{"id":23585,"date":"2021-06-19T08:41:11","date_gmt":"2021-06-19T12:41:11","guid":{"rendered":"http:\/\/fcomnow.com\/?page_id=23585"},"modified":"2021-11-04T21:47:05","modified_gmt":"2021-11-05T01:47:05","slug":"register","status":"publish","type":"page","link":"https:\/\/archive.fcomnow.com\/2021\/register\/","title":{"rendered":"Register"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;5px||15px|||&#8221;][et_pb_row _builder_version=&#8221;4.9.10&#8243; _module_preset=&#8221;default&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.10&#8243; _module_preset=&#8221;default&#8221;][dipl_fancy_text fancy_text=&#8221;Registration&#8221; grandient_color_1=&#8221;#EB7144&#8243; grandient_color_2=&#8221;#F6B223&#8243; _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221; body_font=&#8221;Raleway|700|||||||&#8221; body_font_size=&#8221;45px&#8221; 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indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/2021\/wp-json\/wp\/v2\/pages\/23585' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_1_25\"  class=\"gfield gfield--width-full gform_hidden gfield_price gfield_price_1_25 gfield_product_1_25 gfield_hidden_product field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gfield_label_before_complex' for='input_1_25_1' >FCOM Virtual Attendee Registration<\/label><input type='hidden' name='input_25.3' value='1' id='ginput_quantity_1_25' class='gform_hidden' \/><input type='hidden' name='input_25.1' value='FCOM Virtual Attendee Registration' class='gform_hidden' \/><input name='input_25.2' id='ginput_base_price_1_25' type='hidden' value='$0.00' class='gform_hidden ginput_amount' \/><\/div><fieldset id=\"field_1_2\"  class=\"gfield gfield--width-full register-attend buttonized gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><legend class='gfield_label'  >How would you like to attend FCOM 2021?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_2'>\n\t\t\t<div class='gchoice gchoice_1_2_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='In-Person Attendance&lt;br&gt;Naples, FL'  id='choice_1_2_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_2_0' id='label_1_2_0'>In-Person Attendance<br>Naples, FL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_2_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Virtual Attendance&lt;br&gt;Online Only'  id='choice_1_2_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_2_1' id='label_1_2_1'>Virtual Attendance<br>Online Only<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_32\"  class=\"gfield gfield--width-full register-attend buttonized gfield_price gfield_price_1_25 gfield_option_1_25 gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><legend class='gfield_label'  >Profession<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_32'>\n\t\t\t<div class='gchoice gchoice_1_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Physician|59'  id='choice_1_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0'>Physician<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Audiologist|59'  id='choice_1_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1'>Audiologist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Advanced Practice Provider|59'  id='choice_1_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2'>Advanced Practice Provider<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Physician Residents|59'  id='choice_1_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_3' id='label_1_32_3'>Physician Residents<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Clinical Support Staff|59'  id='choice_1_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_4' id='label_1_32_4'>Clinical Support Staff<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Hearing Care Professional &amp; 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font-size: 18px; padding: 15px; background: #ecf0f1\">*Students must register with .edu email for consideration. 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indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/2021\/wp-json\/wp\/v2\/pages\/23585' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_1_25\"  class=\"gfield gfield--width-full gform_hidden gfield_price gfield_price_1_25 gfield_product_1_25 gfield_hidden_product field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gfield_label_before_complex' for='input_1_25_1' >FCOM Virtual Attendee Registration<\/label><input type='hidden' name='input_25.3' value='1' id='ginput_quantity_1_25' class='gform_hidden' \/><input type='hidden' name='input_25.1' value='FCOM Virtual Attendee Registration' class='gform_hidden' \/><input name='input_25.2' id='ginput_base_price_1_25' type='hidden' value='$0.00' class='gform_hidden ginput_amount' \/><\/div><fieldset id=\"field_1_2\"  class=\"gfield gfield--width-full register-attend buttonized gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><legend class='gfield_label'  >How would you like to attend FCOM 2021?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_2'>\n\t\t\t<div class='gchoice gchoice_1_2_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='In-Person Attendance&lt;br&gt;Naples, FL'  id='choice_1_2_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_2_0' id='label_1_2_0'>In-Person Attendance<br>Naples, FL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_2_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Virtual Attendance&lt;br&gt;Online Only'  id='choice_1_2_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_2_1' id='label_1_2_1'>Virtual Attendance<br>Online Only<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_32\"  class=\"gfield gfield--width-full register-attend buttonized gfield_price gfield_price_1_25 gfield_option_1_25 gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><legend class='gfield_label'  >Profession<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_32'>\n\t\t\t<div class='gchoice gchoice_1_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Physician|59'  id='choice_1_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0'>Physician<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Audiologist|59'  id='choice_1_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1'>Audiologist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Advanced Practice Provider|59'  id='choice_1_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2'>Advanced Practice Provider<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Physician Residents|59'  id='choice_1_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_3' id='label_1_32_3'>Physician Residents<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Clinical Support Staff|59'  id='choice_1_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_4' id='label_1_32_4'>Clinical Support Staff<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Hearing Care Professional &amp; Audiology Assistant|59'  id='choice_1_32_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_5' id='label_1_32_5'>Hearing Care Professional & Audiology Assistant<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Administrator and Office Support|59'  id='choice_1_32_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_6' id='label_1_32_6'>Administrator and Office Support<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_32_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Student|0'  id='choice_1_32_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_32_7' id='label_1_32_7'>Student<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_21\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><p style=\"font-weight: bold; font-size: 18px; padding: 15px; background: #ecf0f1\">*Students must register with .edu email for consideration. Documentation of your student status may be requested.<\/p><\/div><div id=\"field_1_24\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><div style=\"padding: 15px; font-size: 21px; font-weight: 600; color: #666; line-height: 32px; background: #efefef; margin: 5px\">\nOnline registration for the in-person meeting is now closed. You can register at the Ritz-Carlton Naples Resort, at Conference Registration Desk located by the Salon Ballrooms.  \n<\/div><\/div><fieldset id=\"field_1_28\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_28\"><legend class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_28'>\n                            \n                            <span id='input_1_28_3_container' class='name_first' >\n                                                    <label for='input_1_28_3' >First<\/label>\n                                                    <input type='text' name='input_28.3' id='input_1_28_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_1_28_6_container' class='name_last' >\n                                                            <label for='input_1_28_6' >Last<\/label>\n                                                            <input type='text' name='input_28.6' id='input_1_28_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_31\"  class=\"gfield gfield--width-full field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label' for='input_1_31' >Credential(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_29\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_29\"><label class='gfield_label' for='input_1_29' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_29' id='input_1_29' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_30\"  class=\"gfield gfield--width-full field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_30\"><label class='gfield_label' for='input_1_30' >Company\/Affiliation<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_1_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_27\"  class=\"gfield gfield--width-full gfield_price gfield_price_1_ gfield_total gfield_total_1_ field_sublabel_above field_description_above gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" data-js-reload=\"field_1_27\"><label class='gfield_label' for='input_1_27' >Registration Fee<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input readonly name='input_27' id='input_1_27' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_1' \/>\n\t\t\t\t\t\t<\/div><\/div><div id=\"field_1_7\"  class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_7\"><style>\n.register-card {\n  width: 100%;\n  color: #666;\n  -webkit-box-shadow: 0 2px 5px rgba(0, 0, 0, 0.3);\n  -moz-box-shadow: 0 2px 5px rgba(0, 0, 0, 0.3);\n  box-shadow: 0 2px 5px 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