{"id":164743,"date":"2021-06-08T10:30:59","date_gmt":"2021-06-08T14:30:59","guid":{"rendered":"https:\/\/samaritanspurse.org\/?p=164743"},"modified":"2024-04-11T10:05:31","modified_gmt":"2024-04-11T14:05:31","slug":"online-logo-request-form","status":"publish","type":"post","link":"https:\/\/samaritanspurse.org\/es\/operation-christmas-child\/online-logo-request-form\/","title":{"rendered":"Online Logo Request Form"},"content":{"rendered":"<main>\r\n\t<!--<header class=\"hero-image\" alt=\"\">\r\n\t\t<div class=\"hero-overlay\">\r\n\t\t<\/div>\r\n\t\t<\/header>-->\r\n\t<div class=\"content-100\"> \r\n\t\t<div class=\"main-container\">\r\n\t\t\t<div class=\"title-container\">\r\n\t\t\t\t\r\n\t\t\t\t<div class=\"title-container-logo\">\r\n\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/sp-comm-arkfiles.s3.theark.cloud\/website\/images\/occ\/logo\/occ-logo-120x101.png\" \/>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"title-container-content\">\r\n\t\t\t\t\t<h1>Online Logo Request Form<\/h1>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<br>\r\n\t\t\t\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t<div class=\"content-box\">\r\n\t\t<div class=\"content-100\">\r\n\t\t\t<div class=\"learn-more\">\r\n\t\t\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_163' ><div id='gf_163' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">OCC Online Logo Request Form<\/h2>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_163'  action='\/es\/wp-json\/wp\/v2\/posts\/164743#gf_163' data-formid='163' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_163' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_163_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal Information<\/h3><\/div><fieldset id=\"field_163_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_163_1'>\n                            \n                            <span id='input_163_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_163_1_3' value=''   aria-required='true'   placeholder='First'  \/>\n                                                    <label for='input_163_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_163_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_163_1_6' value=''   aria-required='true'   placeholder='Last'  \/>\n                                                    <label for='input_163_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_163_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_2'>Name of Organization<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_163_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_163_3\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_163_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_163_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_163_3_1' value=''   placeholder='Stress Address' aria-required='true'    \/>\n                                        <label for='input_163_3_1' id='input_163_3_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_163_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_163_3_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_163_3_3' id='input_163_3_3_label' class='gform-field-label gform-field-label--type-sub '>Ciudad<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_163_3_4_container' >\n                                        <select name='input_3.4' id='input_163_3_4'     aria-required='true'    ><option value='' selected='selected'>State \/ Province<\/option><option value='AL' >Alabama<\/option><option value='AK' >Alaska<\/option><option value='AZ' >Arizona<\/option><option value='AR' >Arkansas<\/option><option value='CA' >California<\/option><option value='CO' >Colorado<\/option><option value='CT' >Connecticut<\/option><option value='DE' >Delaware<\/option><option value='DC' >District of Columbia<\/option><option value='FL' >Florida<\/option><option value='GA' >Georgia<\/option><option value='GU' >Guam<\/option><option value='HI' >Hawaii<\/option><option value='ID' >Idaho<\/option><option value='IL' >Illinois<\/option><option value='IN' >Indiana<\/option><option value='IA' >Iowa<\/option><option value='KS' >Kansas<\/option><option value='KY' >Kentucky<\/option><option value='LA' >Louisiana<\/option><option value='ME' >Maine<\/option><option value='MD' >Maryland<\/option><option value='MA' >Massachusetts<\/option><option value='MI' >Michigan<\/option><option value='MN' >Minnesota<\/option><option value='MS' >Mississippi<\/option><option value='MO' >Missouri<\/option><option value='MT' >Montana<\/option><option value='NE' >Nebraska<\/option><option value='NV' >Nevada<\/option><option value='NH' >New Hampshire<\/option><option value='NJ' >New Jersey<\/option><option value='NM' >New Mexico<\/option><option value='NY' >New York<\/option><option value='NC' >North Carolina<\/option><option value='ND' >North Dakota<\/option><option value='OH' >Ohio<\/option><option value='OK' >Oklahoma<\/option><option value='OR' >Oregon<\/option><option value='PA' >Pennsylvania<\/option><option value='PR' >Puerto Rico<\/option><option value='RI' >Rhode Island<\/option><option value='SC' >South Carolina<\/option><option value='SD' >South Dakota<\/option><option value='TN' >Tennessee<\/option><option value='TX' >Texas<\/option><option value='UT' >Utah<\/option><option value='VT' >Vermont<\/option><option value='VA' >Virginia<\/option><option value='WA' >Washington<\/option><option value='WV' >West Virginia<\/option><option value='WI' >Wisconsin<\/option><option value='WY' >Wyoming<\/option><\/select>\n                                        <label for='input_163_3_4' id='input_163_3_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_163_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_163_3_5' value=''   placeholder='ZIP \/ Postal Code' aria-required='true'    \/>\n                                    <label for='input_163_3_5' id='input_163_3_5_label' class='gform-field-label gform-field-label--type-sub '>Zip Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_163_3_6' value='USAB' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_163_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_163_5' type='email' value='' class='large'   placeholder='example@email.com' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_163_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_4'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_163_4' type='tel' value='' class='large'  placeholder='(###) ### - ####'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_163_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Trademark Usage Agreement<\/h3><\/div><fieldset id=\"field_163_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_163_8'>Please check each box below to indicate your agreement with the following terms of use for Samaritan\u2019s Purse trademarks:<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_163_8'><div class='gchoice gchoice_163_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='I understand and agree that the words \u201cOperation Christmas Child,\u201d the words \u201cSamaritan\u2019s Purse,\u201d and the Operation Christmas Child design and logo (collectively the \u201cSP Trademarks\u201d) are all registered trademarks owned by Samaritan\u2019s Purse.'  id='choice_163_8_1'   aria-describedby=\"gfield_description_163_8\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_1' id='label_163_8_1' class='gform-field-label gform-field-label--type-inline'>I understand and agree that the words \u201cOperation Christmas Child,\u201d the words \u201cSamaritan\u2019s Purse,\u201d and the Operation Christmas Child design and logo (collectively the \u201cSP Trademarks\u201d) are all registered trademarks owned by Samaritan\u2019s Purse.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='I agree not to use any SP Trademarks without the prior written approval and permission of Samaritan\u2019s Purse.'  id='choice_163_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_2' id='label_163_8_2' class='gform-field-label gform-field-label--type-inline'>I agree not to use any SP Trademarks without the prior written approval and permission of Samaritan\u2019s Purse.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='I agree that if my request is approved by Samaritan\u2019s Purse, such approval will constitute a limited, nonexclusive, and non-transferable license to use the SP Trademarks for only the purposes and timeframe approved by Samaritan\u2019s Purse.'  id='choice_163_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_3' id='label_163_8_3' class='gform-field-label gform-field-label--type-inline'>I agree that if my request is approved by Samaritan\u2019s Purse, such approval will constitute a limited, nonexclusive, and non-transferable license to use the SP Trademarks for only the purposes and timeframe approved by Samaritan\u2019s Purse.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.4' type='checkbox'  value='I agree that if my request is approved by Samaritan\u2019s Purse, any future or different use of the SP Trademarks beyond the duration and purposes authorized by Samaritan\u2019s Purse is not permitted without prior written permission from Samaritan\u2019s Purse.'  id='choice_163_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_4' id='label_163_8_4' class='gform-field-label gform-field-label--type-inline'>I agree that if my request is approved by Samaritan\u2019s Purse, any future or different use of the SP Trademarks beyond the duration and purposes authorized by Samaritan\u2019s Purse is not permitted without prior written permission from Samaritan\u2019s Purse.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.5' type='checkbox'  value='I agree that if my request is approved by Samaritan\u2019s Purse, Samaritan\u2019s Purse may terminate my usage license with seven days written notice, or immediately if I have failed to comply with the terms of this Trademark Usage Agreement.'  id='choice_163_8_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_5' id='label_163_8_5' class='gform-field-label gform-field-label--type-inline'>I agree that if my request is approved by Samaritan\u2019s Purse, Samaritan\u2019s Purse may terminate my usage license with seven days written notice, or immediately if I have failed to comply with the terms of this Trademark Usage Agreement.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.6' type='checkbox'  value='If I am signing this Trademark Usage Agreement on behalf of an organization, I represent that I am authorized to sign for the organization and obligate it to the terms in this Trademark Usage Agreement.'  id='choice_163_8_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_6' id='label_163_8_6' class='gform-field-label gform-field-label--type-inline'>If I am signing this Trademark Usage Agreement on behalf of an organization, I represent that I am authorized to sign for the organization and obligate it to the terms in this Trademark Usage Agreement.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_163_8_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.7' type='checkbox'  value='By checking this box, I understand and agree with the terms of this Trademark Usage Agreement, and I intend and consent for checking this box to serve as my signature the same as if I had signed my name on paper.'  id='choice_163_8_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_163_8_7' id='label_163_8_7' class='gform-field-label gform-field-label--type-inline'>By checking this box, I understand and agree with the terms of this Trademark Usage Agreement, and I intend and consent for checking this box to serve as my signature the same as if I had signed my name on paper.<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_8_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Seleccionar todos\" data-label-deselect=\"Deseleccionar todos\">Seleccionar todos<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_163_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Logo Use<\/h3><\/div><div id=\"field_163_24\" class=\"gfield gfield--type-sp_attachment_upload gfield--input-type-sp_attachment_upload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_24'>Mockup File Upload<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_163_24'><p style='font-size:14px !important;padding-left:0 !important;'><i>Please upload a mockup file of how you intend to use the Operation Christmas Child logo.  Valid file types are jpg, and pdf.<\/i><\/p><\/div><div class='ginput_container ginput_container_text large'>\t\t\t<div class='spau-content-wrapper'>\n\t\t\t\t<span id='input_163_24_btn-photo' data-photobutton class='btn btn-success fileinput-button'>\n\t\t\t\t<i class='glyphicon glyphicon-plus'><\/i>\n\t\t\t\t<span>Add file...<\/span>\n\t\t\t\t<!-- The file input field used as target for the file upload widget -->\n\t\t\t\t\t\t\t\t<input id='input_163_24_fileupload' data-file-upload type='file' name='input_163_24_files[]'>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t<span id='input_163_24_fileUploadedBool' data-uploadbutton>Your file has not been uploaded.<\/span>\n\t\t\t\t<br>\n\t\t\t\t<br>\n\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t<div id='input_163_24_progress' data-progress-bar class='progress'>\n\t\t\t\t\t<div class='progress-bar progress-bar-success'><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<!-- The container for the uploaded files -->\n\t\t\t\t<div id='input_163_24_files' data-file-wrapper class='input_163_24_files'><\/div>\n\t\t\t\t<br>\n\t\t\t\t\t\t\t\t\t\t<input type=hidden name='input_24' id='input_163_24_field' value='' \/>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div><\/div><div id=\"field_163_6\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_6'>Intention of Logo Use<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_163_6'>Describe how and where you intend to use the Operation Christmas Child logo, as well as if this item will contain any other information (include URL if requesting use on a website):<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_163_6' class='textarea small'  aria-describedby=\"gfield_description_163_6\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_163_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional Information<\/h3><\/div><div id=\"field_163_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_16'>Operation Christmas Child Regional Office<\/label><div class='gfield_description' id='gfield_description_163_16'>Are you a Connect volunteer? If so, please select your Regional Office..<\/div><div class='ginput_container ginput_container_select'><select name='input_16' id='input_163_16' class='large gfield_select'  aria-describedby=\"gfield_description_163_16\"   aria-invalid=\"false\" ><option value='Please select...' >Please select...<\/option><option value='Carolinas Regional Office' >Carolinas Regional Office<\/option><option value='Florida \u2013 Puerto Rico Regional Office' >Florida \u2013 Puerto Rico Regional Office<\/option><option value='Great Lakes Regional Office' >Great Lakes Regional Office<\/option><option value='Lower Midwest Regional Office' >Lower Midwest Regional Office<\/option><option value='Mid-Atlantic North Regional Office' >Mid-Atlantic North Regional Office<\/option><option value='Mid-Atlantic South Regional Office' >Mid-Atlantic South Regional Office<\/option><option value='Mid-South Regional Office' >Mid-South Regional Office<\/option><option value='Northeast Regional Office' >Northeast Regional Office<\/option><option value='Northwest Regional Office' >Northwest Regional Office<\/option><option value='Southeast Regional Office' >Southeast Regional Office<\/option><option value='Southwest Regional Office' >Southwest Regional Office<\/option><option value='Texas \u2013 Louisiana Regional Office' >Texas \u2013 Louisiana Regional Office<\/option><option value='Upper Midwest Regional Office' >Upper Midwest Regional Office<\/option><option value='West Coast Regional Office' >West Coast Regional Office<\/option><\/select><\/div><\/div><div id=\"field_163_13\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br><\/div><div id=\"field_163_20\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"https:\/\/sp-comm-arkfiles.s3.theark.cloud\/website\/pdfs\/OCC\/style-guide\/SP%20Style%20Guide_Version%202021.1_OCC%20logo%20standards.pdf\"><p style=\"text-align:center\">OCC Logo and Guidelines<\/a><\/p><\/div><div id=\"field_163_23\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br><\/div><div id=\"field_163_21\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_163_21'>CAPTCHA<\/label><div id='input_163_21' class='ginput_container ginput_recaptcha' 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