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(recommended)\",\"isError\":false}],\"type\":\"field\"},{\"action\":[{\"id\":\"action_0_1494136287039\",\"visibility\":\"Hide\",\"isError\":false,\"field\":\"14\"},{\"id\":\"action_1_1494136287039\",\"visibility\":\"Show\",\"isError\":false,\"field\":\"13\"},{\"id\":\"action_2_1494136287039\",\"visibility\":\"Hide\",\"isError\":false,\"field\":\"9\"}],\"id\":\"1494136287038\",\"index\":\"17\",\"link\":\"Any\",\"priority\":\"17\",\"terms\":[{\"id\":\"term_0_1494136287039\",\"field\":\"12\",\"operator\":\"equals\",\"value\":\"Internet Banking\",\"isError\":false}],\"type\":\"field\"},{\"action\":[{\"id\":\"action_0_1516265872227\",\"visibility\":\"Hide\",\"isError\":false,\"field\":\"13\"},{\"id\":\"action_1_1516265872227\",\"visibility\":\"Show\",\"isError\":false,\"field\":\"14\"},{\"id\":\"action_2_1516265872227\",\"visibility\":\"Hide\",\"isError\":false,\"field\":\"9\"}],\"id\":\"1493961635656\",\"index\":\"18\",\"link\":\"All\",\"priority\":\"18\",\"terms\":[{\"id\":\"term_1_1516265872227\",\"field\":\"12\",\"operator\":\"equals\",\"value\":\"eziDebit (5 easy payments)\",\"isError\":false}],\"type\":\"field\"}]);\n   JotForm.init(function(){\n      JotForm.description('input_17', 'We will only use your phone number in the event we cannot contact you via email.');\n\n JotForm.calendarMonths = [\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"];\n JotForm.calendarDays = [\"Sunday\",\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\",\"Sunday\"];\n JotForm.calendarOther = {\"today\":\"Today\"};\n var languageOptions = document.querySelectorAll('#langList li'); \n for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) { \n   languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar(\"5\", false, {\"days\":{\"monday\":true,\"tuesday\":true,\"wednesday\":true,\"thursday\":true,\"friday\":true,\"saturday\":true,\"sunday\":true},\"future\":true,\"past\":true,\"custom\":false,\"ranges\":false,\"start\":\"\",\"end\":\"\"}); }, 0); });\n } \n JotForm.setCalendar(\"5\", false, {\"days\":{\"monday\":true,\"tuesday\":true,\"wednesday\":true,\"thursday\":true,\"friday\":true,\"saturday\":true,\"sunday\":true},\"future\":true,\"past\":true,\"custom\":false,\"ranges\":false,\"start\":\"\",\"end\":\"\"});\n      productID = {\"0\":\"input_9_1000\",\"1\":\"input_9_1001\",\"2\":\"input_9_1003\",\"3\":\"input_9_1002\"};\n      paymentType = \"product\";\n      JotForm.setCurrencyFormat('NZD',true, 'point');\n      JotForm.totalCounter({\"input_9_1000\":{\"price\":\"179\"},\"input_9_1001\":{\"price\":\"119\"},\"input_9_1003\":{\"price\":\"79\"},\"input_9_1002\":{\"price\":\"179\"}});\n      $$('.form-product-custom_quantity').each(function(el, i){el.observe('blur', function(){isNaN(this.value) || this.value < 1 ? this.value = '0' : this.value})});\n      $$('.form-product-custom_quantity').each(function(el, i){el.observe('focus', function(){this.value == 0 ? this.value = '' : this.value})});\n      JotForm.setStripeSettings('pk_live_jEvKtLOOfX8e0aFOEAttabAT', 'none');\n      JotForm.alterTexts({\"alphabetic\":\"This field can only contain letters\",\"alphanumeric\":\"This field can only contain letters and numbers.\",\"ccDonationMinLimitError\":\"Minimum amount is {minAmount} 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Only {extensions} are allowed.\",\"numeric\":\"This field can only contain numeric values\",\"pastDatesDisallowed\":\"Date must not be in the past.\",\"pleaseWait\":\"Please wait...\",\"required\":\"This field is required.\",\"requireEveryCell\":\"Every cell is required.\",\"requireEveryRow\":\"Every row is required.\",\"requireOne\":\"At least one field required.\",\"submissionLimit\":\"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.\",\"uploadExtensions\":\"You can only upload following files:\",\"uploadFilesize\":\"File size cannot be bigger than:\",\"uploadFilesizemin\":\"File size cannot be smaller than:\",\"url\":\"This field can only contain a valid URL\",\"wordLimitError\":\"Too many words. The limit is\",\"wordMinLimitError\":\"Too few words.  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Please try another one.\",\"couponInvalid\":\"Coupon is invalid.\",\"couponValid\":\"Coupon is valid.\",\"shippingShipping\":\"Shipping:\",\"taxTax\":\"Tax:\",\"totalSubTotal\":\"Subtotal:\",\"totalTotal\":\"Total:\"}, true);\n\tJotForm.clearFieldOnHide=\"disable\";\n    \/*INIT-END*\/\n});\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n\n   JotForm.prepareCalculationsOnTheFly([null,{\"name\":\"10wcRegistration\",\"qid\":\"1\",\"text\":\"10WC Registration\",\"type\":\"control_head\"},{\"name\":\"submit2\",\"qid\":\"2\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"name\":\"name\",\"qid\":\"3\",\"text\":\"Name\",\"type\":\"control_fullname\"},null,{\"name\":\"dateOf\",\"qid\":\"5\",\"text\":\"Date of Birth:\",\"type\":\"control_datetime\"},null,null,{\"name\":\"howDid8\",\"qid\":\"8\",\"text\":\"How did you hear about 10WC?\",\"type\":\"control_textbox\"},{\"name\":\"myProducts\",\"qid\":\"9\",\"text\":\"Payment\",\"type\":\"control_stripe\"},null,null,{\"name\":\"howWould\",\"qid\":\"12\",\"text\":\"How would you like to pay?\",\"type\":\"control_radio\"},{\"name\":\"clickTo\",\"qid\":\"13\",\"text\":\"\\nYou must complete this payment within the next 24 hours.&nbsp;\\nInstructions on how to pay via internet banking with POLi will be provided in the email sent to you once you click the submit button below.\",\"type\":\"control_text\"},{\"name\":\"pinstructionsOn\",\"qid\":\"14\",\"text\":\"\\nYou must complete this payment within the next 24 hours.&nbsp;\\nInstructions on how to pay via eziDebit will be provided in the email sent to you once you click the submit button below.\\nPlease Note: 10 Week Challenge Online registration does not get accepted until your first payment is processed, we recommend you make this payment to come out immediately. Your eziDebit payment is automatically set to $26 or $38 x 5 (depending if you are a newcomer or repeater) and includes a $11 admin fee. For NZ customers BSB is the first 6 digits on your bank account number. You can use your international credit card too but please note eziDebit charges a fee for this. Use anything as your reference.\",\"type\":\"control_text\"},{\"name\":\"challengeType\",\"qid\":\"15\",\"text\":\"Challenge Type\",\"type\":\"control_radio\"},{\"name\":\"clickTo16\",\"qid\":\"16\",\"text\":\"Country\",\"type\":\"control_widget\"},{\"name\":\"phoneNumber\",\"qid\":\"17\",\"text\":\"Phone Number\",\"type\":\"control_phone\"},{\"name\":\"email\",\"qid\":\"18\",\"text\":\"Email\",\"type\":\"control_email\"},{\"name\":\"repeatEmail\",\"qid\":\"19\",\"text\":\"Repeat Email\",\"type\":\"control_email\"},{\"name\":\"clickTo20\",\"qid\":\"20\",\"text\":\"Sorry, eziDebit is not available for the Lifestyle Repeater Challenge - please select another payment option\",\"type\":\"control_text\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,{\"name\":\"10wcRegistration\",\"qid\":\"1\",\"text\":\"10WC Registration\",\"type\":\"control_head\"},{\"name\":\"submit2\",\"qid\":\"2\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"name\":\"name\",\"qid\":\"3\",\"text\":\"Name\",\"type\":\"control_fullname\"},null,{\"name\":\"dateOf\",\"qid\":\"5\",\"text\":\"Date of Birth:\",\"type\":\"control_datetime\"},null,null,{\"name\":\"howDid8\",\"qid\":\"8\",\"text\":\"How did you hear about 10WC?\",\"type\":\"control_textbox\"},{\"name\":\"myProducts\",\"qid\":\"9\",\"text\":\"Payment\",\"type\":\"control_stripe\"},null,null,{\"name\":\"howWould\",\"qid\":\"12\",\"text\":\"How would you like to pay?\",\"type\":\"control_radio\"},{\"name\":\"clickTo\",\"qid\":\"13\",\"text\":\"\\nYou must complete this payment within the next 24 hours.&nbsp;\\nInstructions on how to pay via internet banking with POLi will be provided in the email sent to you once you click the submit button below.\",\"type\":\"control_text\"},{\"name\":\"pinstructionsOn\",\"qid\":\"14\",\"text\":\"\\nYou must complete this payment within the next 24 hours.&nbsp;\\nInstructions on how to pay via eziDebit will be provided in the email sent to you once you click the submit button below.\\nPlease Note: 10 Week Challenge Online registration does not get accepted until your first payment is processed, we recommend you make this payment to come out immediately. Your eziDebit payment is automatically set to $26 or $38 x 5 (depending if you are a newcomer or repeater) and includes a $11 admin fee. For NZ customers BSB is the first 6 digits on your bank account number. You can use your international credit card too but please note eziDebit charges a fee for this. 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value=\"71240602839857\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li id=\"cid_1\" class=\"form-input-wide always-hidden\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_1\" class=\"form-header\" data-component=\"header\">\n              10WC Registration\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_3\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_3\" for=\"first_3\">\n          Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_3\" class=\"form-input-wide jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"first_3\" name=\"q3_name[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"first_3\" id=\"sublabel_first\" style=\"min-height:13px;\"> First Name <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"last_3\" name=\"q3_name[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"last_3\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_18\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_18\" for=\"input_18\">\n          Email\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_18\" class=\"form-input-wide jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"email\" id=\"input_18\" name=\"q18_email\" class=\"form-textbox validate[required, Email]\" size=\"30\" value=\"\" data-component=\"email\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_18\" style=\"min-height:13px;\"> example@example.com <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_19\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_19\" for=\"input_19\">\n          Repeat Email\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_19\" class=\"form-input-wide jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"email\" id=\"input_19\" name=\"q19_repeatEmail\" class=\"form-textbox validate[required, Email]\" size=\"30\" value=\"\" data-component=\"email\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_19\" style=\"min-height:13px;\"> example@example.com <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_phone\" id=\"id_17\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_17\" for=\"input_17_area\">\n          Phone Number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_17\" class=\"form-input-wide jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"tel\" id=\"input_17_area\" name=\"q17_phoneNumber[area]\" class=\"form-textbox validate[required]\" size=\"3\" value=\"\" data-component=\"areaCode\" required=\"\" \/>\n              <span class=\"phone-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"input_17_area\" id=\"sublabel_area\" style=\"min-height:13px;\"> Area Code <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"tel\" id=\"input_17_phone\" name=\"q17_phoneNumber[phone]\" class=\"form-textbox validate[required]\" size=\"8\" value=\"\" data-component=\"phone\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"input_17_phone\" id=\"sublabel_phone\" style=\"min-height:13px;\"> Phone Number <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_datetime\" id=\"id_5\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_5\" for=\"month_5\">\n          Date of Birth:\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_5\" class=\"form-input-wide jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"month_5\" name=\"q5_dateOf[month]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" required=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"month_5\" id=\"sublabel_month\" style=\"min-height:13px;\"> Month <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"day_5\" name=\"q5_dateOf[day]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" required=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"day_5\" id=\"sublabel_day\" style=\"min-height:13px;\"> Day <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"year_5\" name=\"q5_dateOf[year]\" type=\"tel\" size=\"4\" data-maxlength=\"4\" value=\"\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"year_5\" id=\"sublabel_year\" style=\"min-height:13px;\"> Year <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <img class=\"showAutoCalendar\" alt=\"Pick a Date\" id=\"input_5_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" style=\"vertical-align:middle;\" data-component=\"datetime\" \/>\n              <label class=\"form-sub-label\" for=\"input_5_pick\" style=\"min-height:13px;\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_widget\" id=\"id_16\">\n        <label class=\"form-label form-label-top\" id=\"label_16\" for=\"input_16\">\n          Country\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_16\" class=\"form-input-wide jf-required\">\n          <div style=\"width:100%;text-align:Left;\" data-component=\"widget-field\">\n            <iframe frameborder=\"0\" scrolling=\"no\" allowtransparency=\"true\" data-type=\"iframe\" class=\"custom-field-frame\" id=\"customFieldFrame_16\" src=\"\" style=\"border:none;width:365px;height:50px;\" data-width=\"365\" data-height=\"50\">\n            <\/iframe>\n            <div class=\"widget-inputs-wrapper\">\n              <input id=\"input_16\" class=\"form-hidden form-widget widget-required \" type=\"hidden\" name=\"q16_clickTo16\" value=\"\" \/>\n              <input id=\"widget_settings_16\" class=\"form-hidden form-widget-settings\" type=\"hidden\" value=\"%5B%7B%22name%22%3A%22country%22%2C%22value%22%3A%22New%20Zealand%22%7D%2C%7B%22name%22%3A%22submit%22%2C%22value%22%3A%22Whole%20country%20name%22%7D%5D\" data-version=\"2\" \/>\n            <\/div>\n            <script type=\"text\/javascript\">\n            setTimeout(function()\n{\n  var _cFieldFrame = document.getElementById(\"customFieldFrame_16\");\n  _cFieldFrame.onload = function()\n  {\n    widgetFrameLoaded(16, {\n      \"formID\": 71240602839857\n    })\n  };\n  _cFieldFrame.src = \"\/\/widgets.jotform.io\/pickers\/?pickerType=countries&qid=16&ref=\" + encodeURIComponent(window.location.protocol + \"\/\/\" + window.location.host);\n  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first time <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_15_1\" name=\"q15_challengeType\" value=\"Plant Based - Vegetarian\" required=\"\" \/>\n              <label id=\"label_input_15_1\" for=\"input_15_1\"> Plant Based - Vegetarian <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_15_2\" name=\"q15_challengeType\" value=\"Repeater - I am back for more!\" required=\"\" \/>\n              <label id=\"label_input_15_2\" for=\"input_15_2\"> Repeater - I am back for more! <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_15_3\" name=\"q15_challengeType\" value=\"Lifestyle Repeater\" required=\"\" \/>\n              <label id=\"label_input_15_3\" for=\"input_15_3\"> Lifestyle Repeater <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_12\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_12\" for=\"input_12\">\n          How would you like to pay?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_12\" class=\"form-input-wide jf-required\">\n          <div class=\"form-single-column\" data-component=\"radio\">\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_0\" name=\"q12_howWould\" checked=\"\" value=\"Credit or Debit Card (recommended)\" required=\"\" \/>\n              <label id=\"label_input_12_0\" for=\"input_12_0\"> Credit or Debit Card (recommended) <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_1\" name=\"q12_howWould\" value=\"Internet Banking\" required=\"\" \/>\n              <label id=\"label_input_12_1\" for=\"input_12_1\"> Internet Banking <\/label>\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_12_2\" name=\"q12_howWould\" value=\"eziDebit (5 easy payments)\" required=\"\" \/>\n              <label id=\"label_input_12_2\" for=\"input_12_2\"> eziDebit (5 easy payments) <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_13\">\n        <div id=\"cid_13\" class=\"form-input-wide\">\n          <div id=\"text_13\" class=\"form-html\" data-component=\"text\">\n            <p><img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/poli-logo-44.164.png\" width=\"177\" height=\"80\" \/><\/p>\n            <p><span style=\"text-decoration: underline;\"><strong>You must complete this payment within the next 24 hours. <\/strong><\/span><\/p>\n            <p><strong>Instructions on how to pay via internet banking with POLi will be provided in the email sent to you once you click the submit button below.<\/strong><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_14\">\n        <div id=\"cid_14\" class=\"form-input-wide\">\n          <div id=\"text_14\" class=\"form-html\" data-component=\"text\">\n            <p><img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/ezidebit_global_rgb-600x162.645.jpg\" width=\"254\" height=\"69\" \/><\/p>\n            <p><span style=\"text-decoration: underline;\"><strong>You must complete this payment within the next 24 hours. <\/strong><\/span><\/p>\n            <p><strong>Instructions on how to pay via eziDebit will be provided in the email sent to you once you click the submit button below.<\/strong><\/p>\n            <p><strong>Please Note:<\/strong> 10 Week Challenge Online registration does not get accepted until your first payment is processed, we recommend you make this payment to come out immediately. Your eziDebit payment is automatically set to $26 or $38 x 5 (depending if you are a newcomer or repeater) and includes a $11 admin fee. For NZ customers BSB is the first 6 digits on your bank account number. You can use your international credit card too but please note eziDebit charges a fee for this. Use anything as your reference.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_20\">\n        <div id=\"cid_20\" class=\"form-input-wide\">\n          <div id=\"text_20\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"color: #ff0000;\"><strong>Sorry, eziDebit is not available for the Lifestyle Repeater Challenge - please select another payment option<\/strong><\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_stripe\" id=\"id_9\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_9\" for=\"input_9\"> Payment <\/label>\n        <div id=\"cid_9\" class=\"form-input-wide\">\n          <div data-wrapper-react=\"true\">\n            <div data-wrapper-react=\"true\">\n              <input type=\"hidden\" name=\"simple_fpc\" data-payment_type=\"stripe\" data-component=\"payment1\" value=\"9\" \/>\n              <input type=\"hidden\" name=\"payment_total_checksum\" id=\"payment_total_checksum\" data-component=\"payment2\" \/>\n              <div data-wrapper-react=\"true\">\n                <span class=\"form-product-item hover-product-item\">\n                  <img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/minilogo.897.png\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle;\" \/>\n                  <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                    <input class=\"form-checkbox \" type=\"checkbox\" id=\"input_9_1000\" name=\"q9_myProducts[][id]\" value=\"1000\" \/>\n                    <label for=\"input_9_1000\" class=\"form-product-container\">\n                      <span data-wrapper-react=\"true\">\n                        <span class=\"form-product-name\" id=\"product-name-input_9_1000\">\n                          Newcomer\n                        <\/span>\n                        <span class=\"form-product-details\">\n                          <b>\n                            <span data-wrapper-react=\"true\">\n                              $\n                              <span id=\"input_9_1000_price\">\n                                179.00\n                              <\/span>\n                              NZD\n                            <\/span>\n                          <\/b>\n                        <\/span>\n                      <\/span>\n                    <\/label>\n                  <\/div>\n                <\/span>\n                <br\/>\n                <span class=\"form-product-item hover-product-item\">\n                  <img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/minilogo.897.png\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle;\" \/>\n                  <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                    <input class=\"form-checkbox \" type=\"checkbox\" id=\"input_9_1001\" name=\"q9_myProducts[][id]\" value=\"1001\" \/>\n                    <label for=\"input_9_1001\" class=\"form-product-container\">\n                      <span data-wrapper-react=\"true\">\n                        <span class=\"form-product-name\" id=\"product-name-input_9_1001\">\n                          Repeater\n                        <\/span>\n                        <span class=\"form-product-details\">\n                          <b>\n                            <span data-wrapper-react=\"true\">\n                              $\n                              <span id=\"input_9_1001_price\">\n                                119.00\n                              <\/span>\n                              NZD\n                            <\/span>\n                          <\/b>\n                        <\/span>\n                      <\/span>\n                    <\/label>\n                  <\/div>\n                <\/span>\n                <br\/>\n                <span class=\"form-product-item hover-product-item\">\n                  <img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/minilogo.897.png\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle;\" \/>\n                  <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                    <input class=\"form-checkbox \" type=\"checkbox\" id=\"input_9_1003\" name=\"q9_myProducts[][id]\" value=\"1003\" \/>\n                    <label for=\"input_9_1003\" class=\"form-product-container\">\n                      <span data-wrapper-react=\"true\">\n                        <span class=\"form-product-name\" id=\"product-name-input_9_1003\">\n                          Lifestyle Repeater\n                        <\/span>\n                        <span class=\"form-product-details\">\n                          <b>\n                            <span data-wrapper-react=\"true\">\n                              $\n                              <span id=\"input_9_1003_price\">\n                                79.00\n                              <\/span>\n                              NZD\n                            <\/span>\n                          <\/b>\n                        <\/span>\n                      <\/span>\n                    <\/label>\n                  <\/div>\n                <\/span>\n                <br\/>\n                <span class=\"form-product-item hover-product-item\">\n                  <img src=\"https:\/\/www.jotform.com\/uploads\/fluxdesignlab\/form_files\/plantbased.608.png\" alt=\"product\" class=\"form-product-image-with-options\" width=\"50\" style=\"height:auto;vertical-align:middle;\" \/>\n                  <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                    <input class=\"form-checkbox \" type=\"checkbox\" id=\"input_9_1002\" name=\"q9_myProducts[][id]\" value=\"1002\" \/>\n                    <label for=\"input_9_1002\" class=\"form-product-container\">\n                      <span data-wrapper-react=\"true\">\n                        <span class=\"form-product-name\" id=\"product-name-input_9_1002\">\n                          Plant Based\n                        <\/span>\n                        <span class=\"form-product-details\">\n                          <b>\n                            <span data-wrapper-react=\"true\">\n                              $\n                              <span id=\"input_9_1002_price\">\n                                179.00\n                              <\/span>\n                              NZD\n                            <\/span>\n                          <\/b>\n                        <\/span>\n                      <\/span>\n                    <\/label>\n                  <\/div>\n                <\/span>\n                <br\/>\n                <div id=\"coupon-container\" style=\"border:1px solid lightgray;padding:5px;border-radius:6px;width:200px;margin-top:8px;\">\n                  <table id=\"coupon-table\">\n                    <tr>\n                      <th colspan=\"2\" style=\"text-align:left;\">\n                        <span id=\"coupon-header\">\n                          Enter coupon\n                        <\/span>\n                      <\/th>\n                    <\/tr>\n                    <tr>\n                      <td>\n                        <input name=\"coupon-input\" id=\"coupon-input\" type=\"text\" size=\"15\" autocomplete=\"off\" \/>\n                      <\/td>\n                      <td width=\"40%\" style=\"text-align:center;\">\n                        <img src=\"https:\/\/cdn.jotfor.ms\/\/images\/ajax-loader.gif\" alt=\"coupon\" id=\"coupon-loader\" style=\"display:none;vertical-align:top;\" \/>\n                        <button type=\"button\" id=\"coupon-button\" data-qid=\"input_9\" value=\"\">\n                          Apply\n                        <\/button>\n                      <\/td>\n                    <\/tr>\n                    <tr>\n                      <th colspan=\"2\" style=\"text-align:left;\">\n                        <span id=\"coupon-message\">\n                        <\/span>\n                      <\/th>\n                    <\/tr>\n                  <\/table>\n                <\/div>\n                <br\/>\n                <input id=\"input_9_coupon\" type=\"hidden\" name=\"coupon\" \/>\n                <span class=\"form-payment-total\">\n                  <b>\n                    <span id=\"total-text\">\n                      Total:\n                    <\/span>\n                    \u00a0\n                    <span class=\"form-payment-price\">\n                      <span data-wrapper-react=\"true\">\n                        $\n                        <span id=\"payment_total\">\n                          0.00\n                        <\/span>\n                        NZD\n                      <\/span>\n                    <\/span>\n                  <\/b>\n                <\/span>\n              <\/div>\n              <hr\/>\n            <\/div>\n            <table class=\"form-address-table payment-form-table\" cellpadding=\"0\" cellspacing=\"0\">\n              <tbody>\n                <tr>\n                  <th colspan=\"2\" style=\"text-align:left;margin-top:20px;display:table;\" id=\"ccTitle9\">\n                    Credit Card Details\n                  <\/th>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_firstName\" id=\"sublabel_cc_firstName\" style=\"min-height:13px;margin:0 0 3px 0;\"> First Name <\/label>\n                      <input type=\"text\" id=\"input_9_cc_firstName\" name=\"q9_myProducts[cc_firstName]\" class=\"form-textbox cc_firstName\" size=\"20\" value=\"\" data-component=\"cc_firstName\" \/>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_lastName\" id=\"sublabel_cc_lastName\" style=\"min-height:13px;margin:0 0 3px 0;\"> Last Name <\/label>\n                      <input type=\"text\" id=\"input_9_cc_lastName\" name=\"q9_myProducts[cc_lastName]\" class=\"form-textbox cc_lastName\" size=\"20\" value=\"\" data-component=\"cc_lastName\" \/>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_number\" id=\"sublabel_cc_number\" style=\"min-height:13px;margin:0 0 3px 0;\"> Credit Card Number <\/label>\n                      <input type=\"number\" id=\"input_9_cc_number\" name=\"q9_myProducts[cc_number]\" class=\"form-textbox cc_number\" autocomplete=\"off\" size=\"20\" value=\"\" data-component=\"cc_number\" \/>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_ccv\" id=\"sublabel_cc_ccv\" style=\"min-height:13px;margin:0 0 3px 0;\"> Security Code <\/label>\n                      <input type=\"number\" id=\"input_9_cc_ccv\" name=\"q9_myProducts[cc_ccv]\" class=\"form-textbox cc_ccv\" autocomplete=\"off\" style=\"width:52px;\" value=\"\" data-component=\"cc_ccv\" \/>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_exp_month\" id=\"sublabel_cc_exp_month\" style=\"min-height:13px;margin:0 0 3px 0;\"> Expiration Month <\/label>\n                      <select class=\"form-dropdown cc_exp_month\" name=\"q9_myProducts[cc_exp_month]\" id=\"input_9_cc_exp_month\" data-component=\"cc_exp_month\">\n                        <option>  <\/option>\n                        <option value=\"1\"> January <\/option>\n                        <option value=\"2\"> February <\/option>\n                        <option value=\"3\"> March <\/option>\n                        <option value=\"4\"> April <\/option>\n                        <option value=\"5\"> May <\/option>\n                        <option value=\"6\"> June <\/option>\n                        <option value=\"7\"> July <\/option>\n                        <option value=\"8\"> August <\/option>\n                        <option value=\"9\"> September <\/option>\n                        <option value=\"10\"> October <\/option>\n                        <option value=\"11\"> November <\/option>\n                        <option value=\"12\"> December <\/option>\n                      <\/select>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_9_cc_exp_year\" id=\"sublabel_cc_exp_year\" style=\"min-height:13px;margin:0 0 3px 0;\"> Expiration Year <\/label>\n                      <select class=\"form-dropdown cc_exp_year\" name=\"q9_myProducts[cc_exp_year]\" id=\"input_9_cc_exp_year\" data-component=\"cc_exp_year\">\n                        <option>  <\/option>\n                        <option value=\"2018\"> 2018 <\/option>\n                        <option value=\"2019\"> 2019 <\/option>\n                        <option value=\"2020\"> 2020 <\/option>\n                        <option value=\"2021\"> 2021 <\/option>\n                        <option value=\"2022\"> 2022 <\/option>\n                        <option value=\"2023\"> 2023 <\/option>\n                        <option value=\"2024\"> 2024 <\/option>\n                        <option value=\"2025\"> 2025 <\/option>\n                        <option value=\"2026\"> 2026 <\/option>\n                        <option value=\"2027\"> 2027 <\/option>\n                        <option value=\"2028\"> 2028 <\/option>\n                        <option value=\"2029\"> 2029 <\/option>\n                        <option value=\"2030\"> 2030 <\/option>\n                        <option value=\"2031\"> 2031 <\/option>\n                        <option value=\"2032\"> 2032 <\/option>\n                        <option value=\"2033\"> 2033 <\/option>\n                        <option value=\"2034\"> 2034 <\/option>\n                        <option value=\"2035\"> 2035 <\/option>\n                        <option value=\"2036\"> 2036 <\/option>\n                        <option value=\"2037\"> 2037 <\/option>\n                      <\/select>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n              <\/tbody>\n            <\/table>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_8\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_8\" for=\"input_8\"> How did you hear about 10WC? <\/label>\n        <div id=\"cid_8\" class=\"form-input-wide\">\n          <input type=\"text\" id=\"input_8\" name=\"q8_howDid8\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"margin-left:156px;\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\" data-component=\"button\">\n              Submit\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"71240602839857\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"71240602839857-71240602839857\";\n  <\/script>\n  <script src=\"https:\/\/cdn.jotfor.ms\/js\/widgetResizer.js?REV=3.3.4218\" type=\"text\/javascript\"><\/script>\n<\/form><\/body>\n<\/html>\n","The 10 Week Challenge",Array,0);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");var iframe=document.getElementById("71240602839857");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
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