<script type="text/javascript" src="/sites/default/modules/civicrm/packages/jquery/jquery.js"></script>
<script type="text/javascript" src="/sites/default/modules/civicrm/packages/jquery/plugins/jquery.validate.js"></script>
<script type="text/javascript">var cj = jQuery.noConflict(); $ = cj;</script>

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<link rel="stylesheet" href="/sites/default/modules/civicrm/css/extras.css" type="text/css" /><form action="/en/civicrm/profile/create?gid=10&amp;reset=1" method="post" name="Edit" id="Edit" >

<script type="text/javascript" src="/sites/default/modules/civicrm/js/Common.js"></script>
<script type="text/javascript" src="/sites/default/civicrm/templates/CRM/Profile/Form/10/outreach.js"></script>
<style type="text/css" media="all">@import url("/sites/default/civicrm/templates/CRM/Profile/Form/10/outreach.css");</style>

<div id="crm-container" class="outreach-node" lang="en" xml:lang="en" style="float: left; ">

<div class="messages help"><p>
Please provide us with some information about you, so Transparency International Georgia can use the best possible means to get in touch.</p></div>

<div class="form-layout-compressed">
<div id="outreach-left">
<h3>Your Contact Info</h3>
<div id="editrow-first_name" class="crm-section editrow_first_name-section form-item"><div class="label"><label for="first_name">First Name <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="30" name="first_name" type="text" id="first_name" class="form-text big required" /></div><div class="clear"></div></div>
<div id="editrow-last_name" class="crm-section editrow_last_name-section form-item"><div class="label"><label for="last_name">Last Name <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="30" name="last_name" type="text" id="last_name" class="form-text big required" /></div><div class="clear"></div></div>
<div id="editrow-email-2" class="crm-section editrow_email-2-section form-item"><div class="label"><label for="email-2">Email <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="30" name="email-2" type="text" id="email-2" class="form-text big required" /></div><div class="clear"></div></div>
</div>

<div id="outreach-right">
<h3>How would you like to hear from us?</h3>

<div id="editrow-custom_1" class="crm-section editrow_custom_1-section form-item"><div class="label"><label>Reports <span class="crm-marker" title="This field is required.">*</span>
</label></div><div class="edit-value content"><input value="1" type="radio" id="CIVICRM_QFID_1_2" checked="checked" name="custom_1" class="form-radio" /><label for="CIVICRM_QFID_1_2">Yes</label>&nbsp;<input value="0" type="radio" id="CIVICRM_QFID_0_4" name="custom_1" class="form-radio" /><label for="CIVICRM_QFID_0_4">No</label></div><div class="clear"></div></div>

<div id="editrow-custom_3" class="crm-section editrow_custom_3-section form-item"><div class="label"><label> Weekly summary
<span class="crm-marker" title="This field is required.">*</span>
</label>

</div>

<div class="edit-value content"><input value="1" checked="checked" type="radio" id="CIVICRM_QFID_1_10" name="custom_3" class="form-radio" />

<label for="CIVICRM_QFID_1_10">Yes</label>&nbsp;<input value="0" type="radio" id="CIVICRM_QFID_0_12" name="custom_3" class="form-radio" /><label for="CIVICRM_QFID_0_12">No</label></div><div class="clear">
</div></div>

<div id="editrow-custom_2" class="crm-section editrow_custom_2-section form-item"><div class="label"><label>Press Releases and Statements <span class="crm-marker" title="This field is required.">*</span>
</label></div><div class="edit-value content"><input value="1" type="radio" id="CIVICRM_QFID_1_6" name="custom_2" class="form-radio" /><label for="CIVICRM_QFID_1_6">Yes</label>&nbsp;<input value="0" type="radio" id="CIVICRM_QFID_0_8" name="custom_2" checked="checked" class="form-radio" /><label for="CIVICRM_QFID_0_8">No</label></div><div class="clear"></div></div>

<div id="editrow-custom_8" class="crm-section editrow_custom_8-section form-item"><div class="label"><label> Blog posts
<span class="crm-marker" title="This field is required.">*</span>

</label></div><div class="edit-value content"><input value="1" type="radio" id="CIVICRM_QFID_1_14" name="custom_8" class="form-radio" /><label for="CIVICRM_QFID_1_14">Yes</label>&nbsp;<input value="0" type="radio" id="CIVICRM_QFID_0_16" name="custom_8" class="form-radio" checked="checked"/><label for="CIVICRM_QFID_0_16">No</label></div><div class="clear"></div></div>

<div id="outreach-checkall" class="crm-section form-item"><button class="minimal checkall" onclick="return Outreach.checkAll();">Check All</button></div>

</div>

</div>
<div style="clear:both"></div>

<div class="messages help"><p>
<strong>The information you provide will NOT be shared with any third party organisations.</strong></p></div>

<div class="crm-submit-buttons">
<button class="minimal" accesskey="S" name="_qf_Edit_next" value="Submit" type="submit" id="_qf_Edit_next" />Submit</button> <button class="minimal" name="_qf_Edit_cancel" value="Reset" type="reset" id="_qf_Edit_cancel" />Reset</button>
</div>

</div><!-- end form-layout-compressed for last profile -->

<input name="postURL" type="hidden" value="/en/outreach/thanks" />
<input name="cancelURL" type="hidden" value="/en/civicrm/profile?reset=1&amp;gid=10" />
<input name="add_to_group" type="hidden" value="2" />
<input name="_qf_default" type="hidden" value="Edit:cancel" />

</form>
<div class="clear-block"></div>