{"id":464,"date":"2025-01-12T17:49:53","date_gmt":"2025-01-12T17:49:53","guid":{"rendered":"https:\/\/lw-sda.org\/?page_id=464"},"modified":"2025-01-12T18:03:50","modified_gmt":"2025-01-12T18:03:50","slug":"new-membership-request","status":"publish","type":"page","link":"https:\/\/lw-sda.org\/index.php\/new-membership-request\/","title":{"rendered":"New Membership Request"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n<style>#wpzf-466 + .notice { margin-top: 20px; padding: 15px; border-radius: 4px; }#wpzf-466 + .notice.success { background-color: #e7f7ed; color: #227045; border-left: 4px solid #46b450; }#wpzf-466 + .notice.error { background-color: #fde8e8; color: #8a1f11; border-left: 4px solid #cc0000; }#wpzf-466 + .notice p { margin: 0; }<\/style><!-- ZOOM Forms Start -->\n\t\t\t<form id=\"wpzf-466\" method=\"post\" action=\"https:\/\/lw-sda.org\/wp-admin\/admin-post.php\" class=\"wpzoom-forms_form\">\n\t\t\t<input type=\"hidden\" name=\"action\" value=\"wpzf_submit\" \/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"466\" \/>\n\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"e36e5d2c66\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/464\" \/>\n\t\t\t\n<div class=\"wp-block-wpzoom-forms-form\">\n<div class=\"wp-block-group\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"flex-basis:100%\">\n<p><strong>Your Name<\/strong><\/p>\n\n\n\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"padding-right:var(--wp--preset--spacing--40)\">\n<label for=\"input_name\"><label for=\"input_name\">First<\/label><sup class=\"wp-block-wpzoom-forms-required\">*<\/sup><\/label><input type=\"text\" name=\"wpzf_input_name\" id=\"input_name\" placeholder=\"\" required class=\"wp-block-wpzoom-forms-text-name-field\"\/>\n<\/div>\n\n\n\n<div class=\"wp-block-column\">\n<label for=\"input_44c5e8a3\"><label for=\"input_44c5e8a3\">Last<\/label><sup class=\"wp-block-wpzoom-forms-required\">*<\/sup><\/label><input type=\"text\" name=\"wpzf_input_44c5e8a3\" id=\"input_44c5e8a3\" placeholder=\"\" required data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n<\/div>\n<\/div>\n\n\n\n<label for=\"input_email\"><label for=\"input_email\">Email<\/label><sup class=\"wp-block-wpzoom-forms-required\">*<\/sup><\/label><input type=\"email\" name=\"wpzf_input_email\" id=\"input_email\" placeholder=\"\" required data-replyto=\"true\" class=\"wp-block-wpzoom-forms-text-email-field fullwidth\"\/>\n\n\n\n<label for=\"input_1bb8d86c\"><label for=\"input_1bb8d86c\">Phone number<\/label><\/label><input type=\"tel\" name=\"wpzf_input_1bb8d86c\" id=\"input_1bb8d86c\" placeholder=\"\" class=\"wp-block-wpzoom-forms-text-phone-field\"\/>\n\n\n\n<div style=\"height:40px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-group\">\n<label for=\"input_148e7630\"><label for=\"input_148e7630\">Preferred Method of Contact<\/label><\/label><select name=\"wpzf_input_148e7630\" id=\"input_148e7630\" defaultvalue=\"Item #1\" class=\"wp-block-wpzoom-forms-select-field\"><option value=\"Email\">Email<\/option><option value=\"Phone\">Phone<\/option><option value=\"Text SMS\">Text SMS<\/option><\/select>\n\n\n\n<label for=\"input_395a33bf\"><label for=\"input_395a33bf\">Date of Birth<\/label><sup class=\"wp-block-wpzoom-forms-required\">*<\/sup><\/label><input data-datepicker=\"true\" data-date-format=\"m\/d\/Y\" data-mode=\"single\" type=\"text\" name=\"wpzf_input_395a33bf\" id=\"input_395a33bf\" placeholder=\"m\/d\/Y\" required class=\"wp-block-wpzoom-forms-datepicker-field\"\/>\n<\/div>\n\n\n\n<p><strong>Your Address<\/strong><\/p>\n\n\n\n<label for=\"input_63de4a79\"><label for=\"input_63de4a79\">Street address<\/label><\/label><input type=\"text\" name=\"wpzf_input_63de4a79\" id=\"input_63de4a79\" placeholder=\"\" data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n\n\n\n<label for=\"input_c2f48087\"><label for=\"input_c2f48087\">Address Line 2<\/label><\/label><input type=\"text\" name=\"wpzf_input_c2f48087\" id=\"input_c2f48087\" placeholder=\"\" data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n\n\n\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"padding-right:var(--wp--preset--spacing--40)\">\n<label for=\"input_aded2b39\"><label for=\"input_aded2b39\">City<\/label><\/label><input type=\"text\" name=\"wpzf_input_aded2b39\" id=\"input_aded2b39\" placeholder=\"\" data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n<\/div>\n\n\n\n<div class=\"wp-block-column\">\n<label for=\"input_5d19b773\"><label for=\"input_5d19b773\">ZIP Code<\/label><\/label><input type=\"text\" name=\"wpzf_input_5d19b773\" id=\"input_5d19b773\" placeholder=\"\" data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"padding-right:var(--wp--preset--spacing--40)\">\n<label for=\"input_3c1eb2cc\"><label for=\"input_3c1eb2cc\">State<\/label><\/label><select name=\"wpzf_input_3c1eb2cc\" id=\"input_3c1eb2cc\" defaultvalue=\"Item #1\" class=\"wp-block-wpzoom-forms-select-field\"><option value=\"Alabama\">Alabama<\/option><option value=\"Alaska\">Alaska<\/option><option value=\"Arizona\">Arizona<\/option><option value=\"Arkansas\">Arkansas<\/option><option value=\"California\">California<\/option><option value=\"Colorado\">Colorado<\/option><option value=\"Connecticut\">Connecticut<\/option><option value=\"Delaware\">Delaware<\/option><option value=\"Florida\">Florida<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Hawaii\">Hawaii<\/option><option value=\"Idaho\">Idaho<\/option><option value=\"Illinois\">Illinois<\/option><option value=\"Indiana\">Indiana<\/option><option value=\"Iowa\">Iowa<\/option><option value=\"Kansas\">Kansas<\/option><option value=\"Kentucky\">Kentucky<\/option><option value=\"Louisiana\">Louisiana<\/option><option value=\"Maine\">Maine<\/option><option value=\"Maryland\">Maryland<\/option><option value=\"Massachusetts\">Massachusetts<\/option><option value=\"Michigan\">Michigan<\/option><option value=\"Minnesota\">Minnesota<\/option><option value=\"Mississippi\">Mississippi<\/option><option value=\"Missouri\">Missouri<\/option><option value=\"Montana\">Montana<\/option><option value=\"Nebraska\">Nebraska<\/option><option value=\"Nevada\">Nevada<\/option><option value=\"New Hampshire\">New Hampshire<\/option><option value=\"New Jersey\">New Jersey<\/option><option value=\"New Mexico\">New Mexico<\/option><option value=\"New York\">New York<\/option><option value=\"North Carolina\">North Carolina<\/option><option value=\"North Dakota\">North Dakota<\/option><option value=\"Ohio\">Ohio<\/option><option value=\"Oklahoma\">Oklahoma<\/option><option value=\"Oregon\">Oregon<\/option><option value=\"Pennsylvania\">Pennsylvania<\/option><option value=\"Rhode Island\">Rhode Island<\/option><option value=\"South Carolina\">South Carolina<\/option><option value=\"South Dakota\">South Dakota<\/option><option value=\"Tennessee\">Tennessee<\/option><option value=\"Texas\">Texas<\/option><option value=\"Utah\">Utah<\/option><option value=\"Vermont\">Vermont<\/option><option value=\"Virginia\">Virginia<\/option><option value=\"Washington\">Washington<\/option><option value=\"West Virginia\">West Virginia<\/option><option value=\"Wisconsin\">Wisconsin<\/option><option value=\"Wyoming\">Wyoming<\/option><\/select>\n\n\n\n<div class=\"wp-block-group\">\n<label for=\"input_da89a131\"><label for=\"input_da89a131\">Gender<\/label><\/label><ul class=\"wp-block-wpzoom-forms-radio-field\"><li><label><input type=\"radio\" name=\"wpzf_input_da89a131\" id=\"input_da89a131\" value=\"Male\"\/>Male<\/label><\/li><li><label><input type=\"radio\" name=\"wpzf_input_da89a131\" id=\"input_da89a131\" value=\"Female\"\/>Female<\/label><\/li><\/ul>\n\n\n\n<label for=\"input_cdca97d6\"><label for=\"input_cdca97d6\">Marital Status<\/label><\/label><ul class=\"wp-block-wpzoom-forms-radio-field\"><li><label><input type=\"radio\" name=\"wpzf_input_cdca97d6\" id=\"input_cdca97d6\" value=\"Single\"\/>Single<\/label><\/li><li><label><input type=\"radio\" name=\"wpzf_input_cdca97d6\" id=\"input_cdca97d6\" value=\"Married\"\/>Married<\/label><\/li><li><label><input type=\"radio\" name=\"wpzf_input_cdca97d6\" id=\"input_cdca97d6\" value=\"Widowed\"\/>Widowed<\/label><\/li><li><label><input type=\"radio\" name=\"wpzf_input_cdca97d6\" id=\"input_cdca97d6\" value=\"Divorced \/ Separated\"\/>Divorced \/ Separated<\/label><\/li><\/ul>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator aligncenter has-alpha-channel-opacity\"\/>\n<\/div>\n<\/div>\n\n\n\n<label for=\"input_ab78919f\"><label for=\"input_ab78919f\">Race Ethnicity<\/label><\/label><ul class=\"wp-block-wpzoom-forms-multi-checkbox-field\"><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"African \/ African American\"\/>African \/ African American<\/label><\/li><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"Asian \/ Asian Pacific Islander\"\/>Asian \/ Asian Pacific Islander<\/label><\/li><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"Caucasian\"\/>Caucasian<\/label><\/li><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"Hispanic \/ Latin\"\/>Hispanic \/ Latin<\/label><\/li><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"Native American \/ 1st Nation\"\/>Native American \/ 1st Nation<\/label><\/li><li><label><input type=\"checkbox\" name=\"wpzf_input_ab78919f[]\" id=\"input_ab78919f\" value=\"Other\"\/>Other<\/label><\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<label for=\"input_3e939f7f\"><label for=\"input_3e939f7f\">Do you reside in the same household of a current Living Word Church Member?<\/label><\/label><ul class=\"wp-block-wpzoom-forms-radio-field\"><li><label><input type=\"radio\" name=\"wpzf_input_3e939f7f\" id=\"input_3e939f7f\" value=\"Yes\"\/>Yes<\/label><\/li><li><label><input type=\"radio\" name=\"wpzf_input_3e939f7f\" id=\"input_3e939f7f\" value=\"No\"\/>No<\/label><\/li><\/ul>\n\n\n\n<label for=\"input_75ff9e9d\"><label for=\"input_75ff9e9d\">If Yes, Name of Living Word Church Member<\/label><\/label><input type=\"text\" name=\"wpzf_input_75ff9e9d\" id=\"input_75ff9e9d\" placeholder=\"\" data-subject=\"false\" class=\"wp-block-wpzoom-forms-text-plain-field\"\/>\n\n\n\n<div class=\"wp-block-columns 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