{"id":15648,"date":"2024-11-15T10:02:43","date_gmt":"2024-11-15T10:02:43","guid":{"rendered":"https:\/\/amaycure.digitalvibesmarketing.com\/?page_id=15648"},"modified":"2024-12-14T08:58:51","modified_gmt":"2024-12-14T08:58:51","slug":"book-now","status":"publish","type":"page","link":"https:\/\/amaycure.com\/ar\/book-now\/","title":{"rendered":"\u0627\u062d\u062c\u0632 \u0631\u062d\u0644\u062a\u0643"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"15648\" class=\"elementor elementor-15648 elementor-14647\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e8f6f8f e-flex e-con-boxed e-con e-parent\" data-id=\"e8f6f8f\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-9ee5898 e-con-full e-flex e-con e-child\" data-id=\"9ee5898\" data-element_type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ec268d3 e-con-full e-flex e-con e-child\" data-id=\"ec268d3\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1faabdd elementor-widget elementor-widget-shortcode\" data-id=\"1faabdd\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_2' style='display:none'><style>#gform_wrapper_2[data-form-index=\"0\"].gform-theme,[data-parent-form=\"2_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg version='1.1' xmlns='http:\/\/www.w3.org\/2000\/svg' width='640' height='640'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">\u0627\u062d\u062c\u0632 \u0631\u062d\u0644\u062a\u0643<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/ar\/wp-json\/wp\/v2\/pages\/15648#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>5<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_2_17\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Next Steps: Install a Payment Add-On<\/h3><div class='gsection_description' id='gfield_description_2_17'>To accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https:\/\/www.gravityforms.com\/blog\/payment-add-ons). Important: Delete this tip before you publish the form.<\/div><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\" ><h3 class=\"gsection_title\">\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0634\u062e\u0635\u064a\u0629<\/h3><\/div><fieldset id=\"field_2_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_1\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0627\u0633\u0645<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>\u0627\u0644\u0627\u0633\u0645<\/label>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><div id=\"field_2_20\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\" ><label class='gfield_label gform-field-label' for='input_2_20'>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_20' id='input_2_20' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_20_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_2_20_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_20' class='gform_hidden' value='https:\/\/amaycure.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_2_22\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_22\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u062c\u0646\u0633<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_22'><div class='gchoice gchoice_2_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='\u0630\u0643\u0631'  id='choice_2_22_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_22_1' id='label_2_22_1' class='gform-field-label gform-field-label--type-inline'>\u0630\u0643\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='\u0627\u0646\u062b\u0649'  id='choice_2_22_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_22_2' id='label_2_22_2' class='gform-field-label gform-field-label--type-inline'>\u0627\u0646\u062b\u0649<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_22_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.3' type='checkbox'  value='\u0622\u062e\u0631'  id='choice_2_22_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_22_3' id='label_2_22_3' class='gform-field-label gform-field-label--type-inline'>\u0622\u062e\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_22_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.4' type='checkbox'  value='\u062a\u0641\u0636\u0644 \u0639\u062f\u0645 \u0627\u0644\u0643\u0634\u0641'  id='choice_2_22_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_22_4' id='label_2_22_4' class='gform-field-label gform-field-label--type-inline'>\u062a\u0641\u0636\u0644 \u0639\u062f\u0645 \u0627\u0644\u0643\u0634\u0641<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\" ><label class='gfield_label gform-field-label' for='input_2_23'>\u0627\u0644\u062c\u0646\u0633\u064a\u0629<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_2_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_24\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_24\" ><label class='gfield_label gform-field-label' for='input_2_24'>\u0631\u0642\u0645 \u062c\u0648\u0627\u0632 \u0627\u0644\u0633\u0641\u0631<\/label><div class='ginput_container ginput_container_number'><input name='input_24' id='input_2_24' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_9' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_25\" ><h3 class=\"gsection_title\">\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0627\u062a\u0635\u0627\u0644<\/h3><\/div><div id=\"field_2_27\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_27\" ><label class='gfield_label gform-field-label' for='input_2_27'>\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_27' id='input_2_27' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible pcafe_sp_field\"  data-field-class=\"pcafe_sp_field\" data-js-reload=\"field_2_3\" ><label class='gfield_label gform-field-label' for='input_2_3'>\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone' data-formid='2' data-fieldid='3' data-auto_flag='1' data-flag='flagdial' data-pre_country='AE' data-de_country='us'><span class='spf-phone error-msg hide'><\/span><span class='spf-phone valid-msg hide'><\/span><input name='input_3' id='input_2_3' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><fieldset id=\"field_2_4\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_4\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0639\u0646\u0648\u0627\u0646<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_country ginput_container_address gform-grid-row' id='input_2_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_4_1_container' >\n                                        <label for='input_2_4_1' id='input_2_4_1_label' class='gform-field-label gform-field-label--type-sub '>\u0627\u0644\u0634\u0627\u0631\u0639<\/label>\n                                        <input type='text' name='input_4.1' id='input_2_4_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_4_3_container' >\n                                    <label for='input_2_4_3' id='input_2_4_3_label' class='gform-field-label gform-field-label--type-sub '>\u0627\u0644\u0645\u062f\u064a\u0646\u0629<\/label>\n                                    <input type='text' name='input_4.3' id='input_2_4_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_4.4' id='input_2_4_4' value=''\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_2_4_6_container' >\n                                        <label for='input_2_4_6' id='input_2_4_6_label' class='gform-field-label gform-field-label--type-sub '>\u0627\u0644\u0628\u0644\u062f<\/label>\n                                        <select name='input_4.6' id='input_2_4_6'   aria-required='false'   autocomplete=\"country-name\" ><option value='' selected='selected'><\/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' >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='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' >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='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/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 Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/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='Eswatini' >Eswatini<\/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 Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/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='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;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='Macao' >Macao<\/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' >Micronesia<\/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='Netherlands' >Netherlands<\/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 Macedonia' >North Macedonia<\/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='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/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' >Saint Martin<\/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' >Sint Maarten<\/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='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the 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='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/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='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/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><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_31' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\" ><h3 class=\"gsection_title\">\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0637\u0628\u064a\u0629<\/h3><\/div><div id=\"field_2_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_28\" ><label class='gfield_label gform-field-label' for='input_2_28'>\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u062d\u0627\u0644\u064a\u0629<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_2_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_29\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0644\u062f\u064a\u0643 \u062d\u0633\u0627\u0633\u064a\u0629 \u061f<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_29'><div class='gchoice gchoice_2_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='\u0646\u0639\u0645'  id='choice_2_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_1' id='label_2_29_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0639\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='\u0644\u0627'  id='choice_2_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_2' id='label_2_29_2' class='gform-field-label gform-field-label--type-inline'>\u0644\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_30\" ><label class='gfield_label gform-field-label' for='input_2_30'>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_2_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_32\" ><label class='gfield_label gform-field-label' for='input_2_32'>\u0627\u0644\u0639\u0645\u0644\u064a\u0627\u062a \u0627\u0644\u062c\u0631\u0627\u062d\u064a\u0629 \u0627\u0644\u0633\u0627\u0628\u0642\u0629\/\u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0637\u0628\u064a<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_2_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_10' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_10' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\" ><h3 class=\"gsection_title\">\u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0637\u0628\u064a \u0627\u0644\u0645\u0637\u0644\u0648\u0628<\/h3><\/div><fieldset id=\"field_2_33\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_33\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u0645\u0647\u062a\u0645 \u0628\u0647\u0627 :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_33'><div class='gchoice gchoice_2_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u062a\u062c\u0645\u064a\u0644'  id='choice_2_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_1' id='label_2_33_1' class='gform-field-label gform-field-label--type-inline'>\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u062a\u062c\u0645\u064a\u0644<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u0623\u0633\u0646\u0627\u0646'  id='choice_2_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_2' id='label_2_33_2' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u0623\u0633\u0646\u0627\u0646<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='\u0625\u062c\u0631\u0627\u0621\u0627\u062a \u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628'  id='choice_2_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_3' id='label_2_33_3' class='gform-field-label gform-field-label--type-inline'>\u0625\u062c\u0631\u0627\u0621\u0627\u062a \u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.4' type='checkbox'  value='\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0639\u0638\u0627\u0645'  id='choice_2_33_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_4' id='label_2_33_4' class='gform-field-label gform-field-label--type-inline'>\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0639\u0638\u0627\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.5' type='checkbox'  value='\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u062e\u0635\u0648\u0628\u0629'  id='choice_2_33_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_5' id='label_2_33_5' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c\u0627\u062a \u0627\u0644\u062e\u0635\u0648\u0628\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.6' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u0633\u0631\u0637\u0627\u0646'  id='choice_2_33_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_6' id='label_2_33_6' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u0633\u0631\u0637\u0627\u0646<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.7' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u062c\u0644\u062f'  id='choice_2_33_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_7' id='label_2_33_7' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u062c\u0644\u062f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.8' type='checkbox'  value='\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0633\u0645\u0646\u0629 \u0648\u0625\u062f\u0627\u0631\u0629 \u0627\u0644\u0648\u0632\u0646'  id='choice_2_33_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_8' id='label_2_33_8' class='gform-field-label gform-field-label--type-inline'>\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0633\u0645\u0646\u0629 \u0648\u0625\u062f\u0627\u0631\u0629 \u0627\u0644\u0648\u0632\u0646<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.9' type='checkbox'  value='\u0639\u0645\u0644\u064a\u0629 \u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0645\u0633\u0627\u0644\u0643 \u0627\u0644\u0628\u0648\u0644\u064a\u0629'  id='choice_2_33_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_9' id='label_2_33_9' class='gform-field-label gform-field-label--type-inline'>\u0639\u0645\u0644\u064a\u0629 \u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u0645\u0633\u0627\u0644\u0643 \u0627\u0644\u0628\u0648\u0644\u064a\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.11' type='checkbox'  value='\u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0637\u0628\u064a\u0639\u064a \u0648\u0625\u0639\u0627\u062f\u0629 \u0627\u0644\u062a\u0623\u0647\u064a\u0644'  id='choice_2_33_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_11' id='label_2_33_11' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0637\u0628\u064a\u0639\u064a \u0648\u0625\u0639\u0627\u062f\u0629 \u0627\u0644\u062a\u0623\u0647\u064a\u0644<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.12' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u0639\u064a\u0648\u0646'  id='choice_2_33_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_12' id='label_2_33_12' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u0639\u064a\u0648\u0646<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.13' type='checkbox'  value='\u0627\u0644\u0639\u0644\u0627\u062c \u0628\u0627\u0644\u062e\u0644\u0627\u064a\u0627 \u0627\u0644\u062c\u0630\u0639\u064a\u0629'  id='choice_2_33_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_13' id='label_2_33_13' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0639\u0644\u0627\u062c \u0628\u0627\u0644\u062e\u0644\u0627\u064a\u0627 \u0627\u0644\u062c\u0630\u0639\u064a\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.14' type='checkbox'  value='\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631\u064a \u0648\u0627\u0644\u063a\u062f\u062f \u0627\u0644\u0635\u0645\u0627\u0621'  id='choice_2_33_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_14' id='label_2_33_14' class='gform-field-label gform-field-label--type-inline'>\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631\u064a \u0648\u0627\u0644\u063a\u062f\u062f \u0627\u0644\u0635\u0645\u0627\u0621<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.15' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u0627\u0639\u0635\u0627\u0628'  id='choice_2_33_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_15' id='label_2_33_15' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u0627\u0639\u0635\u0627\u0628<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.16' type='checkbox'  value='\u0632\u0631\u0627\u0639\u0629 \u0627\u0644\u0634\u0639\u0631'  id='choice_2_33_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_16' id='label_2_33_16' class='gform-field-label gform-field-label--type-inline'>\u0632\u0631\u0627\u0639\u0629 \u0627\u0644\u0634\u0639\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.17' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u0631\u0648\u0645\u0627\u062a\u064a\u0632\u0645'  id='choice_2_33_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_17' id='label_2_33_17' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u0631\u0648\u0645\u0627\u062a\u064a\u0632\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.18' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0647\u0634\u0627\u0634\u0629 \u0627\u0644\u0639\u0638\u0627\u0645'  id='choice_2_33_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_18' id='label_2_33_18' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0647\u0634\u0627\u0634\u0629 \u0627\u0644\u0639\u0638\u0627\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.19' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0627\u0644\u0627\u0646\u0641 \u0648\u0627\u0644\u0627\u0630\u0646 \u0648\u0627\u0644\u062d\u0646\u062c\u0631\u0629'  id='choice_2_33_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_19' id='label_2_33_19' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0627\u0644\u0627\u0646\u0641 \u0648\u0627\u0644\u0627\u0630\u0646 \u0648\u0627\u0644\u062d\u0646\u062c\u0631\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.21' type='checkbox'  value='\u0639\u0644\u0627\u062c \u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u062c\u0647\u0627\u0632 \u0627\u0644\u0647\u0636\u0645\u064a'  id='choice_2_33_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_21' id='label_2_33_21' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0627\u062c \u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u062c\u0647\u0627\u0632 \u0627\u0644\u0647\u0636\u0645\u064a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.22' type='checkbox'  value='\u0637\u0628 \u0627\u0644\u0643\u0644\u0649 \u0648\u0639\u0644\u0627\u062c \u0627\u0644\u0643\u0644\u0649'  id='choice_2_33_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_22' id='label_2_33_22' class='gform-field-label gform-field-label--type-inline'>\u0637\u0628 \u0627\u0644\u0643\u0644\u0649 \u0648\u0639\u0644\u0627\u062c \u0627\u0644\u0643\u0644\u0649<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.23' type='checkbox'  value='\u0637\u0628 \u0627\u0644\u0623\u0637\u0641\u0627\u0644 \u0648\u0639\u0644\u0627\u062c \u0627\u0644\u0623\u0637\u0641\u0627\u0644'  id='choice_2_33_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_23' id='label_2_33_23' class='gform-field-label gform-field-label--type-inline'>\u0637\u0628 \u0627\u0644\u0623\u0637\u0641\u0627\u0644 \u0648\u0639\u0644\u0627\u062c \u0627\u0644\u0623\u0637\u0641\u0627\u0644<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.24' type='checkbox'  value='\u0627\u0644\u0623\u0644\u0645'  id='choice_2_33_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_24' id='label_2_33_24' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0623\u0644\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_33_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.25' type='checkbox'  value='\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):'  id='choice_2_33_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_33_25' id='label_2_33_25' class='gform-field-label gform-field-label--type-inline'>\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\" ><label class='gfield_label gform-field-label' for='input_2_45'>\u0625\u0630\u0627 \u0643\u0627\u0646 \u063a\u064a\u0631 \u0630\u0644\u0643\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_2_45' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_34\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_34\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0648\u062c\u0647\u0629 \u0627\u0644\u0645\u0641\u0636\u0644\u0629<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_34'><div class='gchoice gchoice_2_34_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.1' type='checkbox'  value='\u0627\u0628\u0648 \u0638\u0628\u064a'  id='choice_2_34_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_1' id='label_2_34_1' class='gform-field-label gform-field-label--type-inline'>\u0627\u0628\u0648 \u0638\u0628\u064a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.2' type='checkbox'  value='\u062f\u0628\u064a'  id='choice_2_34_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_2' id='label_2_34_2' class='gform-field-label gform-field-label--type-inline'>\u062f\u0628\u064a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.3' type='checkbox'  value='\u062a\u0631\u0643\u064a\u0627'  id='choice_2_34_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_3' id='label_2_34_3' class='gform-field-label gform-field-label--type-inline'>\u062a\u0631\u0643\u064a\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.4' type='checkbox'  value='\u062a\u0627\u064a\u0644\u0627\u0646\u062f'  id='choice_2_34_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_4' id='label_2_34_4' class='gform-field-label gform-field-label--type-inline'>\u062a\u0627\u064a\u0644\u0627\u0646\u062f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.5' type='checkbox'  value='\u0627\u0644\u0645\u0645\u0644\u0643\u0629 \u0627\u0644\u0645\u062a\u062d\u062f\u0629'  id='choice_2_34_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_5' id='label_2_34_5' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0645\u0645\u0644\u0643\u0629 \u0627\u0644\u0645\u062a\u062d\u062f\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.6' type='checkbox'  value='\u0627\u0644\u0648\u0644\u0627\u064a\u0627\u062a \u0627\u0644\u0645\u062a\u062d\u062f\u0629 \u0627\u0644\u0623\u0645\u0631\u064a\u0643\u064a\u0629'  id='choice_2_34_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_6' id='label_2_34_6' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0648\u0644\u0627\u064a\u0627\u062a \u0627\u0644\u0645\u062a\u062d\u062f\u0629 \u0627\u0644\u0623\u0645\u0631\u064a\u0643\u064a\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.7' type='checkbox'  value='\u0623\u0644\u0645\u0627\u0646\u064a\u0627'  id='choice_2_34_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_7' id='label_2_34_7' class='gform-field-label gform-field-label--type-inline'>\u0623\u0644\u0645\u0627\u0646\u064a\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.8' type='checkbox'  value='\u0645\u0627\u0644\u064a\u0632\u064a\u0627'  id='choice_2_34_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_8' id='label_2_34_8' class='gform-field-label gform-field-label--type-inline'>\u0645\u0627\u0644\u064a\u0632\u064a\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.9' type='checkbox'  value='\u062c\u0646\u0648\u0628 \u0643\u0648\u0631\u064a\u0627'  id='choice_2_34_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_9' id='label_2_34_9' class='gform-field-label gform-field-label--type-inline'>\u062c\u0646\u0648\u0628 \u0643\u0648\u0631\u064a\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.11' type='checkbox'  value='\u0627\u0644\u062c\u0645\u0647\u0648\u0631\u064a\u0629 \u0627\u0644\u062a\u0634\u064a\u0643\u064a\u0629'  id='choice_2_34_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_11' id='label_2_34_11' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u062c\u0645\u0647\u0648\u0631\u064a\u0629 \u0627\u0644\u062a\u0634\u064a\u0643\u064a\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.12' type='checkbox'  value='\u0627\u0644\u0647\u0646\u062f'  id='choice_2_34_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_12' id='label_2_34_12' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0647\u0646\u062f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.13' type='checkbox'  value='\u0627\u0633\u0628\u0627\u0646\u064a\u0627'  id='choice_2_34_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_13' id='label_2_34_13' class='gform-field-label gform-field-label--type-inline'>\u0627\u0633\u0628\u0627\u0646\u064a\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.14' type='checkbox'  value='\u0645\u0635\u0631'  id='choice_2_34_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_14' id='label_2_34_14' class='gform-field-label gform-field-label--type-inline'>\u0645\u0635\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_34_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.15' type='checkbox'  value='\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f)'  id='choice_2_34_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_34_15' id='label_2_34_15' class='gform-field-label gform-field-label--type-inline'>\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_54\" ><label class='gfield_label gform-field-label' for='input_2_54'>\u0625\u0630\u0627 \u0643\u0627\u0646 \u063a\u064a\u0631 \u0630\u0644\u0643\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_2_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_35' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_35' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' data-js='page-field-id-35' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_36\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_36\" ><h3 class=\"gsection_title\">\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0633\u0641\u0631<\/h3><\/div><fieldset id=\"field_2_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0647\u0644 \u062a\u062d\u062a\u0627\u062c \u0625\u0644\u0649 \u062d\u062c\u0632 \u062a\u0630\u0643\u0631\u0629 \u0637\u064a\u0631\u0627\u0646\u061f<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_37'><div class='gchoice gchoice_2_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='\u0646\u0639\u0645'  id='choice_2_37_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_37_1' id='label_2_37_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0639\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_37_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.2' type='checkbox'  value='\u0644\u0627'  id='choice_2_37_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_37_2' id='label_2_37_2' class='gform-field-label gform-field-label--type-inline'>\u0644\u0627<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\" ><h3 class=\"gsection_title\">\u062a\u0648\u0627\u0631\u064a\u062e \u0627\u0644\u0633\u0641\u0631 \u0627\u0644\u0645\u0641\u0636\u0644\u0629:<\/h3><\/div><div id=\"field_2_40\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\" ><label class='gfield_label gform-field-label' for='input_2_40'>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u063a\u0627\u062f\u0631\u0629<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_40' id='input_2_40' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_40_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_2_40_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_40' class='gform_hidden' value='https:\/\/amaycure.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_41\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\" ><label class='gfield_label gform-field-label' for='input_2_41'>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0639\u0648\u062f\u0629<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_41' id='input_2_41' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_41_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_2_41_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_41' class='gform_hidden' value='https:\/\/amaycure.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\" ><label class='gfield_label gform-field-label' for='input_2_42'>\u0634\u0631\u0643\u0627\u062a \u0627\u0644\u0637\u064a\u0631\u0627\u0646 \u0627\u0644\u0645\u0641\u0636\u0644\u0629<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_43\" ><label class='gfield_label gform-field-label' for='input_2_43'>\u062f\u0631\u062c\u0629 \u0627\u0644\u0637\u064a\u0631\u0627\u0646 \u0627\u0644\u0645\u0641\u0636\u0644\u0629<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_44\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_44\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0633\u0643\u0646 :<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_44'><div class='gchoice gchoice_2_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='\u0641\u0646\u062f\u0642 ( \u0639\u0627\u062f\u064a )'  id='choice_2_44_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_44_1' id='label_2_44_1' class='gform-field-label gform-field-label--type-inline'>\u0641\u0646\u062f\u0642 ( \u0639\u0627\u062f\u064a )<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='\u0641\u0646\u062f\u0642 (\u0641\u0627\u062e\u0631)'  id='choice_2_44_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_44_2' id='label_2_44_2' class='gform-field-label gform-field-label--type-inline'>\u0641\u0646\u062f\u0642 (\u0641\u0627\u062e\u0631)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_44_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.3' type='checkbox'  value='\u0639\u064a\u0627\u062f\u0629\/\u0645\u0633\u062a\u0634\u0641\u0649'  id='choice_2_44_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_44_3' id='label_2_44_3' class='gform-field-label gform-field-label--type-inline'>\u0639\u064a\u0627\u062f\u0629\/\u0645\u0633\u062a\u0634\u0641\u0649<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_44_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.4' type='checkbox'  value='\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f)'  id='choice_2_44_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_44_4' id='label_2_44_4' class='gform-field-label gform-field-label--type-inline'>\u0623\u062e\u0631\u0649 (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\" ><label class='gfield_label gform-field-label' for='input_2_46'>\u0625\u0630\u0627 \u0643\u0627\u0646 \u063a\u064a\u0631 \u0630\u0644\u0643\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_47\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_47\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0631\u0641\u064a\u0642 \u0627\u0644\u0633\u0641\u0631<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_47'><div class='gchoice gchoice_2_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='\u0644\u0627 \u064a\u0648\u062c\u062f'  id='choice_2_47_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_1' id='label_2_47_1' class='gform-field-label gform-field-label--type-inline'>\u0644\u0627 \u064a\u0648\u062c\u062f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='\u0623\u0633\u0631\u0629'  id='choice_2_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_2' id='label_2_47_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u0633\u0631\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.3' type='checkbox'  value='\u0627\u0644\u0623\u0635\u062f\u0642\u0627\u0621'  id='choice_2_47_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_3' id='label_2_47_3' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0623\u0635\u062f\u0642\u0627\u0621<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.4' type='checkbox'  value='\u0645\u0633\u0627\u0639\u062f \u0634\u062e\u0635\u064a'  id='choice_2_47_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_4' id='label_2_47_4' class='gform-field-label gform-field-label--type-inline'>\u0645\u0633\u0627\u0639\u062f \u0634\u062e\u0635\u064a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.5' type='checkbox'  value='\u063a\u064a\u0631 \u0630\u0644\u0643'  id='choice_2_47_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_5' id='label_2_47_5' class='gform-field-label gform-field-label--type-inline'>\u063a\u064a\u0631 \u0630\u0644\u0643<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\" ><label class='gfield_label gform-field-label' for='input_2_48'>\u0625\u0630\u0627 \u0643\u0627\u0646 \u063a\u064a\u0631 \u0630\u0644\u0643\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_2_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_49\" ><h3 class=\"gsection_title\">\u062e\u062f\u0645\u0627\u062a \u0625\u0636\u0627\u0641\u064a\u0629<\/h3><\/div><fieldset id=\"field_2_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_50\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u062e\u062f\u0645\u0627\u062a \u0625\u0636\u0627\u0641\u064a\u0629 \u0645\u0647\u062a\u0645 \u0628\u0647\u0627<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_50'><div class='gchoice gchoice_2_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='\u062e\u062f\u0645\u0627\u062a \u0627\u0644\u062a\u0631\u062c\u0645\u0629'  id='choice_2_50_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_1' id='label_2_50_1' class='gform-field-label gform-field-label--type-inline'>\u062e\u062f\u0645\u0627\u062a \u0627\u0644\u062a\u0631\u062c\u0645\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='\u0627\u0644\u0646\u0642\u0644 \u0627\u0644\u062e\u0627\u0635'  id='choice_2_50_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_2' id='label_2_50_2' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0646\u0642\u0644 \u0627\u0644\u062e\u0627\u0635<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='\u0628\u0631\u0627\u0645\u062c \u0627\u0644\u0631\u062d\u0644\u0627\u062a'  id='choice_2_50_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_3' id='label_2_50_3' class='gform-field-label gform-field-label--type-inline'>\u0628\u0631\u0627\u0645\u062c \u0627\u0644\u0631\u062d\u0644\u0627\u062a<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='\u0631\u0639\u0627\u064a\u0629 \u0645\u0627 \u0628\u0639\u062f \u0627\u0644\u0639\u0644\u0627\u062c'  id='choice_2_50_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_4' id='label_2_50_4' class='gform-field-label gform-field-label--type-inline'>\u0631\u0639\u0627\u064a\u0629 \u0645\u0627 \u0628\u0639\u062f \u0627\u0644\u0639\u0644\u0627\u062c<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='\u0627\u0644\u0627\u0633\u062a\u0642\u0628\u0627\u0644 \u0645\u0646 \u0627\u0644\u0645\u0637\u0627\u0631\/\u0627\u0644\u0641\u0646\u062f\u0642'  id='choice_2_50_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_5' id='label_2_50_5' class='gform-field-label gform-field-label--type-inline'>\u0627\u0644\u0627\u0633\u062a\u0642\u0628\u0627\u0644 \u0645\u0646 \u0627\u0644\u0645\u0637\u0627\u0631\/\u0627\u0644\u0641\u0646\u062f\u0642<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0633\u0641\u0631 \u0648\u0627\u0644\u0633\u064a\u0627\u062d\u0629 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629'  id='choice_2_50_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_6' id='label_2_50_6' class='gform-field-label gform-field-label--type-inline'>\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0633\u0641\u0631 \u0648\u0627\u0644\u0633\u064a\u0627\u062d\u0629 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.7' type='checkbox'  value='\u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u062a\u0623\u0634\u064a\u0631\u0629'  id='choice_2_50_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_7' id='label_2_50_7' class='gform-field-label gform-field-label--type-inline'>\u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u062a\u0623\u0634\u064a\u0631\u0629<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.8' type='checkbox'  value='\u0622\u062e\u0631'  id='choice_2_50_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_8' id='label_2_50_8' class='gform-field-label gform-field-label--type-inline'>\u0622\u062e\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_51\" ><label class='gfield_label gform-field-label' for='input_2_51'>\u0625\u0630\u0627 \u0643\u0627\u0646 \u063a\u064a\u0631 \u0630\u0644\u0643\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_2_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_52\" ><h3 class=\"gsection_title\">\u0627\u0644\u0645\u0648\u0627\u0641\u0642\u0629 \u0648\u0627\u0644\u0627\u062a\u0641\u0627\u0642<\/h3><\/div><fieldset id=\"field_2_55\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_55\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0627\u0644\u0645\u0648\u0627\u0641\u0642\u0629 \u0648\u0627\u0644\u0625\u0642\u0631\u0627\u0631<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_55.1' id='input_2_55_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_55_1' >\u0623\u064f\u0642\u0631\u0651 \u0628\u0635\u062d\u0629 \u062c\u0645\u064a\u0639 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u064f\u0642\u062f\u0651\u0645\u0629 \u0623\u0639\u0644\u0627\u0647. \u0648\u0623\u064f\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 \u0645\u064f\u0634\u0627\u0631\u0643\u0629 \u0628\u064a\u0627\u0646\u0627\u062a\u064a \u0627\u0644\u0637\u0628\u064a\u0629 \u0645\u0639 \u0645\u064f\u0642\u062f\u0651\u0645\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0648\u0627\u0644\u0647\u064a\u0626\u0627\u062a \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629 \u0644\u062a\u0631\u062a\u064a\u0628\u0627\u062a \u0627\u0644\u0633\u064a\u0627\u062d\u0629 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629.<\/label><input type='hidden' name='input_55.2' value='\u0623\u064f\u0642\u0631\u0651 \u0628\u0635\u062d\u0629 \u062c\u0645\u064a\u0639 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u064f\u0642\u062f\u0651\u0645\u0629 \u0623\u0639\u0644\u0627\u0647. \u0648\u0623\u064f\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 \u0645\u064f\u0634\u0627\u0631\u0643\u0629 \u0628\u064a\u0627\u0646\u0627\u062a\u064a \u0627\u0644\u0637\u0628\u064a\u0629 \u0645\u0639 \u0645\u064f\u0642\u062f\u0651\u0645\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0648\u0627\u0644\u0647\u064a\u0626\u0627\u062a \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629 \u0644\u062a\u0631\u062a\u064a\u0628\u0627\u062a \u0627\u0644\u0633\u064a\u0627\u062d\u0629 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629.' class='gform_hidden' \/><input type='hidden' name='input_55.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_2_53\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_53\" ><label class='gfield_label gform-field-label' for='input_2_53'>\u0627\u0644\u062a\u0642\u0627\u0631\u064a\u0631 \u0627\u0644\u0637\u0628\u064a\u0629<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1342177280' \/><input name='input_53' id='input_2_53' type='file' class='large' aria-describedby=\"gfield_upload_rules_2_53 gfield_description_2_53\" onchange='javascript:gformValidateFileSize( this, 1342177280 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_2_53'>Max. file size: 1 GB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_2_53'><\/div><\/div><div class='gfield_description' id='gfield_description_2_53'>\u064a\u0631\u062c\u0649 \u0625\u0631\u0641\u0627\u0642 \u062c\u0645\u064a\u0639 \u0627\u0644\u062a\u0642\u0627\u0631\u064a\u0631 \u0627\u0644\u0637\u0628\u064a\u0629 \u0648\u0627\u0644\u062a\u062d\u0642\u064a\u0642\u0627\u062a \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629 (\u0645\u062b\u0644 \u0627\u0644\u062a\u0635\u0648\u064a\u0631\u060c \u0641\u062d\u0648\u0635\u0627\u062a \u0627\u0644\u062f\u0645 .. \u0625\u0644\u062e)<\/div><\/div><div id=\"field_2_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_2_8\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Credit Card<\/h3><div class='gsection_description' id='gfield_description_2_8'>Replace this field with a field specific to your payment gateway whenever possible.<\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='\u0625\u0631\u0633\u0627\u0644'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' 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