Select Page
<style type="text/css">
.beta-base .preheader, .beta-base .header, .beta-base .sidebar, .beta-base .body, .beta-base .footer, #mainContent {
    text-align: start;
}
.beta-base .preheader, .beta-base .header, .beta-base .body, .beta-base .sidebar, .beta-base .leftSidebar, .beta-base .rightSidebar, .beta-base .footer {
    margin: 0;
    padding: 0;
    border: none;
    white-space: normal;
    line-height: normal;
}
.beta-base .title, .beta-base .subtitle, .beta-base .text, .beta-base img {
    margin: 0;
    padding: 0;
    background: none;
    border: none;
    white-space: normal;
    line-height: normal;
}
.beta-base .bodyContainer td.preheader{
    padding: 10px 0;
}
.beta-base .bodyContainer td.header {
    padding: 0;
    height: 30px;
}
.beta-base .bodyContainer td.body, .beta-base .bodyContainer td.footer,
.beta-base .bodyContainer td.sidebar, .beta-base .bodyContainer td.leftSidebar, .beta-base .bodyContainer td.rightSidebar {
    padding: 20px;
}
.beta-base .bodyContainer td.header p, .beta-base .bodyContainer td.preheader p, .beta-base .bodyContainer td.body p,
.beta-base .bodyContainer td.footer p, .beta-base .bodyContainer td.sidebar p,
.beta-base .bodyContainer td.leftSidebar p, .beta-base .bodyContainer td.rightSidebar p {
    margin: 0;
    color: inherit;
}
.beta-base .bodyContainer td.header div.title, .beta-base .bodyContainer td.preheader div.title, .beta-base .bodyContainer td.body div.title,
.beta-base .bodyContainer td.footer div.title, .beta-base .bodyContainer td.sidebar div.title,
.beta-base .bodyContainer td.leftSidebar div.title, .beta-base .bodyContainer td.rightSidebar div.title,
.beta-base .bodyContainer td.header div.subtitle, .beta-base .bodyContainer td.preheader div.subtitle, .beta-base .bodyContainer td.body div.subtitle,
.beta-base .bodyContainer td.footer div.subtitle, .beta-base .bodyContainer td.sidebar div.subtitle,
.beta-base .bodyContainer td.leftSidebar div.subtitle, .beta-base .bodyContainer td.rightSidebar div.subtitle,
.beta-base .bodyContainer td.header div.text, .beta-base .bodyContainer td.preheader div.text, .beta-base .bodyContainer td.body div.text, .beta-base .bodyContainer td.body div.text div,
.beta-base .bodyContainer td.footer div.text, .beta-base .bodyContainer td.sidebar div.text,
.beta-base .bodyContainer td.leftSidebar div.text, .beta-base .bodyContainer td.rightSidebar div.text {
    overflow: auto;
}
.beta-base .optout {
    margin-bottom: 10px;
    margin-top: 10px;
}
div.infusion-captcha {
    width: 220px;
    padding: 10px;
}
div.infusion-captcha input, div.infusion-captcha select, div.infusion-captcha textarea {
    width: 95%;
    display: inline-block;
    vertical-align: middle;
}
table.infusion-field-container td.infusion-field-input-container {
    padding-bottom: 12px;
}
table.infusion-field-container td + .infusion-field-input-container {
    padding-bottom: 0 !important;
}
table.infusion-field-container td + .infusion-field-label-container {
    padding-bottom: 12px !important;
}
table.infusion-field-container td.infusion-field-input-container input[type='text'],
table.infusion-field-container td.infusion-field-input-container input[type='password'],
table.infusion-field-container td.infusion-field-input-container textarea {
    width: 100%;
    margin: 0;
}
table.infusion-field-container td.infusion-field-input-container input[type='text'],
table.infusion-field-container td.infusion-field-input-container input[type='password'],
table.infusion-field-container td.infusion-field-input-container select {
    background-color: #fff;
    border-radius: 6px;
    border: 1px solid #ddd;
    box-sizing: border-box;
    padding: 8px 16px;
    height: 40px;
    line-height: normal;
    outline: none;
    -webkit-appearance: none;
    -webkit-transition: border .3s ease;
    transition: border .3s ease;
}
table.infusion-field-container td.infusion-field-input-container select {
    background-image: url("data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' viewBox='0 0 24 24' id='chevron-down'%3E%3Cpath d='M6.293 9.293a1 1 0 0 1 1.414 0L12 13.586l4.293-4.293a1 1 0 1 1 1.414 1.414l-5 5a1 1 0 0 1-1.414 0l-5-5a1 1 0 0 1 0-1.414z' fill-rule='evenodd'%3E%3C/path%3E%3C/svg%3E");
    background-size: 20px;
    background-position: calc(100% - 6px) center;
    background-repeat: no-repeat;
}
table.infusion-field-container td.infusion-field-input-container select {
    width: 100%;
    margin: 0;
}
table.infusion-field-container td.infusion-field-input-container select.infusion-multiselect {
    height: auto;
    background-image: none;
}
table.infusion-field-container td.infusion-field-input-container input[type='text']:focus,
table.infusion-field-container td.infusion-field-input-container input[type='password']:focus {
    border-color: #bbb;
}
table.infusion-field-container td.infusion-field-label-container {
    padding-right: 5px;
    max-width: 200px;
}
td.header .image-snippet img {
    vertical-align: bottom;
}
#webformErrors {
    color: #990000;
    font-size: 14px;
}
html, body {
    margin: 0;
    padding: 0;
    height: 100%;
}
.infusion-form {
    margin: 0;
    height: 100%;
}
.infusion-option {
    display: block;
    text-align: left;
}
@media only screen and (max-width: 675px) {
    .infusion-form .infusion-field-container,
    .infusion-form .infusion-field-container tr,
    .infusion-form .infusion-field-container td,
    .infusion-form .infusion-field-container tbody {
        display: block;
    }
    .infusion-form .infusion-field-container .pika-table tr {
        display: table-row !important;
        margin-bottom: 0 !important;
    }
    .infusion-form .infusion-field-container .pika-table td {
        display: table-cell !important;
    }
    .infusion-form .infusion-field-container .pika-table tbody {
        display: table-row-group !important;
    }
    .infusion-form table.bodyContainer {
        width: 100% !important;
    }
    .infusion-form img {
        max-width: 100%;
        height: auto;
    }
    .infusion-form .image-snippet[contentid="spotlight"] {
        width: 64px;
    }
    .infusion-form .infusion-field-input-container {
        width: 100% !important;
    }
    .infusion-form .video-container iframe {
        width: 100%;
    }
    .infusion-form .infusion-submit button {
        width: 100% !important;
    }
}
</style><style type="text/css">
.beta-font-b h1, .beta-font-b h2, .beta-font-b h3, .beta-font-b h4, .beta-font-b h5, .beta-font-b h6 {
    font-family: arial,sans-serif;
}
.beta-font-b h1 {font-size: 24px;}
.beta-font-b h2 {font-size: 20px;}
.beta-font-b h3 {font-size: 14px;}
.beta-font-b h4 {font-size: 12px;}
.beta-font-b h5 {font-size: 10px;}
.beta-font-b h6 {font-size: 8px;}
.beta-font-b address {font-style: italic;}
.beta-font-b pre {font-family: Courier New, monospace;}
.beta-font-b .title, .beta-font-b .title p {
    font-size: 20px;
    font-weight: bold;
    font-family: arial,sans-serif;
}
.beta-font-b .subtitle, .beta-font-b .subtitle p {
    font-size: 11px;
    font-weight: normal;
    font-family: arial,sans-serif;
}
.beta-font-b .text, .beta-font-b p {
    font-size: 12px;
    font-family: arial,sans-serif;
}
.beta-font-b .preheader .text, .beta-font-b .preheader .text p {
    font-size: 11px;
    font-family: arial,sans-serif;
}
.beta-font-b .footer a {
    font-size: 11px;
    font-family: arial,sans-serif;
}
.beta-font-b .footer .text {
    font-size: 10px;
    font-family: verdana,sans-serif;
}
.beta-font-b .sidebar .title, .beta-font-b .leftSidebar .title, .beta-font-b .rightSidebar .title {
    font-size: 15px;
    font-weight: bold;
    font-family: arial,sans-serif;
}
.beta-font-b .sidebar .subtitle, .beta-font-b .leftSidebar .subtitle, .beta-font-b .rightSidebar .subtitle {
    font-size: 12px;
    font-family: arial, sans-serif;
}
.beta-font-b .sidebar .text, .beta-font-b .sidebar .text p, .beta-font-b .leftSidebar .text, .beta-font-b .rightSidebar .text {
    font-size: 11px;
    font-family: arial, sans-serif;
}
.infusion-field-label-container {
    font-size: 14px;
    font-family: arial,sans-serif;
}
.infusion-field-input-container {
    color: #000000;
    font-size: 12px;
}
.infusion-option label {
    color: #000000;
    font-size: 14px;
    font-family: arial,sans-serif;
}
</style><style type="text/css">
.default .background{
background-color:#FFFFFF;
;
}
.default .title{
color:#000000;
;
}
.default .subtitle{
color:#000000;
;
}
.default .text{
color:#000000;
;
}
.default a{
color:#0645AD;
;
}
.default .background .preheader .text{
color:#1a242e;
;
}
.default .background .preheader a{
color:#0645ad;
;
}
.default .header{
background-color:#FFFFFF;
;
}
.default .header .title{
color:#000000;
;
}
.default .header .subtitle{
color:#000000;
;
}
.default .header .text{
color:#000000;
;
}
.default .header .a{
color:#157db8;
;
}
.default .hero{
background-color:#025c8d;
;
}
.default .hero .title{
color:#ffffff;
;
}
.default .hero .subtitle{
color:#ffffff;
;
}
.default .hero .text{
color:#ffffff;
;
}
.default .hero .a{
color:#157db8;
;
}
.default .quote{
background-color:#013b5a;
;
}
.default .quote:after{
border-color:#013b5a transparent transparent transparent;
;
}
.default .quote .title{
color:#ffffff;
;
}
.default .quote .subtitle{
color:#ffffff;
;
}
.default .quote .text{
color:#ffffff;
;
}
.default .quote .a{
color:#157db8;
;
}
.default .body{
background-color:#FFFFFF;
;
}
.default .main{
background-color:#ffffff;
;
}
.default .main .title{
color:#000000;
;
}
.default .main .subtitle{
color:#000000;
;
}
.default .main .text{
color:#000000;
;
}
.default .main .a{
color:#157db8;
;
}
.default .sidebar{
background-color:#ffffff;
;
}
.default .sidebar .title{
color:#000000;
;
}
.default .sidebar .subtitle{
color:#000000;
;
}
.default .sidebar .text{
color:#000000;
;
}
.default .sidebar .a{
color:#157db8;
;
}
.default .leftSidebar{
background-color:#ffffff;
;
}
.default .leftSidebar .title{
color:#f15c25;
;
}
.default .leftSidebar .subtitle{
color:#669940;
;
}
.default .rightSidebar{
background-color:#ffffff;
;
}
.default .rightSidebar .title{
color:#f15c25;
;
}
.default .rightSidebar .subtitle{
color:#669940;
;
}
.default .footer{
background-color:#FFFFFF;
;
}
.default .footer .text{
color:#0D0D0D;
;
}
.default .footer .title{
color:#000000;
;
}
.default .footer a{
color:#1B3BDE;
;
}
.default .footer .subtitle{
color:#000000;
;
}
.default .infusion-field-label-container{
font-size:16px;
;
}
.default .infusion-field-label-container{
font-family:Arial;
;
}
.default .infusion-field-label-container{
color:#000000;
;
}
.default .infusion-field-input{
font-size:16px;
;
}
.default .infusion-option label{
font-size:16px;
;
}
.default .infusion-option label{
font-family:Arial;
;
}
.default .infusion-option label{
color:#000000;
;
}
.default .webFormBodyContainer{
border-width:0px;
;
}
.default .webFormBodyContainer{
border-style:Hidden;
;
}
.default .webFormBodyContainer{
border-color:#000000;
;
}
</style><style type="text/css">
.infusion-field-label-container {
text-align:Left;
}
.infusion-field-input-container {
width:400px;
}
.infusion-field-label-container {
vertical-align:Middle;
}
.bodyContainer {
width:500px;
}
</style><script src="https://zv571.infusionsoft.app/app/webTracking/getTrackingCode?b=1.70.0.316372-hf-202101112002" type="text/javascript">
</script><script src="https://zv571.infusionsoft.com/resources/external/recaptcha/production/recaptcha.js?b=1.70.0.316372-hf-202101112002" type="text/javascript">
</script><script async="async" defer="defer" src="https://www.google.com/recaptcha/api.js?onload=onloadInfusionRecaptchaCallback&render=explicit" type="text/javascript">
</script><link href="https://cdnjs.cloudflare.com/ajax/libs/pikaday/1.5.1/css/pikaday.min.css" rel="stylesheet" type="text/css" />
  <div class="text" id="webformErrors" name="errorContent"> 
  </div> 
  <script src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.17.0/moment.min.js" type="text/javascript"></script>
  <script src="https://cdnjs.cloudflare.com/ajax/libs/pikaday/1.5.1/pikaday.min.js" type="text/javascript"></script>
  <form accept-charset="UTF-8" action="https://zv571.infusionsoft.com/app/form/process/a3c02e1668ce6b5219ba1cb54845c635" class="infusion-form" id="inf_form_a3c02e1668ce6b5219ba1cb54845c635" method="POST" name="CAIN Application Completed" onsubmit="submitWebForm()"> 
   <script type="text/javascript">
function submitWebForm() {
var form = document.forms[0];
var resolution = document.createElement('input');
resolution.setAttribute('id', 'screenResolution');
resolution.setAttribute('type', 'hidden');
resolution.setAttribute('name', 'screenResolution');
var resolutionString = screen.width + 'x' + screen.height;
resolution.setAttribute('value', resolutionString);
form.appendChild(resolution);
var pluginString = '';
if (window.ActiveXObject) {
    var activeXNames = {'AcroPDF.PDF':'Adobe Reader',
        'ShockwaveFlash.ShockwaveFlash':'Flash',
        'QuickTime.QuickTime':'Quick Time',
        'SWCtl':'Shockwave',
        'WMPLayer.OCX':'Windows Media Player',
        'AgControl.AgControl':'Silverlight'};
    var plugin = null;
    for (var activeKey in activeXNames) {
        try {
            plugin = null;
            plugin = new ActiveXObject(activeKey);
        } catch (e) {
            // do nothing, the plugin is not installed
        }
        pluginString += activeXNames[activeKey] + ',';
    }
    var realPlayerNames = ['rmockx.RealPlayer G2 Control',
        'rmocx.RealPlayer G2 Control.1',
        'RealPlayer.RealPlayer(tm) ActiveX Control (32-bit)',
        'RealVideo.RealVideo(tm) ActiveX Control (32-bit)',
        'RealPlayer'];
    for (var index = 0; index < realPlayerNames.length; index++) {
        try {
            plugin = new ActiveXObject(realPlayerNames[index]);
        } catch (e) {
            continue;
        }
        if (plugin) {
            break;
        }
    }
    if (plugin) {
        pluginString += 'RealPlayer,';
    }
} else {
    for (var i = 0; i < navigator.plugins.length; i++) {
        pluginString += navigator.plugins[i].name + ',';
    }
}
pluginString = pluginString.substring(0, pluginString.lastIndexOf(','));
var plugins = document.createElement('input');
plugins.setAttribute('id', 'pluginList');
plugins.setAttribute('type', 'hidden');
plugins.setAttribute('name', 'pluginList');
plugins.setAttribute('value', pluginString);
form.appendChild(plugins);
var java = navigator.javaEnabled();
var javaEnabled = document.createElement('input');
javaEnabled.setAttribute('id', 'javaEnabled');
javaEnabled.setAttribute('type', 'hidden');
javaEnabled.setAttribute('name', 'javaEnabled');
javaEnabled.setAttribute('value', java);
form.appendChild(javaEnabled);
jQuery('.infusion-submit button').attr('disabled', true);
}
</script>
   <input name="inf_form_xid" type="hidden" value="a3c02e1668ce6b5219ba1cb54845c635" />
   <input name="inf_form_name" type="hidden" value="CAIN Application Completed" />
   <input name="infusionsoft_version" type="hidden" value="1.70.0.316372" /> 
   <div class="default beta-base beta-font-b" id="mainContent" style="height:100%"> 
    <table cellpadding="10" cellspacing="0" class="background" style="width: 100%; height: 100%"><tbody><tr><td align="center" valign="top"> 
        <table bgcolor="#FFFFFF" cellpadding="20" cellspacing="0" class="bodyContainer webFormBodyContainer" width="100%"><tbody><tr><td bgcolor="#FFFFFF" class="body" sectionid="body" valign="top"> 
            <div> 
             <div style="height:15px; line-height:15px;">
               &nbsp; 
             </div> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_Iamapplyingfor">I am applying for: *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_custom_Iamapplyingfor" name="inf_custom_Iamapplyingfor"><option selected="selected" value="Professional Membership">Professional Membership</option><option value="Student Membership">Student Membership</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_FirstName">First Name *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_FirstName" name="inf_field_FirstName" placeholder="First Name *" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_LastName">Last Name *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_LastName" name="inf_field_LastName" placeholder="Last Name *" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_Nameasyouwantittoappearoncertificate">Name As You Wish It to Appear on Certificate (this must be your legal name) *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_Nameasyouwantittoappearoncertificate" name="inf_custom_Nameasyouwantittoappearoncertificate" placeholder="Name As You Wish It to Appear on Certificate (this must be your legal name) *" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_Birthday">Date of Birth *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-calendar-wrapper" style="display: flex"> 
                  <script>
Infusion.depends(['Component.Calendar']);
</script>
                  <input class="infusion-field-input-container infusion-date-input" id="inf_field_Birthday" name="inf_field_Birthday" onkeydown="if(pressDate){return pressDate(event,this,false)}" placeholder="Date of Birth *" size="10px" style="display: table-cell;" type="text" /> 
                  <div class="calendar-picker-container" style="padding-left:10px; position:relative;"> 
                   <div class="cal-popup" data-locale="us" onclick="Infusion.Component.Calendar.showPopUp({calName:'inf_field_Birthday_cal', textFieldName:'inf_field_Birthday', locale:'us',yearRange:'100',maxYear:'2021',elem: this });"> 
                    <svg height="24" id="inf_field_Birthday_img" viewbox="0 0 28 28" width="24"> 
                     <path d="M7 10H12V15H7M19 19H5V8H19M19 3H18V1H16V3H8V1H6V3H5C3.9 3 3 3.9 3 5V19A2 2 0 0 0 5 21H19A2 2 0 0 0 21 19V5A2 2 0 0 0 19 3Z"> 
                     </path> 
                    </svg> 
                   </div> 
                   <div class="pikaday-container" id="inf_field_Birthday_calContainer" style="right: 0;"> 
                   </div> 
                  </div> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_Email">Email *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_Email" name="inf_field_Email" placeholder="Email *" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_Phone1">Phone Number *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_Phone1" name="inf_field_Phone1" placeholder="Phone Number *" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_Website">Website (if applicable)</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_Website" name="inf_field_Website" placeholder="Website (if applicable)" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_Company">Business Name</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_Company" name="inf_field_Company" placeholder="Business Name" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_Instagramifyouhaveit">Instagram </label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_Instagramifyouhaveit" name="inf_custom_Instagramifyouhaveit" placeholder="Instagram" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_FacebookPage">Facebook </label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_FacebookPage" name="inf_custom_FacebookPage" placeholder="Facebook" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_LinkedIn">Linked In</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_LinkedIn" name="inf_custom_LinkedIn" placeholder="Linked In" type="text" /> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_field_StreetAddress1">Street Address 1 *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_StreetAddress1" name="inf_field_StreetAddress1" placeholder="Street Address 1 *" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_StreetAddress2">Street Address 2</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_StreetAddress2" name="inf_field_StreetAddress2" placeholder="Street Address 2" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_City">City *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_City" name="inf_field_City" placeholder="City *" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_State">State *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_State" name="inf_field_State" placeholder="State *" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_PostalCode">Postal Code *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_field_PostalCode" name="inf_field_PostalCode" placeholder="Postal Code *" type="text" /> </td></tr><tr><td class="infusion-field-label-container"> <label for="inf_field_Country">Country *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_field_Country" name="inf_field_Country"><option value="">Please select one</option><option value="Afghanistan">Afghanistan</option><option value="Åland Islands">Åland Islands</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">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas (the)">Bahamas (the)</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 (Plurinational State of)">Bolivia (Plurinational State of)</option><option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</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 (the)">British Indian Ocean Territory (the)</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="Cabo Verde">Cabo Verde</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cayman Islands (the)">Cayman Islands (the)</option><option value="Central African Republic (the)">Central African Republic (the)</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 (the)">Cocos (Keeling) Islands (the)</option><option value="Colombia">Colombia</option><option value="Comoros (the)">Comoros (the)</option><option value="Congo (the Democratic Republic of the)">Congo (the Democratic Republic of the)</option><option value="Congo (the)">Congo (the)</option><option value="Cook Islands (the)">Cook Islands (the)</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 (the)">Czech Republic (the)</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic (the)">Dominican Republic (the)</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 (the) [Malvinas]">Falkland Islands (the) [Malvinas]</option><option value="Faroe Islands (the)">Faroe Islands (the)</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 (the)">French Southern Territories (the)</option><option value="Gabon">Gabon</option><option value="Gambia (the)">Gambia (the)</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 Island and McDonald Islands">Heard Island and McDonald Islands</option><option value="Holy See (the)">Holy See (the)</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 (Islamic Republic of)">Iran (Islamic Republic of)</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="Johnston Island">Johnston Island</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="Korea (the Democratic People's Republic of)">Korea (the Democratic People's Republic of)</option><option value="Korea (the Republic of)">Korea (the Republic of)</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Lao People's Democratic Republic (the)">Lao People's Democratic Republic (the)</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="Macao">Macao</option><option value="Macedonia (the former Yugoslav Republic of)">Macedonia (the former Yugoslav Republic of)</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 (the)">Marshall Islands (the)</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="Midway Islands">Midway Islands</option><option value="Moldova (the Republic of)">Moldova (the Republic of)</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="Netherlands (the)">Netherlands (the)</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger (the)">Niger (the)</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana Islands (the)">Northern Mariana Islands (the)</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 (the)">Philippines (the)</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 (the)">Russian Federation (the)</option><option value="Rwanda">Rwanda</option><option value="Saint Barthélemy">Saint Barthélemy</option><option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin (French part)">Saint Martin (French part)</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</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 Sudan">South Sudan</option><option value="Southern Rhodesia">Southern Rhodesia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan (the)">Sudan (the)</option><option value="Suriname">Suriname</option><option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syrian Arab Republic">Syrian Arab Republic</option><option value="Taiwan (Province of China)">Taiwan (Province of China)</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania, United Republic of">Tanzania, United Republic of</option><option value="Thailand">Thailand</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 (the)">Turks and Caicos Islands (the)</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates (the)">United Arab Emirates (the)</option><option value="United Kingdom">United Kingdom</option><option value="United States">United States</option><option value="United States Minor Outlying Islands (the)">United States Minor Outlying Islands (the)</option><option value="Upper Volta">Upper Volta</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Venezuela (Bolivarian Republic of)">Venezuela (Bolivarian Republic of)</option><option value="Viet Nam">Viet Nam</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">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_DesignationsYouAreApplyingForCAIN">Designation(s) You Are Applying For: *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_custom_DesignationsYouAreApplyingForCAIN" name="inf_custom_DesignationsYouAreApplyingForCAIN"><option value="">Please select one</option><option value="Registered Holistic Nutrition Practitioner (RHNP)">Registered Holistic Nutrition Practitioner (RHNP)</option><option value="Registered Health & Nutrition Counsellor">Registered Health & Nutrition Counsellor</option><option value="Combo Designation RHNP & RHNC">Combo Designation RHNP & RHNC</option><option value="Student Member (no designation)">Student Member (no designation)</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_Doyouhaveliabilityinsurance1">Do you have Liability Insurance? *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_custom_Doyouhaveliabilityinsurance1" name="inf_custom_Doyouhaveliabilityinsurance1"><option value="">Please select one</option><option value="YES">YES</option><option value="NO">NO</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_WhichSchoolDidYouAttendCAIN">Which School Did You Attend? </label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_custom_WhichSchoolDidYouAttendCAIN" name="inf_custom_WhichSchoolDidYouAttendCAIN"><option value="">Please select one</option><option value="Nutritional Therapy Association">Nutritional Therapy Association</option><option value="Nutraphoria School of Holistic Nutrition">Nutraphoria School of Holistic Nutrition</option><option value="Pacific Rim College">Pacific Rim College</option><option value="Institute for Transformational Nutrition">Institute for Transformational Nutrition</option><option value="American Fitness Professionals and Associates">American Fitness Professionals and Associates</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_ProgramCompleted">Name of Program / Course Taken *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_ProgramCompleted" name="inf_custom_ProgramCompleted" placeholder="Name of Program / Course Taken *" type="text" /> </td></tr></tbody></table> 
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            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_DateofGraduationestimateifstillastudent">Date of Graduation *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
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             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_HowDidYouHearAboutUs2">How Did You Hear About Us? *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-field-input-container"> 
                  <select id="inf_custom_HowDidYouHearAboutUs2" name="inf_custom_HowDidYouHearAboutUs2"><option selected="selected" value="My school">My school</option><option value="Referral from a colleague">Referral from a colleague</option><option value="Google Search">Google Search</option><option value="Facebook Ad">Facebook Ad</option><option value="Instagram Ad">Instagram Ad</option><option value="Other">Other</option></select> 
                 </div> </td></tr></tbody></table> 
            </div> 
            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_Ifapersonreferredyoupleasesharetheirname">If a person referred you, please share their name.</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_Ifapersonreferredyoupleasesharetheirname" name="inf_custom_Ifapersonreferredyoupleasesharetheirname" placeholder="If a person referred you, please share their name." type="text" /> </td></tr></tbody></table> 
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            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_BybecomingamemberIamoptingintoamemberonlynewsletter">I understand I am opting in to CAIN Member Only emails. I can opt-out at any time. *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
                 <div class="infusion-radio"> 
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                   <span class="infusion-option"><input id="inf_custom_BybecomingamemberIamoptingintoamemberonlynewsletter_Yes" name="inf_custom_BybecomingamemberIamoptingintoamemberonlynewsletter" style="margin-right:3px;" type="radio" value="Yes" /><label for="inf_custom_BybecomingamemberIamoptingintoamemberonlynewsletter_Yes">Yes</label></span> 
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             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_NOTES">Notes: Is there anything else you want us to know?</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> <input class="infusion-field-input" id="inf_custom_NOTES" name="inf_custom_NOTES" placeholder="Notes: Is there anything else you want us to know?" type="text" /> </td></tr></tbody></table> 
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            <div> 
             <table class="infusion-field-container" style="width:400;"><tbody><tr><td class="infusion-field-label-container"> <label for="inf_custom_IhavereadandagreetoabidebytheCAINCodeofEthics2">I have read and agree to abide by the C.A.I.N. Code of Ethics. *</label> </td></tr><tr><td class="infusion-field-input-container" style="width:400px;"> 
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                   <span class="infusion-option"><input id="inf_custom_IhavereadandagreetoabidebytheCAINCodeofEthics2_1" name="inf_custom_IhavereadandagreetoabidebytheCAINCodeofEthics2" style="margin-right:3px;" type="radio" value="1" /><label for="inf_custom_IhavereadandagreetoabidebytheCAINCodeofEthics2_1">Yes</label></span>
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             <table class="infusion-field-container" style="width:100%;"><tbody><tr><td class="infusion-field-input-container" style="width:400px;"> <span class="infusion-option"><input id="inf_option_BysubmittingthisapplicationIconfirmthatIhavereadandagreetoabidebytheTermsandConditionsofmembershipsetforthbyCAIN" name="inf_option_BysubmittingthisapplicationIconfirmthatIhavereadandagreetoabidebytheTermsandConditionsofmembershipsetforthbyCAIN" style="margin-right:3px;" type="checkbox" value="420" /><label for="inf_option_BysubmittingthisapplicationIconfirmthatIhavereadandagreetoabidebytheTermsandConditionsofmembershipsetforthbyCAIN">By submitting this application, I confirm that I have read and agree to abide by the Terms and Conditions of membership set forth by CAIN *</label></span> </td></tr></tbody></table> 
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