{"id":108544,"date":"2024-02-23T12:24:47","date_gmt":"2024-02-23T11:24:47","guid":{"rendered":"https:\/\/www.fbcv.es\/?page_id=108544"},"modified":"2024-02-23T12:28:35","modified_gmt":"2024-02-23T11:28:35","slug":"autorizacion-campeonato-espana","status":"publish","type":"page","link":"https:\/\/www.fbcv.es\/va\/autorizacion-campeonato-espana\/","title":{"rendered":"Autorizaci\u00f3n Campeonato Espa\u00f1a"},"content":{"rendered":"<div id=\"tdi_1\" class=\"tdc-zone\"><div class=\"tdc_zone tdi_2  wpb_row td-pb-row\"  >\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_2{\r\n                    min-height: 0;\r\n                }\n<\/style><div id=\"tdi_3\" class=\"tdc-row stretch_row_content td-stretch-content\"><div class=\"vc_row tdi_4  wpb_row td-pb-row\" >\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_4,\r\n                .tdi_4 .tdc-columns{\r\n                    min-height: 0;\r\n                }.tdi_4,\r\n\t\t\t\t.tdi_4 .tdc-columns{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_4 .tdc-columns{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_4:before,\r\n\t\t\t\t.tdi_4:after{\r\n\t\t\t\t    display: table;\r\n\t\t\t\t}\n<\/style><div class=\"vc_column tdi_6  wpb_column vc_column_container tdc-column td-pb-span12\">\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_6{\r\n                    vertical-align: baseline;\r\n                }.tdi_6 > .wpb_wrapper,\r\n\t\t\t\t.tdi_6 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_6 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_6 > .wpb_wrapper > .vc_row_inner{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t}.tdi_6 > .wpb_wrapper{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t    height: auto;\r\n\t\t\t\t}\n<\/style><div class=\"wpb_wrapper\" ><div class=\"wpb_wrapper td_block_wrap vc_raw_html tdi_8\"><div class=\"td-fix-index\"><div class=\"stripes big estatico pg-fbcv\">\n<div class=\"tira1\"><\/div>\n<div class=\"tira2\"><\/div>\n\n<div class=\"tira4\"><\/div>\n<div class=\"tira5\"><\/div>\n<div class=\"tira6\"><\/div>\n<div class=\"tira7\"><\/div>\n<div class=\"tira8\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"tdi_9\" class=\"tdc-row\"><div class=\"vc_row tdi_10  wpb_row td-pb-row\" >\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_10,\r\n                .tdi_10 .tdc-columns{\r\n                    min-height: 0;\r\n                }.tdi_10,\r\n\t\t\t\t.tdi_10 .tdc-columns{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_10 .tdc-columns{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_10:before,\r\n\t\t\t\t.tdi_10:after{\r\n\t\t\t\t    display: table;\r\n\t\t\t\t}\n<\/style><div class=\"vc_column tdi_12  wpb_column vc_column_container tdc-column td-pb-span12\">\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_12{\r\n                    vertical-align: baseline;\r\n                }.tdi_12 > .wpb_wrapper,\r\n\t\t\t\t.tdi_12 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_12 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_12 > .wpb_wrapper > .vc_row_inner{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t}.tdi_12 > .wpb_wrapper{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t    height: auto;\r\n\t\t\t\t}\n<\/style><div class=\"wpb_wrapper\" ><div class=\"wpb_wrapper td_block_wrap vc_raw_html tdi_14 encima\"><div class=\"td-fix-index\"><div class=\"breadcrumbs breadcrumb-basica\"> <a href=\"\/va\/\">Inici <\/a>  <span> &gt; <\/span>  <a href=\"https:\/\/www.fbcv.es\/va\/actividades\/\">Activitats<\/a>  <span> &gt; <\/span>  <a href=\"\/va\/actividades\/autorizacion-preseleccion-autonomica-3x3\/\"><b>Autorizaci\u00f3n Campeonato de Espa\u00f1a<\/b><\/a>  \n<\/div><\/div><\/div><div class=\"wpb_wrapper td_block_wrap vc_raw_html tdi_16\"><div class=\"td-fix-index\"><h1 class=\"titulo-pagina-fbcv\">Autorizaci\u00f3n Campeonato de Espa\u00f1a<\/h1><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"tdi_17\" class=\"tdc-row\"><div class=\"vc_row tdi_18  wpb_row td-pb-row\" >\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_18,\r\n                .tdi_18 .tdc-columns{\r\n                    min-height: 0;\r\n                }.tdi_18,\r\n\t\t\t\t.tdi_18 .tdc-columns{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_18 .tdc-columns{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_18:before,\r\n\t\t\t\t.tdi_18:after{\r\n\t\t\t\t    display: table;\r\n\t\t\t\t}\n<\/style><div class=\"vc_column tdi_20  wpb_column vc_column_container tdc-column td-pb-span12\">\n<style scoped>\n\/* custom css - generated by TagDiv Composer *\/\n\n\/* custom css - generated by TagDiv Composer *\/\n.tdi_20{\r\n                    vertical-align: baseline;\r\n                }.tdi_20 > .wpb_wrapper,\r\n\t\t\t\t.tdi_20 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    display: block;\r\n\t\t\t\t}.tdi_20 > .wpb_wrapper > .tdc-elements{\r\n\t\t\t\t    width: 100%;\r\n\t\t\t\t}.tdi_20 > .wpb_wrapper > .vc_row_inner{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t}.tdi_20 > .wpb_wrapper{\r\n\t\t\t\t    width: auto;\r\n\t\t\t\t    height: auto;\r\n\t\t\t\t}\n<\/style><div class=\"wpb_wrapper\" ><div class=\"td_block_wrap td_block_text_with_title tdi_21 tagdiv-type td-pb-border-top td_block_template_9\"  data-td-block-uid=\"tdi_21\" >\n<style>\n\/* custom css - generated by TagDiv Composer *\/\n.td_block_text_with_title{\r\n                  margin-bottom: 44px;\r\n                  -webkit-transform: translateZ(0);\r\n                  transform: translateZ(0);\r\n                }.td_block_text_with_title p:last-child{\r\n                  margin-bottom: 0;\r\n                }\n<\/style><div class=\"td-block-title-wrap\"><\/div><div class=\"td_mod_wrap td-fix-index\"><div class=\"frm_forms  with_frm_style frm_style_estilos-formidable\" id=\"frm_form_22_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form\" id=\"form_autorizacindeljugadoralevn2generacin2011600c3687ab7f06f952f5\" action=\"\" >\n<div class=\"frm_form_fields\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Plataforma de env\u00edo autorizaci\u00f3n Campeonato Espa\u00f1a<\/legend>\r\n\r\n<div class=\"frm_description\"><p>RELLENAR el formulario y ADJUNTAR Autorizaciones de cada jugador\/a.<\/p>\n<\/div><div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"22\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_22\" id=\"frm_hide_fields_22\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"autorizacindeljugadoralevn2generacin2011600c3687ab7f06f952f5\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_22\" name=\"frm_submit_entry_22\" value=\"8dd34e6b77\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/va\/wp-json\/wp\/v2\/pages\/108544\" \/><div id=\"frm_field_373_container\" class=\"frm_form_field form-field  frm_required_field frm_left_container frm12 frm_first\">\r\n    <label for=\"field_b5fx1c829d96bb86a1d760a33\" id=\"field_b5fx1c829d96bb86a1d760a33_label\" class=\"frm_primary_label\">DNI del jugador\/a\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_b5fx1c829d96bb86a1d760a33\" name=\"item_meta[373]\" value=\"\"  data-reqmsg=\"Este campo no puede estar vac\u00edo.\" aria-required=\"true\" data-invmsg=\"Texto no es v\u00e1lido\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_b5fx1c829d96bb86a1d760a33\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_b5fx1c829d96bb86a1d760a33\">Sin espacios 00000000A<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_374_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <div  id=\"field_4cl8vb57a594ca114a657a60e_label\" class=\"frm_primary_label\">Datos del jugador\/a\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_4cl8vb57a594ca114a657a60e_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tDatos del jugador\/a\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_374\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_374-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_4cl8vb57a594ca114a657a60e_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tNom\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_4cl8vb57a594ca114a657a60e_first\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[374][first]\"  data-reqmsg=\"Este campo no puede estar vac\u00edo.\" aria-required=\"true\" data-invmsg=\"Datos del jugador\/a is invalid\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_374_first_desc\">Nom<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_374-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_4cl8vb57a594ca114a657a60e_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tCognoms\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_4cl8vb57a594ca114a657a60e_last\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[374][last]\"  data-reqmsg=\"Este campo no puede estar vac\u00edo.\" aria-required=\"true\" data-invmsg=\"Datos del jugador\/a is invalid\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_374_last_desc\">Cognoms<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_375_container\" class=\"frm_form_field  frm6 frm_first frm_html_container form-field\">\n<p><a href=\"https:\/\/www.fbcv.es\/wp-content\/uploads\/2025\/03\/Autorizacion-viaje.pdf\">Autoritzaci\u00f3 <\/a><\/p>\n<p><a href=\"https:\/\/www.fbcv.es\/wp-content\/uploads\/2025\/03\/Autorizacion-Menores-FEB.pdf\">Autorizaci\u00f3n FEB <\/a><\/p>\n<\/div>\n<div id=\"frm_field_376_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_ydlgtfe75c69ef1a1ec018649\" id=\"field_ydlgtfe75c69ef1a1ec018649_label\" class=\"frm_primary_label\">Adjuntar las AUTORIZACIONES\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-reqmsg=\"Este campo no puede estar vac\u00edo.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[376][]\"  value=\"\"  data-frmfile=\"376\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file376_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file376[]\" id=\"field_ydlgtfe75c69ef1a1ec018649\"\n\t\t\t data-frmfile=\"376\" multiple=\"multiple\"  data-reqmsg=\"Este campo no puede estar vac\u00edo.\" data-invmsg=\"Subida de archivo no es v\u00e1lido\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix\"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewbox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewbox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Adjuntar las AUTORIZACIONES. Arrastra aqu\u00ed la AUTORIZACI\u00d3N (firmada y rellenada). Maximum file size: 5MB\">Arrastra aqu\u00ed la AUTORIZACI\u00d3N (firmada y rellenada)<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Adjuntar las AUTORIZACIONES. Seleccionar Archivo. Maximum file size: 5MB\">Seleccionar Archivo<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 5MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_377_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">Se informa al firmante que la finalidad de esta recogida de datos de car\u00e1cter personal es la de gestionar la participaci\u00f3n del menor en el Programa de Tecnificaci\u00f3n de la FBCV. Los datos identificativos del menor podr\u00e1n ser\u00e1n comunicados a agencias de viajes, hoteles y empresas de transporte con la finalidad de gestionar sus desplazamientos cuando estos sean organizados por la FBCV. Los datos identificativos (nombre e imagen), antropom\u00e9tricos y deportivos del menor podr\u00e1n ser mostrados en los sitios web y redes sociales de la FBCV, as\u00ed como en videos, material promocional y\/o publicitario, material formativo y manuales deportivos siendo las im\u00e1genes tomadas exclusivamente durante el desarrollo de entrevistas, reuniones, entrenamientos, partidos, concentraciones, campeonatos, cursos o conferencias asociados al Programa de Tecnificaci\u00f3n de la FBCV, respetando siempre la dignidad y honor personal del menor. En cualquier caso, podr\u00e1 ejercitar gratuitamente los derechos de acceso, rectificaci\u00f3n, cancelaci\u00f3n y oposici\u00f3n dirigi\u00e9ndose al Responsable del Fichero, la Federaci\u00f3n Baloncesto Comunidad Valenciana (FBCV), en Monestir de Poblet, 14 - 1\u00ba - 3\u00aa 46015 Valencia.<\/div>\n<div id=\"frm_field_378_container\" class=\"frm_form_field frm_section_heading frm_hidden frm_invisible_section form-field\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">REVISI\u00d3N<\/h3>\r\n\r\n\r\n<div id=\"frm_field_382_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first vertical_radio\">\r\n    <div  id=\"field_833my3d4f525013_label\" class=\"frm_primary_label\">CTO \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_833my3d4f525013_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_382-378-2\">\t\t\t<label  for=\"field_833my3d4f525013-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[382]\" id=\"field_833my3d4f525013-2\" value=\"3\u00ba PERSONAS\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"CTO  is invalid\" aria-invalid=\"false\"  \/> 3\u00ba PERSONAS<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_382-378-3\">\t\t\t<label  for=\"field_833my3d4f525013-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[382]\" id=\"field_833my3d4f525013-3\" value=\"PARADA VLC\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"CTO  is invalid\" aria-invalid=\"false\"  \/> PARADA VLC<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_382-378-4\">\t\t\t<label  for=\"field_833my3d4f525013-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[382]\" id=\"field_833my3d4f525013-4\" value=\"PARADA CST\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"CTO  is invalid\" aria-invalid=\"false\"  \/> PARADA CST<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_382-378-5\">\t\t\t<label  for=\"field_833my3d4f525013-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[382]\" id=\"field_833my3d4f525013-5\" value=\"PARADA ALC\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"CTO  is invalid\" aria-invalid=\"false\"  \/> PARADA ALC<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_382-378-6\">\t\t\t<label  for=\"field_833my3d4f525013-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[382]\" id=\"field_833my3d4f525013-6\" value=\"NO bus\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"CTO  is invalid\" aria-invalid=\"false\"  \/> NO bus<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_667_container\" class=\"frm_form_field form-field  frm_top_container frm6 vertical_radio\">\r\n    <div  id=\"field_7xrua_label\" class=\"frm_primary_label\">FEB Autorizaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_7xrua_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_667-378-2\">\t\t\t<label  for=\"field_7xrua-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[667]\" id=\"field_7xrua-2\" value=\"SI\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"FEB Autorizaci\u00f3n is invalid\" aria-invalid=\"false\"  \/> SI<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_667-378-3\">\t\t\t<label  for=\"field_7xrua-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[667]\" id=\"field_7xrua-3\" value=\"No\"\n\t\t   data-sectionid=\"378\" data-invmsg=\"FEB Autorizaci\u00f3n is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1894_container\" class=\"frm_form_field form-field\">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Enviar<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__666a97c8669f0\">\n\t\t\t\t<label for=\"frm_email_22\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_22\" type=\"text\" class=\"frm_verify\" name=\"frm__666a97c8669f0\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"IBcCNQkNg9C4BUYSwjyYGTDiGuYwo35ihtXtFtX+686uVR\/fDWnSVJncCnAJiFsl\" \/><\/div>\n<\/fieldset>\n<\/div>\n<input type=\"hidden\" name=\"trp-form-language\" 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