Application Form Page

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.af-quirksMode .af-element{padding-left:0!important;padding-right:0!important;} .choiceList-radio-inline .af-element-radio{float:left;} .lbl-right .af-element label{text-align:right;} body { } #af-form-648275968 .bodyText p { margin: 0 0 1em !important; } #af-form-648275968 .af-body { padding-top: } #af-form-648275968 .af-body .af-textWrap { width: 100% !important; } #af-form-648275968 .af-body .af-element { padding-top: 0px!important; padding-bottom: 0px!important; } #af-form-648275968 .af-body .af-element:first-child { margin-top: 0 !important; } #af-form-648275968 .af-body label.previewLabel { font-weight: 700 !important; margin-top: 0.25rem !important; margin-bottom: .25rem !important; } #af-form-648275968 .af-body input.text, #af-form-648275968 .af-body textarea { border-radius: 3px !important; box-sizing: border-box !important; color: #444444 !important; font-size: 1rem !important; margin-bottom: 0.75rem !important; padding: 8px 12px !important; -webkit-transition-duration: 0.3s; transition-duration: 0.3s; } #af-form-648275968 .af-body select { width: 100%; } #af-form-648275968 .af-body .af-dateWrap select { width: 33%; } #af-form-648275968 .choiceList-radio-stacked { margin-bottom: 1rem !important; width: 100% !important; } #af-form-648275968 .af-element-radio { margin: 0 !important; } #af-form-648275968 .af-element-radio input.radio { display: inline; height: 0; opacity: 0; overflow: hidden; width: 0; } #af-form-648275968 .af-element-radio input.radio:checked ~ label { font-weight: 700 !important; } #af-form-648275968 .af-element-radio input.radio:focus ~ label { box-shadow: inset 0 0 0 2px rgba(25,35,70,.25); } #af-form-648275968 .af-element-radio input.radio:checked ~ label:before { background-color: #777777; border-color: #d6dee3; } #af-form-648275968 .af-element-radio label.choice { border: 1px solid #d6dee3; border-radius: 3px !important; display: block !important; font-weight: 300 !important; margin: 0.5rem 0 !important; padding: 1rem 1rem 1rem 2rem !important; position: relative; -webkit-transition-duration: 0.3s; transition-duration: 0.3s; } #af-form-648275968 .af-element-radio label.choice:before { background-color: #FFF; border: 1px solid #d6dee3; border-radius: 50%; content: ”; height: 0.75rem; margin-left: -1.3rem; position: absolute; -webkit-transition-duration: 0.3s; transition-duration: 0.3s; width: 0.75rem; } #af-form-648275968 .buttonContainer { box-sizing: border-box !important; } #af-form-648275968 .af-footer { box-sizing: border-box !important; } #af-form-648275968 .af-footer p { margin: 0 !important; } #af-form-648275968 input.submit, #af-form-648275968 #webFormSubmitButton { border: none; border-radius: 3px !important; font-weight: bold; margin-top: 0.5rem !important; margin-bottom: 1rem !Important; padding: 0.6rem 1.5rem !important; -webkit-transition-duration: 0.3s; transition-duration: 0.3s; } #af-form-648275968 input.submit:hover, #af-form-648275968 #webFormSubmitButton:hover { cursor: pointer; opacity: 0.8; } #af-form-648275968 input.text:hover { cursor: pointer; opacity: 0.8; } .poweredBy a, .privacyPolicy p { color: #000000 !important; font-size: 0.65rem !important; } </style> <form method=”post” class=”af-form-wrapper” accept-charset=”UTF-8″ action=”https://www.aweber.com/scripts/addlead.pl” target=”_blank” > <div style=”display: none;”> <input type=”hidden” name=”meta_web_form_id” value=”648275968″ /> <input type=”hidden” name=”meta_split_id” value=”” /> <input type=”hidden” name=”listname” value=”awlist6054989″ /> <input type=”hidden” name=”redirect” value=”https://legacytrustmalaysia.com/thank-you/” id=”redirect_736630b4d9e8287f89596afc567fc649″ /> <input type=”hidden” name=”meta_redirect_onlist” value=”https://legacytrustmalaysia.com/thank-you/” /> <input type=”hidden” name=”meta_adtracking” value=”Legacy_Trust_Application_Form” /> <input type=”hidden” name=”meta_message” value=”1″ /> <input type=”hidden” name=”meta_required” value=”name,custom Mobile No,email,custom Have you written your will,custom Ask us any questions you may have” /> <input type=”hidden” name=”meta_tooltip” value=”” /> </div> <div id=”af-form-648275968″ class=”af-form”><div id=”af-header-648275968″ class=”af-header”><div class=”bodyText”><p>&nbsp;</p></div></div> <div id=”af-body-648275968″ class=”af-body af-standards”> <div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969124″>Name: </label> <div class=”af-textWrap”> <input id=”awf_field-111969124″ type=”text” name=”name” class=”text” value=”” onfocus=” if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;} ” tabindex=”500″ /> </div> <div class=”af-clear”></div></div> <div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969125″>Mobile No:</label> <div class=”af-textWrap”><input type=”text” id=”awf_field-111969125″ class=”text” name=”custom Mobile No” value=”” onfocus=” if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;} ” tabindex=”501″ /></div> <div class=”af-clear”></div></div><div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969126″>Email: </label> <div class=”af-textWrap”><input class=”text” id=”awf_field-111969126″ type=”text” name=”email” value=”” tabindex=”502″ onfocus=” if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;} ” /> </div><div class=”af-clear”></div> </div> <div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969127″>Address:</label> <div class=”af-textWrap”><input type=”text” id=”awf_field-111969127″ class=”text” name=”custom Address” value=”” onfocus=” if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;} ” tabindex=”503″ /></div> <div class=”af-clear”></div></div><div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969128″>How did you know about this event</label> <div class=”af-textWrap”><input type=”text” id=”awf_field-111969128″ class=”text” name=”custom Application form” value=”” onfocus=” if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;} ” tabindex=”504″ /></div> <div class=”af-clear”></div></div><div class=”af-element”><div><label class=”previewLabel” for=”awf_field-1119691290″>Have you ever attended a similar event</label><div class=”choiceList choiceList-radio-inline”> <div class=”af-element-radio multiChoice”> <input class=”radio” type=”radio” id=”awf_field-1119691290″ name=”custom Question 2″ value=”Yes” tabindex=”505″ /> <label class=”choice” for=”awf_field-1119691290″>Yes</label> </div><div class=”af-element-radio multiChoice”> <input class=”radio” type=”radio” id=”awf_field-1119691291″ name=”custom Question 2″ value=”No” tabindex=”506″ /> <label class=”choice” for=”awf_field-1119691291″>No</label> </div></div></div><div class=”af-clear”></div></div><div class=”af-element”><div><label class=”previewLabel” for=”awf_field-1119691300″>Have you written your will:</label><div class=”choiceList choiceList-radio-inline”> <div class=”af-element-radio multiChoice”> <input class=”radio” type=”radio” id=”awf_field-1119691300″ name=”custom Have you written your will” value=”Yes” tabindex=”507″ /> <label class=”choice” for=”awf_field-1119691300″>Yes</label> </div><div class=”af-element-radio multiChoice”> <input class=”radio” type=”radio” id=”awf_field-1119691301″ name=”custom Have you written your will” value=”No” tabindex=”508″ /> <label class=”choice” for=”awf_field-1119691301″>No</label> </div></div></div><div class=”af-clear”></div></div><div class=”af-element”> <label class=”previewLabel” for=”awf_field-111969131″>Ask us any questions you may have:</label> <div class=”af-textWrap”><textarea rows=”” cols=”” name=”custom Ask us any questions you may have” id=”awf_field-111969131″ onfocus=”if (this.value == ”) { this.value = ”; }” onblur=”if (this.value == ”) { this.value=”;}” tabindex=”509″ style=”height:100px”></textarea></div><div class=”af-clear”></div></div><div class=”af-element buttonContainer”> <input name=”submit” class=”submit” type=”submit” value=”Submit” tabindex=”510″ /> <div class=”af-clear”></div> </div> <div class=”af-element privacyPolicy” style=”text-align: center”><p>We respect your <a title=”Privacy Policy” href=”https://www.aweber.com/permission.htm” target=”_blank” rel=”nofollow”>email privacy</a></p> <div class=”af-clear”></div> </div> <div class=”af-element poweredBy” style=”text-align: center; font-size: 9px;”><p><a href=”https://www.aweber.com” title=”AWeber Email Marketing” target=”_blank” rel=”nofollow”>Powered by AWeber Email Marketing</a></p> <div class=”af-clear”></div> </div> <div class=”af-element tag” style=”display:none;”><input id=”awf_tag-111969135″ type=”hidden” name=”tag_111969135″ value=”prospects” /></div> </div> <div id=”af-footer-648275968″ class=”af-footer”><div class=”bodyText”><p>&nbsp;</p></div></div> </div> <div style=”display: none;”><img src=”https://forms.aweber.com/form/displays.htm?id=bCwcTOysnGwc” alt=”” /></div> </form> <script type=”text/javascript”> // Special handling for in-app browsers that don’t always support new windows (function() { function browserSupportsNewWindows(userAgent) { var rules = [ ‘FBIOS’, ‘Twitter for iPhone’, ‘WebView’, ‘(iPhone|iPod|iPad)(?!.*Safari\/)’, ‘Android.*(wv|\.0\.0\.0)’ ]; var pattern = new RegExp(‘(‘ + rules.join(‘|’) + ‘)’, ‘ig’); return !pattern.test(userAgent); } if (!browserSupportsNewWindows(navigator.userAgent || navigator.vendor || window.opera)) { document.getElementById(‘af-form-648275968’).parentElement.removeAttribute(‘target’); } })(); </script><script type=”text/javascript”> <!– (function() { var IE = /*@cc_on!@*/false; if (!IE) { return; } if (document.compatMode && document.compatMode == ‘BackCompat’) { if (document.getElementById(“af-form-648275968”)) { document.getElementById(“af-form-648275968”).className = ‘af-form af-quirksMode’; } if 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