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document.write("                    <p style=\"text-align: center;\"><span style=\"font-family: verdana,geneva; font-size: large;\"><span style=\"color: rgb(23, 54, 93);\"><strong><span style=\"color: rgb(0, 0, 0);\">Transgender Law Center’s Legal Information Helpdesk</span></strong></span></span></p>"+"\n");
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document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50\" id=\"fsCell72195298\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"City\">"+"\n");
document.write("                                                                                                        <label id=\"label72195298\" class=\"fsLabel fsRequiredLabel\" for=\"field72195298\">City<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field72195298\""+"\n");
document.write("  name=\"field72195298\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
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document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"     />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-14\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195299\" aria-describedby=\"fsSupporting72195299\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"U.S. State/Territory\">"+"\n");
document.write("                                                                                                        <label id=\"label72195299\" class=\"fsLabel fsRequiredLabel\" for=\"field72195299\">U.S. State/Territory<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field72195299\" name=\"field72195299\" size=\"1\"required class=\"fsField fsRequired\" aria-required=\"true\">"+"\n");
document.write("        <option value=\"\">&nbsp;</option>"+"\n");
document.write("        <option value=\"AL\">AL</option>"+"\n");
document.write("        <option value=\"AK\">AK</option>"+"\n");
document.write("        <option value=\"AZ\">AZ</option>"+"\n");
document.write("        <option value=\"AR\">AR</option>"+"\n");
document.write("        <option value=\"AS\">AS</option>"+"\n");
document.write("        <option value=\"CA\">CA</option>"+"\n");
document.write("        <option value=\"CO\">CO</option>"+"\n");
document.write("        <option value=\"CT\">CT</option>"+"\n");
document.write("        <option value=\"DC\">DC</option>"+"\n");
document.write("        <option value=\"DE\">DE</option>"+"\n");
document.write("        <option value=\"FL\">FL</option>"+"\n");
document.write("        <option value=\"FM\">FM</option>"+"\n");
document.write("        <option value=\"GA\">GA</option>"+"\n");
document.write("        <option value=\"GU\">GU</option>"+"\n");
document.write("        <option value=\"HI\">HI</option>"+"\n");
document.write("        <option value=\"ID\">ID</option>"+"\n");
document.write("        <option value=\"IL\">IL</option>"+"\n");
document.write("        <option value=\"IN\">IN</option>"+"\n");
document.write("        <option value=\"IA\">IA</option>"+"\n");
document.write("        <option value=\"KS\">KS</option>"+"\n");
document.write("        <option value=\"KY\">KY</option>"+"\n");
document.write("        <option value=\"LA\">LA</option>"+"\n");
document.write("        <option value=\"ME\">ME</option>"+"\n");
document.write("        <option value=\"MD\">MD</option>"+"\n");
document.write("        <option value=\"MA\">MA</option>"+"\n");
document.write("        <option value=\"MH\">MH</option>"+"\n");
document.write("        <option value=\"MI\">MI</option>"+"\n");
document.write("        <option value=\"MN\">MN</option>"+"\n");
document.write("        <option value=\"MP\">MP</option>"+"\n");
document.write("        <option value=\"MS\">MS</option>"+"\n");
document.write("        <option value=\"MO\">MO</option>"+"\n");
document.write("        <option value=\"MT\">MT</option>"+"\n");
document.write("        <option value=\"NE\">NE</option>"+"\n");
document.write("        <option value=\"NV\">NV</option>"+"\n");
document.write("        <option value=\"NH\">NH</option>"+"\n");
document.write("        <option value=\"NJ\">NJ</option>"+"\n");
document.write("        <option value=\"NM\">NM</option>"+"\n");
document.write("        <option value=\"NY\">NY</option>"+"\n");
document.write("        <option value=\"NC\">NC</option>"+"\n");
document.write("        <option value=\"ND\">ND</option>"+"\n");
document.write("        <option value=\"OH\">OH</option>"+"\n");
document.write("        <option value=\"OK\">OK</option>"+"\n");
document.write("        <option value=\"OR\">OR</option>"+"\n");
document.write("        <option value=\"PA\">PA</option>"+"\n");
document.write("        <option value=\"PR\">PR</option>"+"\n");
document.write("        <option value=\"PW\">PW</option>"+"\n");
document.write("        <option value=\"RI\">RI</option>"+"\n");
document.write("        <option value=\"SC\">SC</option>"+"\n");
document.write("        <option value=\"SD\">SD</option>"+"\n");
document.write("        <option value=\"TN\">TN</option>"+"\n");
document.write("        <option value=\"TX\">TX</option>"+"\n");
document.write("        <option value=\"UT\">UT</option>"+"\n");
document.write("        <option value=\"VT\">VT</option>"+"\n");
document.write("        <option value=\"VA\">VA</option>"+"\n");
document.write("        <option value=\"VI\">VI</option>"+"\n");
document.write("        <option value=\"WA\">WA</option>"+"\n");
document.write("        <option value=\"WV\">WV</option>"+"\n");
document.write("        <option value=\"WI\">WI</option>"+"\n");
document.write("        <option value=\"WY\">WY</option>"+"\n");
document.write("        <option value=\"--\">--</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                                                        <div id=\"fsSupporting72195299\" class=\"fsSupporting\">Please select \"--\" if you reside outside of the U.S.</div>"+"\n");
document.write("                                                                        "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsHidden fsSpan50\" id=\"fsCell72195300\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"If in CA, County of residence\">"+"\n");
document.write("                                                                                                        <label id=\"label72195300\" class=\"fsLabel fsRequiredLabel\" for=\"field72195300\">If in CA, County of residence<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field72195300\" name=\"field72195300\" size=\"1\"required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"\">&nbsp;</option>"+"\n");
document.write("        <option value=\"Alameda\">Alameda</option>"+"\n");
document.write("        <option value=\"Alpine\">Alpine</option>"+"\n");
document.write("        <option value=\"Amador\">Amador</option>"+"\n");
document.write("        <option value=\"Butte\">Butte</option>"+"\n");
document.write("        <option value=\"Calaveras\">Calaveras</option>"+"\n");
document.write("        <option value=\"Colusa\">Colusa</option>"+"\n");
document.write("        <option value=\"Contra Costa\">Contra Costa</option>"+"\n");
document.write("        <option value=\"Del Norte\">Del Norte</option>"+"\n");
document.write("        <option value=\"El Dorado\">El Dorado</option>"+"\n");
document.write("        <option value=\"Fresno\">Fresno</option>"+"\n");
document.write("        <option value=\"Glenn\">Glenn</option>"+"\n");
document.write("        <option value=\"Humboldt\">Humboldt</option>"+"\n");
document.write("        <option value=\"Imperial\">Imperial</option>"+"\n");
document.write("        <option value=\"Inyo\">Inyo</option>"+"\n");
document.write("        <option value=\"Kern\">Kern</option>"+"\n");
document.write("        <option value=\"Kings\">Kings</option>"+"\n");
document.write("        <option value=\"Lake\">Lake</option>"+"\n");
document.write("        <option value=\"Lassen\">Lassen</option>"+"\n");
document.write("        <option value=\"Los Angeles\">Los Angeles</option>"+"\n");
document.write("        <option value=\"Madera\">Madera</option>"+"\n");
document.write("        <option value=\"Marin\">Marin</option>"+"\n");
document.write("        <option value=\"Mariposa\">Mariposa</option>"+"\n");
document.write("        <option value=\"Mendocino\">Mendocino</option>"+"\n");
document.write("        <option value=\"Merced\">Merced</option>"+"\n");
document.write("        <option value=\"Modoc\">Modoc</option>"+"\n");
document.write("        <option value=\"Mono\">Mono</option>"+"\n");
document.write("        <option value=\"Monterey\">Monterey</option>"+"\n");
document.write("        <option value=\"Napa\">Napa</option>"+"\n");
document.write("        <option value=\"Nevada\">Nevada</option>"+"\n");
document.write("        <option value=\"Orange\">Orange</option>"+"\n");
document.write("        <option value=\"Placer\">Placer</option>"+"\n");
document.write("        <option value=\"Plumas\">Plumas</option>"+"\n");
document.write("        <option value=\"Riverside\">Riverside</option>"+"\n");
document.write("        <option value=\"Sacramento\">Sacramento</option>"+"\n");
document.write("        <option value=\"San Benito\">San Benito</option>"+"\n");
document.write("        <option value=\"San Bernardino\">San Bernardino</option>"+"\n");
document.write("        <option value=\"San Diego\">San Diego</option>"+"\n");
document.write("        <option value=\"San Francisco\">San Francisco</option>"+"\n");
document.write("        <option value=\"San Joaquin\">San Joaquin</option>"+"\n");
document.write("        <option value=\"San Luis Obispo\">San Luis Obispo</option>"+"\n");
document.write("        <option value=\"San Mateo\">San Mateo</option>"+"\n");
document.write("        <option value=\"Santa Barbara\">Santa Barbara</option>"+"\n");
document.write("        <option value=\"Santa Clara\">Santa Clara</option>"+"\n");
document.write("        <option value=\"Santa Cruz\">Santa Cruz</option>"+"\n");
document.write("        <option value=\"Shasta\">Shasta</option>"+"\n");
document.write("        <option value=\"Sierra\">Sierra</option>"+"\n");
document.write("        <option value=\"Siskiyou\">Siskiyou</option>"+"\n");
document.write("        <option value=\"Solano\">Solano</option>"+"\n");
document.write("        <option value=\"Sonoma\">Sonoma</option>"+"\n");
document.write("        <option value=\"Stanislaus\">Stanislaus</option>"+"\n");
document.write("        <option value=\"Sutter\">Sutter</option>"+"\n");
document.write("        <option value=\"Tehama\">Tehama</option>"+"\n");
document.write("        <option value=\"Trinity\">Trinity</option>"+"\n");
document.write("        <option value=\"Tulare\">Tulare</option>"+"\n");
document.write("        <option value=\"Tuolumne\">Tuolumne</option>"+"\n");
document.write("        <option value=\"Ventura\">Ventura</option>"+"\n");
document.write("        <option value=\"Yolo\">Yolo</option>"+"\n");
document.write("        <option value=\"Yuba\">Yuba</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-15\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195301\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"ZIP Code\">"+"\n");
document.write("                                                                                                        <label id=\"label72195301\" class=\"fsLabel fsRequiredLabel\" for=\"field72195301\">ZIP Code<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field72195301\""+"\n");
document.write("  name=\"field72195301\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"     />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-16\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell72195302\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"If you live outside of the United States, please list your country of residence\">"+"\n");
document.write("                                                                                                        <label id=\"label72195302\" class=\"fsLabel\" for=\"field72195302\">If you live outside of the United States, please list your country of residence                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field72195302\""+"\n");
document.write("  name=\"field72195302\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
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document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-17\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195303\" lang=\"en\" fs-field-type=\"radio\" fs-field-validation-name=\"Are you contacting us on behalf of another person?\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195303\" id=\"label72195303\">"+"\n");
document.write("                            <legend id=\"fsLegend72195303\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Are you contacting us on behalf of another person?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field72195303_1\"><input type=\"radio\" id=\"field72195303_1\" name=\"field72195303\" value=\"No\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" />No</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field72195303_2\"><input type=\"radio\" id=\"field72195303_2\" name=\"field72195303\" value=\"Yes\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" />Yes</label>"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsHidden fsSpan50\" id=\"fsCell72195304\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"If yes, what is your relationship to this person?\">"+"\n");
document.write("                                                                                                        <label id=\"label72195304\" class=\"fsLabel fsRequiredLabel\" for=\"field72195304\">If yes, what is your relationship to this person?<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field72195304\" name=\"field72195304\" size=\"1\"required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"\">&nbsp;</option>"+"\n");
document.write("        <option value=\"Parent\">Parent</option>"+"\n");
document.write("        <option value=\"Legal Guardian\">Legal Guardian</option>"+"\n");
document.write("        <option value=\"Family Member\">Family Member</option>"+"\n");
document.write("        <option value=\"Partner/Spouse\">Partner/Spouse</option>"+"\n");
document.write("        <option value=\"Friend\">Friend</option>"+"\n");
document.write("        <option value=\"Medical or Mental Health Provider\">Medical or Mental Health Provider</option>"+"\n");
document.write("        <option value=\"Social Worker\">Social Worker</option>"+"\n");
document.write("        <option value=\"Attorney\">Attorney</option>"+"\n");
document.write("        <option value=\"Employer\">Employer</option>"+"\n");
document.write("        <option value=\"Teacher/School Administrator\">Teacher/School Administrator</option>"+"\n");
document.write("        <option value=\"Other\">Other</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-18\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100\" id=\"fsCell72195305\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"What is the full name of this person? \">"+"\n");
document.write("                                                                                                        <label id=\"label72195305\" class=\"fsLabel fsRequiredLabel\" for=\"field72195305\">What is the full name of this person? <span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
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document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field72195305\""+"\n");
document.write("  name=\"field72195305\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("   required       value=\"\""+"\n");
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document.write("  class=\"fsField fsFormatText fsRequired   \""+"\n");
document.write("   aria-required=\"true\"       disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
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document.write("            <h2 class=\"fsSectionHeading\">3.     Demographic Information</h2>"+"\n");
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document.write("                    <p>If you are contacting us on behalf of another person, DO NOT respond to the demographic questions with information about yourself. Instead, please only answer all these demographic questions with information about the person in need of legal information or assistance. If you asking on your own behalf, your answers to the demographic questions should reflect yourself.</p>"+"\n");
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document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195316_7\"><input type=\"checkbox\" id=\"field72195316_7\" name=\"field72195316[]\" value=\"Nonbinary\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Nonbinary</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195316_8\"><input type=\"checkbox\" id=\"field72195316_8\" name=\"field72195316[]\" value=\"Two-Spirit\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Two-Spirit</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195316_9\"><input type=\"checkbox\" id=\"field72195316_9\" name=\"field72195316[]\" value=\"Other\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Other</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                                                        <div id=\"fsSupporting72195316\" class=\"fsSupporting\">Please check all boxes that apply to you.</div>"+"\n");
document.write("                                                                        "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsHidden fsSpan50\" id=\"fsCell72195317\" lang=\"en\" fs-field-type=\"text\" fs-field-validation-name=\"If Other, what is your gender?\">"+"\n");
document.write("                                                                                                        <label id=\"label72195317\" class=\"fsLabel\" for=\"field72195317\">If Other, what is your gender?                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <input"+"\n");
document.write("  type=\"text\" id=\"field72195317\""+"\n");
document.write("  name=\"field72195317\""+"\n");
document.write("  size=\"50\""+"\n");
document.write("         value=\"\""+"\n");
document.write("  "+"\n");
document.write("  class=\"fsField fsFormatText    \""+"\n");
document.write("        disabled=\"disabled\""+"\n");
document.write("    />"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-28\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195318\" lang=\"en\" fs-field-type=\"radio\" fs-field-validation-name=\"Do you identify as transgender, transsexual, and/or trans?\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195318\" id=\"label72195318\">"+"\n");
document.write("                            <legend id=\"fsLegend72195318\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Do you identify as transgender, transsexual, and/or trans?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field72195318_1\"><input type=\"radio\" id=\"field72195318_1\" name=\"field72195318\" value=\"No\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" />No</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field72195318_2\"><input type=\"radio\" id=\"field72195318_2\" name=\"field72195318\" value=\"Yes\" class=\"fsField fsRequired horizontal\" aria-required=\"true\" />Yes</label>"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50\" id=\"fsCell72195319\" lang=\"en\" fs-field-type=\"radio\" fs-field-validation-name=\"What are your pronouns?\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195319\" id=\"label72195319\">"+"\n");
document.write("                            <legend id=\"fsLegend72195319\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>What are your pronouns?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field72195319_1\"><input type=\"radio\" id=\"field72195319_1\" name=\"field72195319\" value=\"She/Her\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />She/Her</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field72195319_2\"><input type=\"radio\" id=\"field72195319_2\" name=\"field72195319\" value=\"He/Him\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />He/Him</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field72195319_3\"><input type=\"radio\" id=\"field72195319_3\" name=\"field72195319\" value=\"They/Them\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />They/Them</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field72195319_4\"><input type=\"radio\" id=\"field72195319_4\" name=\"field72195319\" value=\"Name Only\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Name Only</label>"+"\n");
document.write("            "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            <label class=\"fsOptionLabel vertical\" for=\"field72195319_5\"><input type=\"radio\" id=\"field72195319_5\" name=\"field72195319\" value=\"Other\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Other</label>"+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("    "+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-29\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195320\" lang=\"en\" fs-field-type=\"select\" fs-field-validation-name=\"What is your sexual orientation?\">"+"\n");
document.write("                                                                                                        <label id=\"label72195320\" class=\"fsLabel\" for=\"field72195320\">What is your sexual orientation?                                                    </label>"+"\n");
document.write("                                            "+"\n");
document.write("                                        "+"\n");
document.write("                    <select id=\"field72195320\" name=\"field72195320\" size=\"1\" class=\"fsField\">"+"\n");
document.write("        <option value=\"\">&nbsp;</option>"+"\n");
document.write("        <option value=\"Lesbian\">Lesbian</option>"+"\n");
document.write("        <option value=\"Gay\">Gay</option>"+"\n");
document.write("        <option value=\"Bisexual\">Bisexual</option>"+"\n");
document.write("        <option value=\"Heterosexual\">Heterosexual</option>"+"\n");
document.write("        <option value=\"Queer\">Queer</option>"+"\n");
document.write("        <option value=\"Other\">Other</option>"+"\n");
document.write("</select>"+"\n");
document.write("                                                                "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                        "+"\n");
document.write("                    "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50\" id=\"fsCell72195321\" aria-describedby=\"fsSupporting72195321\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Describe your race:\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195321\" id=\"label72195321\">"+"\n");
document.write("                            <legend id=\"fsLegend72195321\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Describe your race:<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                            <label class=\"fsOptionLabel vertical\" for=\"field72195321_1\"><input type=\"checkbox\" id=\"field72195321_1\" name=\"field72195321[]\" value=\"African American/Black\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />African American/Black</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_2\"><input type=\"checkbox\" id=\"field72195321_2\" name=\"field72195321[]\" value=\"Asian/Asian American\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Asian/Asian American</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_3\"><input type=\"checkbox\" id=\"field72195321_3\" name=\"field72195321[]\" value=\"Pacific Islander\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Pacific Islander</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_4\"><input type=\"checkbox\" id=\"field72195321_4\" name=\"field72195321[]\" value=\"Native Amer./Amer. Indian/Alaska Native\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Native Amer./Amer. Indian/Alaska Native</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_5\"><input type=\"checkbox\" id=\"field72195321_5\" name=\"field72195321[]\" value=\"Middle Eastern\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Middle Eastern</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_6\"><input type=\"checkbox\" id=\"field72195321_6\" name=\"field72195321[]\" value=\"Latino/a or Hispanic\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Latino/a or Hispanic</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_7\"><input type=\"checkbox\" id=\"field72195321_7\" name=\"field72195321[]\" value=\"White/Caucasian\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />White/Caucasian</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_8\"><input type=\"checkbox\" id=\"field72195321_8\" name=\"field72195321[]\" value=\"Multiracial\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Multiracial</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_9\"><input type=\"checkbox\" id=\"field72195321_9\" name=\"field72195321[]\" value=\"Other\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Other</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field72195321_10\"><input type=\"checkbox\" id=\"field72195321_10\" name=\"field72195321[]\" value=\"I wish not to state\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />I wish not to state</label>"+"\n");
document.write("                        "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                                                        <div id=\"fsSupporting72195321\" class=\"fsSupporting\">Please check all boxes that apply to you.</div>"+"\n");
document.write("                                                                        "+"\n");
document.write("                    "+"\n");
document.write("                                                </div></fieldset>"+"\n");
document.write("                    "+"\n");
document.write("                    "+"\n");
document.write("                                                </div>"+"\n");
document.write("                                          <div class=\"fs-clear\"></div>"+"\n");
document.write("                        </div>"+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                "+"\n");
document.write("                    "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow3292077-30\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50\" id=\"fsCell72195322\" lang=\"en\" fs-field-type=\"datetime\" fs-field-validation-name=\"When is your birthday?\">"+"\n");
document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195322\" id=\"label72195322\">"+"\n");
document.write("                            <legend id=\"fsLegend72195322\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>When is your birthday?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content\">"+"\n");
document.write("                    "+"\n");
document.write("                                        "+"\n");
document.write("                                <!-- Used to pull in url for jquery -->"+"\n");
document.write("        <span aria-hidden=\"true\" style=\"display:none;\" id=\"fsCalendar72195322ImageUrl\">https://tlcdatacompliance.formstack.com/forms/images/2/calendar.png</span>"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("    <input data-skip-validation data-date-format=\"m/d/YY\" type=\"hidden\" id=\"field72195322Format\" name=\"field72195322Format\" value=\"MDY\" />"+"\n");
document.write("    "+"\n");
document.write("                    <div class=\"hidden\"><label for=\"field72195322M\">Month</label></div>"+"\n");
document.write("        <select id=\"field72195322M\" name=\"field72195322M\" class=\" fsField fsRequired\" aria-required=\"true\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"01\">01</option>"+"\n");
document.write("                    <option value=\"02\">02</option>"+"\n");
document.write("                    <option value=\"03\">03</option>"+"\n");
document.write("                    <option value=\"04\">04</option>"+"\n");
document.write("                    <option value=\"05\">05</option>"+"\n");
document.write("                    <option value=\"06\">06</option>"+"\n");
document.write("                    <option value=\"07\">07</option>"+"\n");
document.write("                    <option value=\"08\">08</option>"+"\n");
document.write("                    <option value=\"09\">09</option>"+"\n");
document.write("                    <option value=\"10\">10</option>"+"\n");
document.write("                    <option value=\"11\">11</option>"+"\n");
document.write("                    <option value=\"12\">12</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <div class=\"hidden\"><label for=\"field72195322D\">Day</label></div>"+"\n");
document.write("        <select id=\"field72195322D\" name=\"field72195322D\" class=\" fsField fsRequired\" aria-required=\"true\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"01\">01</option>"+"\n");
document.write("                    <option value=\"02\">02</option>"+"\n");
document.write("                    <option value=\"03\">03</option>"+"\n");
document.write("                    <option value=\"04\">04</option>"+"\n");
document.write("                    <option value=\"05\">05</option>"+"\n");
document.write("                    <option value=\"06\">06</option>"+"\n");
document.write("                    <option value=\"07\">07</option>"+"\n");
document.write("                    <option value=\"08\">08</option>"+"\n");
document.write("                    <option value=\"09\">09</option>"+"\n");
document.write("                    <option value=\"10\">10</option>"+"\n");
document.write("                    <option value=\"11\">11</option>"+"\n");
document.write("                    <option value=\"12\">12</option>"+"\n");
document.write("                    <option value=\"13\">13</option>"+"\n");
document.write("                    <option value=\"14\">14</option>"+"\n");
document.write("                    <option value=\"15\">15</option>"+"\n");
document.write("                    <option value=\"16\">16</option>"+"\n");
document.write("                    <option value=\"17\">17</option>"+"\n");
document.write("                    <option value=\"18\">18</option>"+"\n");
document.write("                    <option value=\"19\">19</option>"+"\n");
document.write("                    <option value=\"20\">20</option>"+"\n");
document.write("                    <option value=\"21\">21</option>"+"\n");
document.write("                    <option value=\"22\">22</option>"+"\n");
document.write("                    <option value=\"23\">23</option>"+"\n");
document.write("                    <option value=\"24\">24</option>"+"\n");
document.write("                    <option value=\"25\">25</option>"+"\n");
document.write("                    <option value=\"26\">26</option>"+"\n");
document.write("                    <option value=\"27\">27</option>"+"\n");
document.write("                    <option value=\"28\">28</option>"+"\n");
document.write("                    <option value=\"29\">29</option>"+"\n");
document.write("                    <option value=\"30\">30</option>"+"\n");
document.write("                    <option value=\"31\">31</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <div class=\"hidden\"><label for=\"field72195322Y\">Year</label></div>"+"\n");
document.write("        <select id=\"field72195322Y\" name=\"field72195322Y\" class=\" fsField fsRequired\" aria-required=\"true\">"+"\n");
document.write("                    <option value=\"\"> </option>"+"\n");
document.write("                    <option value=\"1948\">1948</option>"+"\n");
document.write("                    <option value=\"1949\">1949</option>"+"\n");
document.write("                    <option value=\"1950\">1950</option>"+"\n");
document.write("                    <option value=\"1951\">1951</option>"+"\n");
document.write("                    <option value=\"1952\">1952</option>"+"\n");
document.write("                    <option value=\"1953\">1953</option>"+"\n");
document.write("                    <option value=\"1954\">1954</option>"+"\n");
document.write("                    <option value=\"1955\">1955</option>"+"\n");
document.write("                    <option value=\"1956\">1956</option>"+"\n");
document.write("                    <option value=\"1957\">1957</option>"+"\n");
document.write("                    <option value=\"1958\">1958</option>"+"\n");
document.write("                    <option value=\"1959\">1959</option>"+"\n");
document.write("                    <option value=\"1960\">1960</option>"+"\n");
document.write("                    <option value=\"1961\">1961</option>"+"\n");
document.write("                    <option value=\"1962\">1962</option>"+"\n");
document.write("                    <option value=\"1963\">1963</option>"+"\n");
document.write("                    <option value=\"1964\">1964</option>"+"\n");
document.write("                    <option value=\"1965\">1965</option>"+"\n");
document.write("                    <option value=\"1966\">1966</option>"+"\n");
document.write("                    <option value=\"1967\">1967</option>"+"\n");
document.write("                    <option value=\"1968\">1968</option>"+"\n");
document.write("                    <option value=\"1969\">1969</option>"+"\n");
document.write("                    <option value=\"1970\">1970</option>"+"\n");
document.write("                    <option value=\"1971\">1971</option>"+"\n");
document.write("                    <option value=\"1972\">1972</option>"+"\n");
document.write("                    <option value=\"1973\">1973</option>"+"\n");
document.write("                    <option value=\"1974\">1974</option>"+"\n");
document.write("                    <option value=\"1975\">1975</option>"+"\n");
document.write("                    <option value=\"1976\">1976</option>"+"\n");
document.write("                    <option value=\"1977\">1977</option>"+"\n");
document.write("                    <option value=\"1978\">1978</option>"+"\n");
document.write("                    <option value=\"1979\">1979</option>"+"\n");
document.write("                    <option value=\"1980\">1980</option>"+"\n");
document.write("                    <option value=\"1981\">1981</option>"+"\n");
document.write("                    <option value=\"1982\">1982</option>"+"\n");
document.write("                    <option value=\"1983\">1983</option>"+"\n");
document.write("                    <option value=\"1984\">1984</option>"+"\n");
document.write("                    <option value=\"1985\">1985</option>"+"\n");
document.write("                    <option value=\"1986\">1986</option>"+"\n");
document.write("                    <option value=\"1987\">1987</option>"+"\n");
document.write("                    <option value=\"1988\">1988</option>"+"\n");
document.write("                    <option value=\"1989\">1989</option>"+"\n");
document.write("                    <option value=\"1990\">1990</option>"+"\n");
document.write("                    <option value=\"1991\">1991</option>"+"\n");
document.write("                    <option value=\"1992\">1992</option>"+"\n");
document.write("                    <option value=\"1993\">1993</option>"+"\n");
document.write("                    <option value=\"1994\">1994</option>"+"\n");
document.write("                    <option value=\"1995\">1995</option>"+"\n");
document.write("                    <option value=\"1996\">1996</option>"+"\n");
document.write("                    <option value=\"1997\">1997</option>"+"\n");
document.write("                    <option value=\"1998\">1998</option>"+"\n");
document.write("                    <option value=\"1999\">1999</option>"+"\n");
document.write("                    <option value=\"2000\">2000</option>"+"\n");
document.write("                    <option value=\"2001\">2001</option>"+"\n");
document.write("                    <option value=\"2002\">2002</option>"+"\n");
document.write("                    <option value=\"2003\">2003</option>"+"\n");
document.write("                    <option value=\"2004\">2004</option>"+"\n");
document.write("                    <option value=\"2005\">2005</option>"+"\n");
document.write("                    <option value=\"2006\">2006</option>"+"\n");
document.write("                    <option value=\"2007\">2007</option>"+"\n");
document.write("                    <option value=\"2008\">2008</option>"+"\n");
document.write("                    <option value=\"2009\">2009</option>"+"\n");
document.write("                    <option value=\"2010\">2010</option>"+"\n");
document.write("                    <option value=\"2011\">2011</option>"+"\n");
document.write("                    <option value=\"2012\">2012</option>"+"\n");
document.write("                    <option value=\"2013\">2013</option>"+"\n");
document.write("                    <option value=\"2014\">2014</option>"+"\n");
document.write("                    <option value=\"2015\">2015</option>"+"\n");
document.write("                    <option value=\"2016\">2016</option>"+"\n");
document.write("                    <option value=\"2017\">2017</option>"+"\n");
document.write("                    <option value=\"2018\">2018</option>"+"\n");
document.write("                    <option value=\"2019\">2019</option>"+"\n");
document.write("                    <option value=\"2020\">2020</option>"+"\n");
document.write("                    <option value=\"2021\">2021</option>"+"\n");
document.write("                    <option value=\"2022\">2022</option>"+"\n");
document.write("                    <option value=\"2023\">2023</option>"+"\n");
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document.write("                                                                                                        <label id=\"label72195323\" class=\"fsLabel fsRequiredLabel\" for=\"field72195323\">What is your approximate annual household income?<span class=\"fsRequiredMarker\">*</span>                                                    </label>"+"\n");
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document.write("        <option value=\"$70,000 - $120,000\">$70,000 - $120,000</option>"+"\n");
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document.write("                                                    "+"\n");
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document.write("            <h2 class=\"fsSectionHeading\">4. Communication Preferences</h2>"+"\n");
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document.write("                            <legend id=\"fsLegend82839490\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Would you like to Opt in/Subscribe to our EMAIL list?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                                                                <fieldset role=\"group\" aria-labelledby=\"fsLegend72195326\" id=\"label72195326\">"+"\n");
document.write("                            <legend id=\"fsLegend72195326\" class=\"fsLabel fsLabelVertical\"><span>Would you like to OPT OUT of our MAILING list?</span></legend>"+"\n");
document.write("                            <div class=\"fieldset-content fsHiddenByFieldSetting\">"+"\n");
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document.write("            <label class=\"fsOptionLabel horizontal\" for=\"field72195326_1\"><input type=\"radio\" id=\"field72195326_1\" name=\"field72195326\" value=\"No\" class=\"fsField horizontal\" />No</label>"+"\n");
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document.write("                                                                                                        <div id=\"fsSupporting72195326\" class=\"fsSupporting\">If you select YES, you will NOT receive any POSTAL MAIL from TLC</div>"+"\n");
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document.write("                                                                "+"\n");
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document.write("                                        "+"\n");
document.write("                                        "+"\n");
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document.write("            "+"\n");
document.write("                                                "+"\n");
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document.write("                            <legend id=\"fsLegend72195327\" class=\"fsLabel fsLabelVertical\"><span>Would you like us to contact you about sharing your story for advocacy and education?</span></legend>"+"\n");
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document.write("                                                                                                        <div id=\"fsSupporting72195327\" class=\"fsSupporting\">We often find that telling a real person’s story (with or without their name) is the best way to educate the public and policymakers about transgender lives.  </div>"+"\n");
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document.write("                                                        "+"\n");
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document.write("                    <p style=\"margin-left: 20px;\"><strong>Unfortunately, we cannot provide any individualized legal advice or legal representation, or take on cases through the Legal Information Helpdesk.&nbsp;</strong></p>"+"\n");
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