{"id":1167,"date":"2022-06-01T10:02:16","date_gmt":"2022-06-01T14:02:16","guid":{"rendered":"https:\/\/forms.csi.ca\/?page_id=1167"},"modified":"2022-06-01T10:02:16","modified_gmt":"2022-06-01T14:02:16","slug":"license-application-fellow-of-csi-fcsi","status":"publish","type":"page","link":"https:\/\/forms.csi.ca\/?page_id=1167","title":{"rendered":"License Application Fellow of CSI (FCSI\u00ae)"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-block\" id=\"wpforms-1153\"><form id=\"wpforms-form-1153\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1153\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1167&#038;wpforms_form_id=1153\" data-token=\"cb6c6fc7aade3c3296548a5c92aa01ac\" data-token-time=\"1786025506\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1153-field_41-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"41\"><h3 id=\"wpforms-1153-field_41\">PERSONAL INFORMATION<\/h3><\/div><div id=\"wpforms-1153-field_1-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first\" data-field-type=\"number\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_1\">Student ID <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1153-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" step=\"any\" required><\/div><div id=\"wpforms-1153-field_32-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-type=\"date-time\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Identity Verification Birthdate <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-small\"><select name=\"wpforms[fields][32][date][d]\" id=\"wpforms-1153-field_32-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][32][date][m]\" id=\"wpforms-1153-field_32-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][32][date][y]\" id=\"wpforms-1153-field_32-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-1153-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Please indicate your name (including any initials used) exactly as it appears on your government-issued photo ID. <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1153-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" required><label for=\"wpforms-1153-field_3\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1153-field_3-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][3][middle]\" ><label for=\"wpforms-1153-field_3-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1153-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" required><label for=\"wpforms-1153-field_3-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_4-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_4_1\" name=\"wpforms[fields][4]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_4_1\">Female<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_4_2\" name=\"wpforms[fields][4]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_4_2\">Male<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_4_3\" name=\"wpforms[fields][4]\" value=\"Non-Binary\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_4_3\">Non-Binary<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Language preference for communication <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_28_1\" name=\"wpforms[fields][28]\" value=\"English\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_28_1\">English<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_28_2\" name=\"wpforms[fields][28]\" value=\"French\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_28_2\">French<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_7-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_7\">Preferred Email Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1153-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1153-field_8-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_8\">Alternate Email Address<\/label><input type=\"email\" id=\"wpforms-1153-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1153-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"117\"><label class=\"wpforms-field-label\">Phone number to reach you <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_117\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_117_1\" name=\"wpforms[fields][117]\" value=\"Personal\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_117_1\">Personal<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_117_2\" name=\"wpforms[fields][117]\" value=\"Business\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_117_2\">Business<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_117_3\" name=\"wpforms[fields][117]\" value=\"Both\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_117_3\">Both<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_21-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"21\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_21\">Personal Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1153-field_21\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][21]\" aria-label=\"Personal Phone\" required><\/div><div id=\"wpforms-1153-field_10-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_10\">Business Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1153-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][10]\" aria-label=\"Business Phone\" required><\/div><div id=\"wpforms-1153-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"118\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_118\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_118_1\" name=\"wpforms[fields][118]\" value=\"Home Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_118_1\">Home Address<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_118_2\" name=\"wpforms[fields][118]\" value=\"Business Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_118_2\">Business Address<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_118_3\" name=\"wpforms[fields][118]\" value=\"Both\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_118_3\">Both<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_14-container\" class=\"wpforms-field wpforms-field-address wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_14\">Home Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1153-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" placeholder=\"Street Address, P.O. box\" required><label for=\"wpforms-1153-field_14\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1153-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" placeholder=\"Apartment, suite, unit, floor, etc.\" ><label for=\"wpforms-1153-field_14-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1153-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" placeholder=\"City\" required><label for=\"wpforms-1153-field_14-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" placeholder=\"State \/ Province\" required><label for=\"wpforms-1153-field_14-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1153-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][14][postal]\" placeholder=\"ZIP \/ Postal\" required><label for=\"wpforms-1153-field_14-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1153-field_14-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][14][country]\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select country &#8212;<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1153-field_14-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_43-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_43\">Business Branch Transit Number (if applicable)<\/label><input type=\"number\" id=\"wpforms-1153-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" step=\"any\" ><\/div><div id=\"wpforms-1153-field_44-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_44\">Employee Number<\/label><input type=\"number\" id=\"wpforms-1153-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" step=\"any\" ><\/div><div id=\"wpforms-1153-field_56-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"56\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_56\">Employer<\/label><input type=\"number\" id=\"wpforms-1153-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" step=\"any\" ><\/div><div id=\"wpforms-1153-field_55-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"number\" data-field-id=\"55\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_55\">Job Title<\/label><input type=\"number\" id=\"wpforms-1153-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" step=\"any\" ><\/div><div id=\"wpforms-1153-field_11-container\" class=\"wpforms-field wpforms-field-address wpforms-one-half wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_11\">Business Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1153-field_11\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][11][address1]\" placeholder=\"Street Address, P.O. box\" required><label for=\"wpforms-1153-field_11\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1153-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" placeholder=\"Apartment, suite, unit, floor, etc.\" ><label for=\"wpforms-1153-field_11-address2\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1153-field_11-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][11][city]\" placeholder=\"City\" required><label for=\"wpforms-1153-field_11-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_11-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][11][state]\" placeholder=\"State \/ Province\" required><label for=\"wpforms-1153-field_11-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1153-field_11-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][11][postal]\" placeholder=\"ZIP \/ Postal\" required><label for=\"wpforms-1153-field_11-postal\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1153-field_11-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][11][country]\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select country &#8212;<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1153-field_11-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_57-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"57\"><label class=\"wpforms-field-label\">To which address would you like us to send your Certificate <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_57\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_57_1\" name=\"wpforms[fields][57]\" value=\"Business Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_57_1\">Business Address<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_57_2\" name=\"wpforms[fields][57]\" value=\"Home Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_57_2\">Home Address<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_58-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"58\"><label class=\"wpforms-field-label\">Which address would you like listed in our FCSI\u00ae directory? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_58\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_58_1\" name=\"wpforms[fields][58]\" value=\"Business Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_58_1\">Business Address<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_58_2\" name=\"wpforms[fields][58]\" value=\"Home Address\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_58_2\">Home Address<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_58_4\" name=\"wpforms[fields][58]\" value=\"I do not wish to have my address listed\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_58_4\">I do not wish to have my address listed<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_15-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"15\"><h3 id=\"wpforms-1153-field_15\">FCSI\u00ae EDUCATIONAL REQUIREMENTS<\/h3><\/div><div id=\"wpforms-1153-field_64-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"64\"><div id=\"wpforms-1153-field_64\"><p>a. Please indicate the designation you hold\r\nand are using towards achieving the FCSI\u00ae.<\/p><\/div><\/div><div id=\"wpforms-1153-field_24-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_24\">Designation <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1153-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" required><div class=\"wpforms-field-description\">* NOTE: External Designations are subject to CSI\u2019s External Designation Recognition policy and fee. See details at <a href=\"https:\/\/www.csi.ca\/en\/credentials\/fcsi\/\" target=\"_blank\">www.fcsi.ca<\/a>.<\/div><\/div><div id=\"wpforms-1153-field_61-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half\" data-field-type=\"number\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_61\">Year granted <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1153-field_61\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][61]\" step=\"any\" required><\/div><div id=\"wpforms-1153-field_65-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"65\"><div id=\"wpforms-1153-field_65\"><p>b. Two (2) Additional CSI Courses<br \/><br \/>\r\nCourses must be from a different stream than that leading to the Designation specified in item a). For additional information, please visit the Learning Path section on the FCSI\u00ae website at <a href=\"https:\/\/www.csi.ca\/en\/credentials\/fcsi\/\" target=\"_blank\">www.fcsi.ca<\/a>.<\/p><\/div><\/div><div id=\"wpforms-1153-field_59-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_59\">CSI Course (1) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1153-field_59\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][59]\" placeholder=\"CSI Course Name\" required><\/div><div id=\"wpforms-1153-field_66-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-one-half\" data-field-type=\"number\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_66\">Year Passed <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1153-field_66\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][66]\" step=\"any\" required><\/div><div id=\"wpforms-1153-field_62-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_62\">CSI Course (2) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1153-field_62\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][62]\" placeholder=\"CSI Course Name\" required><\/div><div id=\"wpforms-1153-field_67-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-one-half\" data-field-type=\"number\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_67\">Year Passed <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1153-field_67\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][67]\" step=\"any\" required><\/div><div id=\"wpforms-1153-field_68-container\" class=\"wpforms-field wpforms-field-html wpforms-one-half wpforms-first\" data-field-type=\"html\" data-field-id=\"68\"><div id=\"wpforms-1153-field_68\"><p>c. Financial Services Industry: Business Drivers and Challenges course (FSDC)<\/p><\/div><\/div><div id=\"wpforms-1153-field_69-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-one-half\" data-field-type=\"number\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_69\">Year Passed <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1153-field_69\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][69]\" step=\"any\" required><\/div><div id=\"wpforms-1153-field_19-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"19\"><h3 id=\"wpforms-1153-field_19\">FCSI\u00ae DECLARATION AND SIGNATURE OF APPLICANT<\/h3><\/div><div id=\"wpforms-1153-field_70-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"70\"><label class=\"wpforms-field-label wpforms-label-hide\">Declare <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1153-field_70_1\" name=\"wpforms[fields][70][]\" value=\"I declare that I have completed this application as completely as I am able and I hereby apply for the Fellow of CSI (FCSI\u00ae).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_70_1\">I declare that I have completed this application as completely as I am able and I hereby apply for the Fellow of CSI (FCSI\u00ae).<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_45-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"45\"><div id=\"wpforms-1153-field_45\"><p>I confirm that:<\/p><\/div><\/div><div id=\"wpforms-1153-field_46-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"46\"><label class=\"wpforms-field-label\">WORK EXPERIENCE REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_46\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1153-field_46_3\" name=\"wpforms[fields][46][]\" value=\"I declare that I have worked in the financial services industry for seven (7) of the last ten (10) years. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_46_3\">I declare that I have worked in the financial services industry for seven (7) of the last ten (10) years. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_72-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"72\"><div id=\"wpforms-1153-field_72\"><p><b>EXPERIENCE VERIFICATION CONTACT INFORMATION\r\n<\/b><br \/><br \/>\r\nPlease provide contact information for the person (or persons) who will be able to verify your work experience declaration. On this application, you are required to provide\r\ndetails on your length of employment within each position you have held, which will allow CSI to affirm that the 7 years out of the last 10 have been fulfilled. However, you\r\nare given the option of providing one or more verifiers. For example, if your current supervisor is able to confirm all of your past experience, then you will require only one\r\nverifier. If, however, your current supervisor is not able to verify all past experience, then you will need to include your current supervisor (for current position) and one or\r\nseveral past supervisors to cover the other positions you have provided for the fulfillment of the required experience.\r\n<br \/><br \/>\r\nProvision of this contact information is your acknowledgement that CSI may retain this information on your file and contact the individual for this purpose only.\r\n<\/p><\/div><\/div><div id=\"wpforms-1153-field_119-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"119\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_119\">From (YYYY-MM)<\/label><input type=\"text\" id=\"wpforms-1153-field_119\" class=\"wpforms-field-medium\" name=\"wpforms[fields][119]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_120-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-type=\"text\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_120\">To (YYYY-MM)<\/label><input type=\"text\" id=\"wpforms-1153-field_120\" class=\"wpforms-field-medium\" name=\"wpforms[fields][120]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_75-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_75\">Organization Name<\/label><input type=\"text\" id=\"wpforms-1153-field_75\" class=\"wpforms-field-medium\" name=\"wpforms[fields][75]\" ><\/div><div id=\"wpforms-1153-field_76-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_76\">Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_76\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][76][first]\" placeholder=\"First\" ><label for=\"wpforms-1153-field_76\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_76-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][76][last]\" placeholder=\"Last\" ><label for=\"wpforms-1153-field_76-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_77-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_77\">Email Address<\/label><input type=\"email\" id=\"wpforms-1153-field_77\" class=\"wpforms-field-medium\" name=\"wpforms[fields][77]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1153-field_78-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-type=\"phone\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_78\">Phone Number<\/label><input type=\"tel\" id=\"wpforms-1153-field_78\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][78]\" aria-label=\"Phone Number\" ><\/div><div id=\"wpforms-1153-field_79-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"79\"><label class=\"wpforms-field-label\">Language preference for communication<\/label><ul id=\"wpforms-1153-field_79\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_79_1\" name=\"wpforms[fields][79]\" value=\"English\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_79_1\">English<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_79_2\" name=\"wpforms[fields][79]\" value=\"French\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_79_2\">French<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_121-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"121\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_121\">From (YYYY-MM) <\/label><input type=\"text\" id=\"wpforms-1153-field_121\" class=\"wpforms-field-medium\" name=\"wpforms[fields][121]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_122-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-type=\"text\" data-field-id=\"122\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_122\">To (YYYY-MM)<\/label><input type=\"text\" id=\"wpforms-1153-field_122\" class=\"wpforms-field-medium\" name=\"wpforms[fields][122]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_84-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_84\">Organization Name<\/label><input type=\"text\" id=\"wpforms-1153-field_84\" class=\"wpforms-field-medium\" name=\"wpforms[fields][84]\" ><\/div><div id=\"wpforms-1153-field_85-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_85\">Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_85\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][85][first]\" placeholder=\"First\" ><label for=\"wpforms-1153-field_85\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_85-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][85][last]\" placeholder=\"Last\" ><label for=\"wpforms-1153-field_85-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_86-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_86\">Email Address<\/label><input type=\"email\" id=\"wpforms-1153-field_86\" class=\"wpforms-field-medium\" name=\"wpforms[fields][86]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1153-field_87-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-type=\"phone\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_87\">Phone Number<\/label><input type=\"tel\" id=\"wpforms-1153-field_87\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][87]\" aria-label=\"Phone Number\" ><\/div><div id=\"wpforms-1153-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"88\"><label class=\"wpforms-field-label\">Language preference for communication<\/label><ul id=\"wpforms-1153-field_88\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_88_1\" name=\"wpforms[fields][88]\" value=\"English\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_88_1\">English<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_88_2\" name=\"wpforms[fields][88]\" value=\"French\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_88_2\">French<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_123-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-type=\"text\" data-field-id=\"123\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_123\">From (YYYY-MM)<\/label><input type=\"text\" id=\"wpforms-1153-field_123\" class=\"wpforms-field-medium\" name=\"wpforms[fields][123]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_124-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-type=\"text\" data-field-id=\"124\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_124\">To (YYYY-MM)<\/label><input type=\"text\" id=\"wpforms-1153-field_124\" class=\"wpforms-field-medium\" name=\"wpforms[fields][124]\" placeholder=\"YYYY-MM\" ><\/div><div id=\"wpforms-1153-field_93-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"93\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_93\">Organization Name<\/label><input type=\"text\" id=\"wpforms-1153-field_93\" class=\"wpforms-field-medium\" name=\"wpforms[fields][93]\" ><\/div><div id=\"wpforms-1153-field_92-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_92\">Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_92\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][92][first]\" placeholder=\"First\" ><label for=\"wpforms-1153-field_92\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_92-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][92][last]\" placeholder=\"Last\" ><label for=\"wpforms-1153-field_92-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_91-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_91\">Email Address<\/label><input type=\"email\" id=\"wpforms-1153-field_91\" class=\"wpforms-field-medium\" name=\"wpforms[fields][91]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-1153-field_90-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-type=\"phone\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_90\">Phone Number<\/label><input type=\"tel\" id=\"wpforms-1153-field_90\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][90]\" aria-label=\"Phone Number\" ><\/div><div id=\"wpforms-1153-field_89-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"89\"><label class=\"wpforms-field-label\">Language preference for communication<\/label><ul id=\"wpforms-1153-field_89\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_89_1\" name=\"wpforms[fields][89]\" value=\"English\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_89_1\">English<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_89_2\" name=\"wpforms[fields][89]\" value=\"French\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_89_2\">French<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_80-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"80\"><label class=\"wpforms-field-label\">ENDORSEMENT REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_80\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_80_1\" name=\"wpforms[fields][80]\" value=\"I declare that my supervisor will endorse me for the FCSI\u00ae credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_80_1\">I declare that my supervisor will endorse me for the FCSI\u00ae credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_80_2\" name=\"wpforms[fields][80]\" value=\"I declare that an active Fellow of CSI will endorse me for the FCSI\u00ae credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_80_2\">I declare that an active Fellow of CSI will endorse me for the FCSI\u00ae credential. I understand that this declaration will be verified by CSI and that CSI will contact the person I have identified (for verification purposes only).<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_81-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"81\"><div id=\"wpforms-1153-field_81\"><p>ENDORSER CONTACT INFORMATION\r\n<br \/><br \/>\r\nPlease provide contact information for your endorsement declaration. Provision of this contact information is your acknowledgement that CSI may retain this information on\r\nyour file and contact the individual noted for this purpose only.\r\n<\/p><\/div><\/div><div id=\"wpforms-1153-field_110-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_110\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_110\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][110][first]\" placeholder=\"First\" required><label for=\"wpforms-1153-field_110\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1153-field_110-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][110][last]\" placeholder=\"Last\" required><label for=\"wpforms-1153-field_110-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1153-field_111-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_111\">Organization Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1153-field_111\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][111]\" required><\/div><div id=\"wpforms-1153-field_112-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-type=\"email\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_112\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1153-field_112\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][112]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1153-field_113-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-type=\"phone\" data-field-id=\"113\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_113\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1153-field_113\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][113]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-1153-field_125-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"125\"><h3 id=\"wpforms-1153-field_125\">FIT AND PROPER REQUIREMENT<\/h3><\/div><div id=\"wpforms-1153-field_129-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"129\"><div id=\"wpforms-1153-field_129\"><p>All candidates are required to declare any legal action, allegations or complaints prior to being granted a designation. Designation\/Fellowship holders must notify CSI of any criminal charges, legal actions or complaints initiated against them within 30 calendar days of occurrence or upon renewal of the credential, whichever comes first. This declaration includes a \u201cFit and Proper Requirement\u201d that sets out the following situations for self-declaration:<\/p><\/div><\/div><div id=\"wpforms-1153-field_52-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"52\"><div id=\"wpforms-1153-field_52\"><p>Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer,\r\nprofessional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer,  professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO,  Insurance Regulator, FINRA, etc.)?,\r\nInsurance Regulator, FINRA, etc.)?<\/p><\/div><\/div><div id=\"wpforms-1153-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"96\"><label class=\"wpforms-field-label wpforms-label-hide\">Have you ever been accused of professional misconduct, disciplined or reprimanded by, or had a licence suspended or revoked by, an employer, professional association or administrative or regulatory authority (i.e. securities commission, law society, real estate association, CIRO, Insurance Regulator, FINRA, etc.)?<\/label><ul id=\"wpforms-1153-field_96\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_96_1\" name=\"wpforms[fields][96]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_96_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_96_2\" name=\"wpforms[fields][96]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_96_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_97-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"97\"><div id=\"wpforms-1153-field_97\"><p>Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt? <\/p><\/div><\/div><div id=\"wpforms-1153-field_98-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"98\"><label class=\"wpforms-field-label wpforms-label-hide\">Are you currently bankrupt or have you at any time in the past 5 years been adjudged bankrupt?<\/label><ul id=\"wpforms-1153-field_98\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_98_1\" name=\"wpforms[fields][98]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_98_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_98_2\" name=\"wpforms[fields][98]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_98_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_99-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"99\"><div id=\"wpforms-1153-field_99\"><p>Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?<\/p><\/div><\/div><div id=\"wpforms-1153-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"101\"><label class=\"wpforms-field-label wpforms-label-hide\">Have you ever been convicted of a criminal offence* in any jurisdiction for which a record suspension or a pardon has not been granted?<\/label><ul id=\"wpforms-1153-field_101\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_101_1\" name=\"wpforms[fields][101]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_101_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_101_2\" name=\"wpforms[fields][101]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_101_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_100-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"100\"><div id=\"wpforms-1153-field_100\"><p>Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating\r\nthe sale of securities, insurance, real estate, mortgages, etc.)?<\/p><\/div><\/div><div id=\"wpforms-1153-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"102\"><label class=\"wpforms-field-label wpforms-label-hide\">Have you ever been convicted of an offense under any financial services or consumer protection legislation in any jurisdiction (i.e., laws regulating the sale of securities, insurance, real estate, mortgages, etc.)?<\/label><ul id=\"wpforms-1153-field_102\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_102_1\" name=\"wpforms[fields][102]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_102_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1153-field_102_2\" name=\"wpforms[fields][102]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_102_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_106-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"106\"><div id=\"wpforms-1153-field_106\"><p>If you have answered \u201cYes\u201d to any of the questions above, please attach all relevant paperwork, including details of any punishment or disciplinary action\r\ntaken. Any information you provide will be collected, stored and used in accordance with applicable law and our privacy policy and will be shared with the\r\nDesignation Ethics Committee to determine your suitability for the designation.\r\n<br \/><br \/>\r\n* \u201cCriminal offence\u201d excludes an offence (i) under a provincial regulatory statute, such as the Highway Traffic Act, unless the provincial statute is\r\nspecifically listed above and unless the provincial conviction involved an offence of dishonesty or theft, such as perjury or subornation of perjury, false\r\nstatement, fraud, embezzlement, or false pretense, or any other offense the commission of which involves some element of deceit or untruthfulness,\r\nand (ii) an offence punishable by summary conviction only that is not an offence of dishonesty or theft.\r\n<\/p><p><\/p><\/div><\/div><div id=\"wpforms-1153-field_107-container\" class=\"wpforms-field wpforms-field-file-upload wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"file-upload\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_107\">Please attach all relevant paperwork <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"107\"\n\t\tdata-form-id=\"1153\"\n\t\tdata-input-name=\"wpforms_1153_107\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"52428800\"\n\t\tdata-max-file-number=\"20\"\n\t\tdata-post-max-size=\"52428800\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 20 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1153-field_107\"\n\t\tname=\"wpforms_1153_107\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-1153-field_126-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"126\"><h3 id=\"wpforms-1153-field_126\">Code of Ethics<\/h3><\/div><div id=\"wpforms-1153-field_127-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"127\"><div id=\"wpforms-1153-field_127\">As a designation holder and throughout my annual designation period, I agree that I will continue to uphold the Code of Ethics and abide by the Ethical Misconduct Process.<\/div><\/div><div id=\"wpforms-1153-field_128-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"128\"><label class=\"wpforms-field-label wpforms-label-hide\">Code of Ethics <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1153-field_128_1\" name=\"wpforms[fields][128][]\" value=\"I agree\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_128_1\">I agree<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_108-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"108\"><label class=\"wpforms-field-label\">INDUSTRY CONTRIBUTION REQUIREMENTS <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_108\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1153-field_108_1\" name=\"wpforms[fields][108][]\" value=\"I understand, and agree to comply with the FCSI\u00ae Industry Contribution Requirements to complete a minimum of 12 hours per calendar year as set out in the FCSI\u00ae Industry Contribution Assessment Tool.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_108_1\">I understand, and agree to comply with the FCSI\u00ae Industry Contribution Requirements to complete a minimum of 12 hours per calendar year as set out in the FCSI\u00ae Industry Contribution Assessment Tool.<\/label><\/li><\/ul><div class=\"wpforms-field-description\"><p>You are not required to submit your documentation on an annual basis, however from time to time some members may be subject to random audits.<\/p><\/div><\/div><div id=\"wpforms-1153-field_53-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"53\"><label class=\"wpforms-field-label\">TRADEMARK LICENSE AGREEMENT <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1153-field_53\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1153-field_53_1\" name=\"wpforms[fields][53][]\" value=\"By signing below I confirm that I have read and consent to the terms and conditions of this Information Release Consent.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1153-field_53_1\">By signing below I confirm that I have read and consent to the terms and conditions of this Information Release Consent.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1153-field_18-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1153-field_18\">Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1153-field_18\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][18]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\" data-input-method=\"draw\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1153-field_18-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-1153-field_115-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"115\"><input type=\"hidden\" id=\"wpforms-1153-field_115\" name=\"wpforms[fields][115]\" value=\"1017980\"><\/div><div id=\"wpforms-1153-field_116-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-type=\"hidden\" data-field-id=\"116\"><input type=\"hidden\" id=\"wpforms-1153-field_116\" name=\"wpforms[fields][116]\" value=\"Fellow of CSI (FCSI\u00ae) Licence Application\"><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1153\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1167\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1153\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Next\" aria-live=\"assertive\" value=\"wpforms-submit\">Next<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/forms.csi.ca\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":50,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1167","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1167","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/users\/50"}],"replies":[{"embeddable":true,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1167"}],"version-history":[{"count":0,"href":"https:\/\/forms.csi.ca\/index.php?rest_route=\/wp\/v2\/pages\/1167\/revisions"}],"wp:attachment":[{"href":"https:\/\/forms.csi.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1167"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}