{"id":3951,"date":"2019-09-30T18:55:42","date_gmt":"2019-09-30T18:55:42","guid":{"rendered":"https:\/\/www.christusems.org\/?page_id=3951"},"modified":"2019-12-18T15:38:58","modified_gmt":"2019-12-18T15:38:58","slug":"membership-payment","status":"publish","type":"page","link":"https:\/\/www.christusems.org\/?page_id=3951","title":{"rendered":"Membership Payment"},"content":{"rendered":"<div id=\"pl-3951\"  class=\"panel-layout\" ><div id=\"pg-3951-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-3951-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3951-0-0-0\" class=\"so-panel widget widget_text panel-first-child panel-last-child\" data-index=\"0\" >\t\t\t<div class=\"textwidget\"><style type=\"text\/css\">#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_52 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_52 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_52 .eform-ui-estimator {\n\t\tmax-width: 980px;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/<\/style><div\nid=\"ipt_fsqm_form_wrap_52\"\nclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_1 ui-front eform-ltr eform-override-element-boxy eform-override-alignment-inherit\"\ndata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\ndata-ui-type=\"1\"\ndata-ui-theme=\"[&quot;https:\\\/\\\/www.christusems.org\\\/wp-content\\\/plugins\\\/wp-fsqm-pro\\\/static\\\/front\\\/css\\\/material-themes\\\/light-themes\\\/purple.css?ver=4.18.0&quot;]\"\ndata-ui-theme-id=\"material-purple\"\ndata-eformanim=\"1\"\ndata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;Membership Payment&quot;,&quot;form_id&quot;:&quot;52&quot;}\"\ndata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\ndata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_52_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_52_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\ndata-eformscroll=\"{&quot;progress&quot;:true,&quot;message&quot;:true,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\ndata-eform-cookie=\"0\"\ndata-subscription-form=\"false\"\ndata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;6b762593dd&quot;}\"\n>\n<noscript><div\nclass=\"ipt_fsqm_form_message_noscript ui-widget ui-widget-content ui-corner-all\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div>Javascript is disabled<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-bottom\"><p>Javascript is disabled on your browser. Please enable it in order to use this form.<\/p><\/div><\/div>\n<\/noscript><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt_uif_init_loader ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Loading<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_uif_conditional_logic\" id=\"ipt_uif_conditional_logic_52\" value=\"{&quot;logics&quot;:{&quot;ipt_fsqm_form_52_pinfo_5&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;pinfo&quot;,&quot;key&quot;:&quot;4&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;1&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;payment&quot;,&quot;m_type&quot;:&quot;pinfo&quot;},&quot;ipt_fsqm_form_52_pinfo_2&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:false,&quot;logic&quot;:{},&quot;type&quot;:&quot;p_name&quot;,&quot;m_type&quot;:&quot;pinfo&quot;}},&quot;indexes&quot;:{&quot;ipt_fsqm_form_52_pinfo_4&quot;:[&quot;ipt_fsqm_form_52_pinfo_5&quot;]},&quot;base&quot;:&quot;52&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_timer_data\" id=\"ipt_fsqm_timer_data_52\" value=\"{&quot;type&quot;:&quot;none&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_epoc_data\" id=\"ipt_fsqm_epoc_data_52\" value=\"{&quot;CURRENTYEAR&quot;:2026,&quot;CURRENTDATE&quot;:1779777042000,&quot;CURRENTDAY&quot;:26,&quot;CURRENTMONTH&quot;:5,&quot;CURRENTHOUR&quot;:6,&quot;CURRENTMINUTE&quot;:30,&quot;CURRENTSECOND&quot;:42,&quot;CURRENTWEEK&quot;:22,&quot;CURRENTEPOC&quot;:20599}\" \/><div\nstyle=\"display: none;\" class=\"ipt_uif_hidden_init\"><form\nmethod=\"post\" action=\"\" class=\"ipt_uif_validate_form ipt_fsqm_main_form\" id=\"ipt_fsqm_form_52\" autocomplete=\"on\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"action\" id=\"action\" value=\"ipt_fsqm_save_form\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_epoc\" class=\"eform-epoc-value\" value=\"1779777042\" \/>\n<input\ntype=\"hidden\" class=\"ipt_fsqm_form_tab_pos\" name=\"fsqm_form52_tab_pos\" value=\"0\" id=\"fsqm_form52_tab_pos\" \/>\n<input\ntype=\"hidden\" id=\"ipt_fsqm_form_data_save\" name=\"ipt_fsqm_form_data_save\" value=\"b1b35114e1\" data-sayt-exclude \/>\t\t\t<input\ntype=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3951\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"form_id\" value=\"52\" \/><div\nclass=\"ipt-eform-width-restrain\"><div\nclass=\"ipt-eform-content \"><div\ndata-settings=\"{&quot;can_previous&quot;:true,&quot;show_progress_bar&quot;:true,&quot;progress_bar_bottom&quot;:false,&quot;block_previous&quot;:false,&quot;any_tab&quot;:false,&quot;type&quot;:&quot;1&quot;,&quot;scroll&quot;:true,&quot;decimal_point&quot;:2,&quot;auto_progress&quot;:false,&quot;auto_progress_delay&quot;:&quot;1500&quot;,&quot;auto_submit&quot;:false,&quot;hidden_buttons&quot;:false,&quot;scroll_on_error&quot;:true}\" class=\"ipt_fsqm_main_tab ipt_uif_tabs horizontal\"><div\nclass=\"ipt-eform-tab-nav-wrap\"><ul><li\nid=\"ipt_fsqm_form_52_tab_0_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_52_tab_0\"><span\nclass=\"eform-tab-labels\">Membership Payment <\/span><\/a><\/li><\/ul>\n<i\nclass=\"eform-tab-nav eform-tab-nav-right ipt-icomoon-angle-right disabled eform-ripple\"><\/i>\n<i\nclass=\"eform-tab-nav eform-tab-nav-left ipt-icomoon-angle-left disabled eform-ripple\"><\/i>\n<span\nclass=\"eform-tab-passive-notifier\"><\/span>\n<span\nclass=\"eform-tab-active-notifier\"><\/span><\/div><div\nid=\"ipt_fsqm_form_52_tab_0\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_52_layout_0_inner\" class=\"ipt-eform-layout-wrapper\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[design][0][m_type]\" id=\"ipt_fsqm_form_52_design_0_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[design][0][type]\" id=\"ipt_fsqm_form_52_design_0_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_52_design_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><p><em\nstyle=\"color: #000000; font-family: arial, helvetica; font-size: 13px;\"><span\nstyle=\"font-size: small;\"><span\nstyle=\"text-decoration-line: underline;\"><strong>NOTICE:<\/strong><\/span>\u00a0After paying for my membership, I agree to\u00a0print, complete and\u00a0mail my\u00a0Membership Application to CHRISTUS EMS 2201 Mobberly Avenue, Longview, TX 75602. My Membership is subject to cancellation if my application is incomplete and\/or not sent to CHRISTUS EMS for processing. By marking the &#8220;I agree&#8221; check box, I am indicating that I have read and agree with this statement and the statements printed on CHRISTUS EMS&#8217; Membership application. Once you click &#8220;I agree&#8221; checkbox below, the online payment section will appear.\u00a0<\/span><\/em><\/p><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][4][m_type]\" id=\"ipt_fsqm_form_52_pinfo_4_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][4][type]\" id=\"ipt_fsqm_form_52_pinfo_4_type\" value=\"s_checkbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_s_checkbox\" id=\"ipt_fsqm_form_52_pinfo_4\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ntype=\"checkbox\"\nclass=\"check_me validate[required] ipt_uif_checkbox filled-in  ipt_uif_s_checkbox\"\nname=\"ipt_fsqm_form_52[pinfo][4][value]\" id=\"ipt_fsqm_form_52_pinfo_4_value_1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_52_pinfo_4_value_1\" data-labelcon=\"&#xe18e;\">\nI agree\t\t\t\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[mcq][1][m_type]\" id=\"ipt_fsqm_form_52_mcq_1_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[mcq][1][type]\" id=\"ipt_fsqm_form_52_mcq_1_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_52_mcq_1\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_52_mcq_1\">I want to:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_52[mcq][1][options][]\"\nid=\"ipt_fsqm_form_52_mcq_1_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_52_mcq_1_options__0\" data-labelcon=\"&#xe18e;\">\nApply for a new membership\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_52[mcq][1][options][]\"\nid=\"ipt_fsqm_form_52_mcq_1_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_52_mcq_1_options__1\" data-labelcon=\"&#xe18e;\">\nRenew an existing membership\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][3][m_type]\" id=\"ipt_fsqm_form_52_pinfo_3_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][3][type]\" id=\"ipt_fsqm_form_52_pinfo_3_type\" value=\"address\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_address\" id=\"ipt_fsqm_form_52_pinfo_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt-eform-address-recipient\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_52[pinfo][3][values][recipient]\"\nid=\"ipt_fsqm_form_52_pinfo_3_values_recipient\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipt-icomoon-user ipticm prefix\"><\/i>\n<label\nfor=\"ipt_fsqm_form_52_pinfo_3_values_recipient\">Name<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt-eform-address-line-one\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_52[pinfo][3][values][line_one]\"\nid=\"ipt_fsqm_form_52_pinfo_3_values_line_one\"\nvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipt-icomoon-address-book ipticm prefix\"><\/i>\n<label\nfor=\"ipt_fsqm_form_52_pinfo_3_values_line_one\">Physical Address:<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt-eform-address-cpz cpz-column-half\"><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt-eform-address-province\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\"ipt_uif_autocomplete  check_me validate[required] ipt_uif_text\"\ndata-autocomplete=\"[]\" data-preset-country=\"\"\t\t\t\t\t\t\t\ttype=\"text\"\nname=\"ipt_fsqm_form_52[pinfo][3][values][province]\"\nid=\"ipt_fsqm_form_52_pinfo_3_values_province\"\nvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipt-icomoon-map-signs ipticm prefix\"><\/i>\n<label\nfor=\"ipt_fsqm_form_52_pinfo_3_values_province\">City<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt-eform-address-zip\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required,custom[zipCode]] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_52[pinfo][3][values][zip]\"\nid=\"ipt_fsqm_form_52_pinfo_3_values_zip\"\nvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipt-icomoon-location ipticm prefix\"><\/i>\n<label\nfor=\"ipt_fsqm_form_52_pinfo_3_values_zip\">Zip Code<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[freetype][1][m_type]\" id=\"ipt_fsqm_form_52_freetype_1_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[freetype][1][type]\" id=\"ipt_fsqm_form_52_freetype_1_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_52_freetype_1\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_52_freetype_1_value\">Membership ID<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me  ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_52[freetype][1][value]\"\nid=\"ipt_fsqm_form_52_freetype_1_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_52_freetype_1_value\">(If already a member)<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[freetype][0][m_type]\" id=\"ipt_fsqm_form_52_freetype_0_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[freetype][0][type]\" id=\"ipt_fsqm_form_52_freetype_0_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_52_freetype_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_52_freetype_0_value\">Amount<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required,custom[number]] ipt_uif_text\"\nmin=\"\" max=\"\" step=\"any\"\t\t\t\ttype=\"number\"\nname=\"ipt_fsqm_form_52[freetype][0][value]\"\nid=\"ipt_fsqm_form_52_freetype_0_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<label\nfor=\"ipt_fsqm_form_52_freetype_0_value\">Write Here<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][5][m_type]\" id=\"ipt_fsqm_form_52_pinfo_5_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][5][type]\" id=\"ipt_fsqm_form_52_pinfo_5_type\" value=\"payment\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_payment column-vertical-heading\" id=\"ipt_fsqm_form_52_pinfo_5\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_mathematical ipt_fsqm_payment_mathematical\" id=\"ipt_fsqm_form_52_pinfo_5_mathematical\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_fancy_container\"><div\nclass=\"ipt_fsqm_payment_mathematical ipt_uif_richtext ipt_uif_mathematical\">\n<input\nname=\"ipt_fsqm_form_52[pinfo][5][value]\" type=\"hidden\" value=\"0\" data-sayt-exclude class=\"ipt_uif_mathematical_input\" data-precision=\"2\" data-formula=\"F0\" data-options=\"{&quot;useGrouping&quot;:true,&quot;separator&quot;:&quot;,&quot;,&quot;decimal&quot;:&quot;.&quot;}\" data-noanim=\"false\" \/>\n<span\nclass=\"ipt_uif_mathematical_span\">0<\/span><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_checkout\" id=\"ipt_fsqm_form_52_pinfo_5_checkout\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional eform-checkout-gateways-radio\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_fsqm_payment_method_radio ipt_uif_question\" data-iptfsqmpp=\"authorizenet\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_52_pinfo_5_pmethod\">Payment Method<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_conditional_input\"><div\nclass=\"ipt_uif_label_column column_random\">\n<input\ndata-condid=\"ipt_fsqm_form_52_5_payment_pp\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_52[pinfo][5][pmethod]\"\nid=\"ipt_fsqm_form_52_pinfo_5_pmethod_paypal_e\"\nvalue=\"paypal_e\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_52_pinfo_5_pmethod_paypal_e\" data-labelcon=\"&#xe18e;\">\nPaypal Payment\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional eform-checkout-gateways\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_question\" id=\"ipt_fsqm_form_52_5_payment_pp\"><div\nclass=\"ipt_uif_message ipt_fsqm_uif_message_green ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3>\n<span\nclass=\"ipt-icomoon-checkmark-circle ipt_uif_text_icon_no_bg\"><\/span>\nPay through PayPal<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>You will be redirected to PayPal checkout page once you submit. After you complete your payment, you will be redirected back to our site with a confirmation.<\/p><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][2][m_type]\" id=\"ipt_fsqm_form_52_pinfo_2_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_52[pinfo][2][type]\" id=\"ipt_fsqm_form_52_pinfo_2_type\" value=\"p_name\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_p_name\" id=\"ipt_fsqm_form_52_pinfo_2\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[custom[personName]] ipt_uif_text\"\nreadonly=\"readonly\"\t\t\t\t\t\ttype=\"text\"\nname=\"ipt_fsqm_form_52[pinfo][2][value]\"\nid=\"ipt_fsqm_form_52_pinfo_2_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear\"><\/div><div\nid=\"ipt_fsqm_form_52_button_container\" class=\"ipt_fsqm_form_button_container ipt_fsqm_form_button_container--classic ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"submit\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_submit medium primary-button\" name=\"ipt_fsqm_form_52_button_submit\" id=\"ipt_fsqm_form_52_button_submit\"> Submit<\/button><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/form><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_success ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3><i\ntitle=\"\" class=\" ipt-icomoon-checkmark-circle ipticm prefix\"><\/i>\nYour form has been submitted<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all ipt_fsqm_success_wrap\"><p>Thank you %NAME% for taking the quiz\/survey\/feedback.<br\n\/>\nWe have received your answers. You can view it anytime from this link below:<br\n\/>\n<a\nhref=\"%TRACK_LINK%\">%TRACK_LINK%<\/a><br\n\/>\nWe have also attached a copy of your submission.<\/p><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-laptop ipticm prefix\"><\/i>\nServer Side Error<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.<\/p><p>If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.<\/p><p\nclass=\"jqXHR\">\n<strong>TextStatus: <\/strong><span\nclass=\"textStatus\">undefined<\/span><br\n\/>\n<strong>HTTP Error: <\/strong><span\nclass=\"errorThrown\">undefined<\/span><\/p><\/div><\/div><div\nstyle=\"display: none\" class=\"ipt_uif_widget_box ipt_fsqm_form_message_process\"><div\nclass=\"ui-widget ui-widget-header ui-corner-all\"><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Processing your request<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_validation_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-warning2 ipticm prefix\"><\/i>\n<span\nclass=\"fsqm_ve_text\">Error<\/span><\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p\nclass=\"fsqm_ve_msg\">Some error has occured.<\/p><\/div><\/div><\/div>\n<\/div>\n\t\t<\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Javascript is disabledJavascript is disabled on your browser. Please enable it in order to use this form. Loading Membership Payment NOTICE:\u00a0After paying for my membership, I agree to\u00a0print, complete and\u00a0mail my\u00a0Membership Application to CHRISTUS EMS 2201 Mobberly Avenue, Longview, TX 75602. My Membership is subject to cancellation if my application is incomplete and\/or not sent [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3951","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3951"}],"version-history":[{"count":4,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3951\/revisions"}],"predecessor-version":[{"id":4422,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3951\/revisions\/4422"}],"wp:attachment":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}