value="RU">Russian Federation
</option>
<option value="RW">Rwanda
</option>
<option value="KN">Saint Kitts and Nevis
</option>
<option value="LC">Saint Lucia
</option>
<option value="WS">Samoa
</option>
<option value="SM">San Marino
</option>
<option value="ST">Sao Tome/Principe
</option>
<option value="SA">Saudi Arabia
</option>
<option value="SN">Senegal
</option>
<option value="CS">Serbia and Montenegro
</option>
<option value="SC">Seychelles
</option>
<option value="SL">Sierra Leone
</option>
<option value="SG">Singapore
</option>
<option value="SK">Slovak Republic
</option>
<option value="SI">Slovenia
</option>
<option value="SB">Solomon Islands
</option>
<option value="SO">Somalia
</option>
<option value="ZA">South Africa
</option>
<option value="ES">Spain
</option>
<option value="LK">Sri Lanka
</option>
<option value="SH">St. Helena
</option>
<option value="PM">St. Pierre and Miquelon
</option>
<option value="VC">St. Vincent and Grenadines
</option>
<option value="SD">Sudan
</option>
<option value="SR">Suriname
</option>
<option value="SJ">Svalbard/Jan Mayen Isls.
</option>
<option value="SZ">Swaziland
</option>
<option value="SE">Sweden
</option>
<option value="CH">Switzerland
</option>
<option value="SY">Syria
</option>
<option value="TW">Taiwan
</option>
<option value="TJ">Tajikistan
</option>
<option value="TZ">Tanzania
</option>
<option value="TH">Thailand
</option>
<option value="TL">Timor-Leste
</option>
<option value="TG">Togo
</option>
<option value="TK">Tokelau
</option>
<option value="TO">Tonga
</option>
<option value="TT">Trinidad and Tobago
</option>
<option value="TN">Tunisia
</option>
<option value="TR">Turkey
</option>
<option value="TM">Turkmenistan
</option>
<option value="TC">Turks/Caicos Isls.
</option>
<option value="TV">Tuvalu
</option>
<option value="UG">Uganda
</option>
<option value="UA">Ukraine
</option>
<option value="AE">United Arab Emirates
</option>
<option value="US">United States
</option>
<option value="UM">US Minor Outlying Is.
</option>
<option value="UY">Uruguay
</option>
<option value="UZ">Uzbekistan
</option>
<option value="VU">Vanuatu
</option>
<option value="VA">Vatican City
</option>
<option value="VE">Venezuela
</option>
<option value="VN">Viet Nam
</option>
<option value="VG">Virgin Islands (British)
</option>
<option value="VI">Virgin Islands (U.S.)
</option>
<option value="WF">Wallis/Futuna Isls.
</option>
<option value="EH">Western Sahara
</option>
<option value="YE">Yemen
</option>
<option value="ZM">Zambia
</option>
<option value="ZW">Zimbabwe
</option> -->
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-6 col-xs-12">
<div id="formElement5" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe270">Email Address <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="emailAddress" id="fe270" value="jane.burigsay@ssa.gov" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="cmp-text">
<p> <span class="elq-required"><em>* Required</em></span></p>
</div>
<div class="container mb-5 mt-5" style="margin-top:15px;">
<div class="row">
<div class="col">
<p><strong>Special Communications </strong></p>
<div class="group-1"><!--Group 1 -->
<div class="row">
<div class="col">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement8" class="elq-field-style form-element-layout row">
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div>
<input type="checkbox" name="prwEbooks" id="prwEbooks" onclick="if(checked==true) {this.form.Unsubscribe.checked=false;}">
<label class="checkbox-aligned elq-item-label" for="fe275">eBooks/Research/Whitepapers </label>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement8" class="elq-field-style form-element-layout row">
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div>
<input type="checkbox" name="prwEdit" id="prwEdit" onclick="if(checked==true) {this.form.Unsubscribe.checked=false;}">
<label class="checkbox-aligned elq-item-label" for="fe279">Editorial Promotions </label>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement8" class="elq-field-style form-element-layout row">
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div>
<input type="checkbox" name="prwLive" id="prwLive" onclick="if(checked==true) {this.form.Unsubscribe.checked=false;}">
<label class="checkbox-aligned elq-item-label" for="fe273">Live Events/Recognition Programs/Awards </label>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col">
<div class="grid-layout-col">
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