{"id":2800,"date":"2021-07-20T12:44:38","date_gmt":"2021-07-20T16:44:38","guid":{"rendered":"https:\/\/joinpasidev.org\/?page_id=2800"},"modified":"2023-09-03T20:52:40","modified_gmt":"2023-09-04T00:52:40","slug":"appeal","status":"publish","type":"page","link":"https:\/\/joinpasidev.org\/index.php\/appeal\/","title":{"rendered":"Appeal"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2800\" class=\"elementor elementor-2800\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-73380b6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"73380b6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ebe0f54\" data-id=\"ebe0f54\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bfb78c2 uael-gf-ajax-yes uael-gf-input-size-md uael-gf-check-yes uael-gf-style-box uael-gf-enable-classes-no uael-gf-button-left uael-gf-btn-size-sm elementor-widget elementor-widget-uael-gf-styler\" data-id=\"bfb78c2\" data-element_type=\"widget\" data-name=\"appealgravity\" style=\"display:none\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t\t<h3 class=\"uael-gf-form-title\"><span class=\"english\">DECLARATION OF SUPPORT<\/span><span class=\"polish\"> DEKLARACJA POPARCIA<\/span><\/h3>\n\t\t\t<p class=\"uael-gf-form-desc\"><h3 id=\"appealchoice\" class=\"english\" style=\"color:red;text-align:center\">I SUPPORT THE 117th US CONGRESS<br \/>SOCIAL SECURITY FAIRNESS ACT OF 2021 - H.R. 82 &amp; S. 1302<\/h3><\/h3><h3 id=\"membershiptypepolish\" class=\"polish\" style=\"color:red;text-align:center\">POPIERAM USTAW\u0118 O UCZCIWO\u015aCI ZABEZPIECZENIA SPO\u0141ECZNEGO Z 2021 R. <br \/>-   H.R. 82 &amp; S. 1302<\/h3><br \/><h5 class=\"english switchpolish\" id=\"appealenglish\" style=\"color:blue;text-align:center;text-decoration:underline\">po polsku<\/h5><h5 class=\"polish switchenglish\" id=\"appealpolish\" style=\"color:blue;text-align:center;text-decoration:underline\">english<\/h5><\/p>\n\t\t<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_23' ><div id='gf_23' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_23' id='gform_23'  action='\/index.php\/wp-json\/wp\/v2\/pages\/2800#gf_23' data-formid='23' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_23' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_23_2\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_2\"><legend class='gfield_label gform-field-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 ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_23_2'>\n                            \n                            <span id='input_23_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_23_2_3' value='' tabindex='2'  aria-required='true'     \/>\n                                                    <label for='input_23_2_3' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">First<\/span><span class=\"polish\" style=\"display:none\">Imi\u0119<\/span><\/label>\n                                                <\/span>\n                            \n                            <span id='input_23_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_23_2_6' value='' tabindex='4'  aria-required='true'     \/>\n                                                    <label for='input_23_2_6' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Last<\/span><span class=\"polish\" style=\"display:none\">Nazwisko<\/span><\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_23_23\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_23\"><legend class='gfield_label gform-field-label'  >Are you signing the Declaration of Support  on behalf of your organization?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_23'>\n\t\t\t<div class='gchoice gchoice_23_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_23_23_0' onchange='gformToggleRadioOther( this )'  tabindex='6'  \/>\n\t\t\t\t\t<label for='choice_23_23_0' id='label_23_23_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_23_23_1' onchange='gformToggleRadioOther( this )'  tabindex='7'  \/>\n\t\t\t\t\t<label for='choice_23_23_1' id='label_23_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_1\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_1\"><label class='gfield_label gform-field-label' for='input_23_1' >Organization Name \/ Position<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_23_1' type='text' value='' class='large'   tabindex='8'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_23_16\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_16\"><legend class='gfield_label gform-field-label'  >Choose Address Type<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_16'>\n\t\t\t<div class='gchoice gchoice_23_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='&lt;span class=&quot;english&quot;&gt;United States&lt;\/span&gt;&lt;span class=&quot;polish&quot;&gt;Stany Zjednoczone&lt;\/span&gt;'  id='choice_23_16_0' onchange='gformToggleRadioOther( this )'  tabindex='9'  \/>\n\t\t\t\t\t<label for='choice_23_16_0' id='label_23_16_0' class='gform-field-label gform-field-label--type-inline'><span class=\"english\">United States<\/span><span class=\"polish\">Stany Zjednoczone<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='&lt;span class=&quot;english&quot;&gt;Canada&lt;\/span&gt;&lt;span class=&quot;polish&quot;&gt;Kanada&lt;\/span&gt;'  id='choice_23_16_1' onchange='gformToggleRadioOther( this )'  tabindex='10'  \/>\n\t\t\t\t\t<label for='choice_23_16_1' id='label_23_16_1' class='gform-field-label gform-field-label--type-inline'><span class=\"english\">Canada<\/span><span class=\"polish\">Kanada<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='&lt;span class=&quot;english&quot;&gt;International&lt;\/span&gt;&lt;span class=&quot;polish&quot;&gt;Mi\u0119dzynarodowy&lt;\/span&gt;'  id='choice_23_16_2' onchange='gformToggleRadioOther( this )'  tabindex='11'  \/>\n\t\t\t\t\t<label for='choice_23_16_2' id='label_23_16_2' class='gform-field-label gform-field-label--type-inline'><span class=\"english\">International<\/span><span class=\"polish\">Mi\u0119dzynarodowy<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_23_17\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_17\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_23_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_23_17_1' value='' tabindex='12'   aria-required='true'    \/>\n                                        <label for='input_23_17_1' id='input_23_17_1_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Street Address<\/span><span class=\"polish\" style=\"display:none\">Ulica, Nr Domu<\/span><\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_23_17_2' value='' tabindex='13'    aria-required='false'   \/>\n                                        <label for='input_23_17_2' id='input_23_17_2_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Address Line 2<\/span><span class=\"polish\" style=\"display:none\">Nr Mieszkania<\/span><\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_23_17_3' value='' tabindex='14'   aria-required='true'    \/>\n                                    <label for='input_23_17_3' id='input_23_17_3_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">City<\/span><span class=\"polish\" style=\"display:none\">Miasto<\/span><\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_17_4_container' >\n                                        <select name='input_17.4' id='input_23_17_4' tabindex='15'    aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_23_17_4' id='input_23_17_4_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">State<\/span><span class=\"polish\" style=\"display:none\">Stan<\/span><\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_23_17_5' value='' tabindex='17'   aria-required='true'    \/>\n                                    <label for='input_23_17_5' id='input_23_17_5_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">ZIP Code<\/span><span class=\"polish\" style=\"display:none\">Kod Pocztowy<\/span><\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_23_17_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_23_18\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_18\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_23_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_23_18_1' value='' tabindex='18'   aria-required='true'    \/>\n                                        <label for='input_23_18_1' id='input_23_18_1_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Street Address<\/span><span class=\"polish\" style=\"display:none\">Ulica, Nr Domu<\/span><\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_18_2_container' >\n                                        <input type='text' name='input_18.2' id='input_23_18_2' value='' tabindex='19'    aria-required='false'   \/>\n                                        <label for='input_23_18_2' id='input_23_18_2_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Address Line 2<\/span><span class=\"polish\" style=\"display:none\">Nr Mieszkania<\/span><\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_23_18_3' value='' tabindex='20'   aria-required='true'    \/>\n                                    <label for='input_23_18_3' id='input_23_18_3_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">City<\/span><span class=\"polish\" style=\"display:none\">Miasto<\/span><\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_18_4_container' >\n                                        <select name='input_18.4' id='input_23_18_4' tabindex='21'    aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_23_18_4' id='input_23_18_4_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Province<\/span><span class=\"polish\" style=\"display:none\">Prowincja<\/span><\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_23_18_5' value='' tabindex='23'   aria-required='true'    \/>\n                                    <label for='input_23_18_5' id='input_23_18_5_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Postal Code<\/span><span class=\"polish\" style=\"display:none\">Kod Pocztowy<\/span><\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_23_18_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_23_19\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_19\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_23_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_23_19_1' value='' tabindex='24'   aria-required='true'    \/>\n                                        <label for='input_23_19_1' id='input_23_19_1_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Street Address<\/span><span class=\"polish\" style=\"display:none\">Ulica, Nr Domu<\/span><\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_19_2_container' >\n                                        <input type='text' name='input_19.2' id='input_23_19_2' value='' tabindex='25'    aria-required='false'   \/>\n                                        <label for='input_23_19_2' id='input_23_19_2_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Address Line 2<\/span><span class=\"polish\" style=\"display:none\">Nr Mieszkania<\/span><\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_23_19_3' value='' tabindex='26'   aria-required='true'    \/>\n                                    <label for='input_23_19_3' id='input_23_19_3_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">City<\/span><span class=\"polish\" style=\"display:none\">Miasto<\/span><\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_19_4_container' >\n                                        <input type='text' name='input_19.4' id='input_23_19_4' value='' tabindex='28'     aria-required='true'    \/>\n                                        <label for='input_23_19_4' id='input_23_19_4_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">State \/ Province \/ Region<\/span><span class=\"polish\" style=\"display:none\">Stan \/ Prowincja \/ Region<\/span><\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_23_19_5' value='' tabindex='29'   aria-required='true'    \/>\n                                    <label for='input_23_19_5' id='input_23_19_5_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">ZIP \/ Postal Code<\/span><span class=\"polish\" style=\"display:none\">Kod Pocztowy<\/span><\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_23_19_6_container' >\n                                        <select name='input_19.6' id='input_23_19_6' tabindex='30'  aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_23_19_6' id='input_23_19_6_label' class='gform-field-label gform-field-label--type-sub '><span class=\"english\">Country<\/span><span class=\"polish\" style=\"display:none\">Kraj<\/span><\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_23_3\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_23_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_23_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_23_3_1' value='' tabindex='31'   aria-required='true'    \/>\n                                        <label for='input_23_3_1' id='input_23_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_23_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_23_3_2' value='' tabindex='32'    aria-required='false'   \/>\n                                        <label for='input_23_3_2' id='input_23_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_23_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_23_3_3' value='' tabindex='33'   aria-required='true'    \/>\n                                    <label for='input_23_3_3' id='input_23_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_23_3_4_container' >\n                                        <input type='text' name='input_3.4' id='input_23_3_4' value='' tabindex='35'     aria-required='true'    \/>\n                                        <label for='input_23_3_4' id='input_23_3_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_23_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_23_3_5' value='' tabindex='36'   aria-required='true'    \/>\n                                    <label for='input_23_3_5' id='input_23_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_23_3_6_container' >\n                                        <select name='input_3.6' id='input_23_3_6' tabindex='37'  aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_23_3_6' id='input_23_3_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_23_22\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_22\"><span class=\"english\">In some cases 9 digit ZIP Code is required. If you don't know it <a href=\"https:\/\/tools.usps.com\/zip-code-lookup.htm?byaddress\" target=\"blank\" style=\"color:blue;text-decoration:underline\" rel=\"noopener\">click here<\/a>.<\/span><span class=\"polish\" style=\"display:none\">W niekt\u00f3rych przypadkach wymagany jest 9-cio cyfrowy kod pocztowy. Je\u015bli jego nie znasz <a href=\"https:\/\/tools.usps.com\/zip-code-lookup.htm?byaddress\" target=\"blank\" style=\"color:blue;text-decoration:underline\" rel=\"noopener\">kliknij tutaj<\/a><\/span><\/div><div id=\"field_23_20\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_20\"><div id=\"validation_message_23_3_1\" class=\"gfield_description validation_message gfield_validation_message\" style=\"display:none\"><\/div><\/div><div id=\"field_23_4\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_4\"><label class='gfield_label gform-field-label' for='input_23_4' >Email<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_4' id='input_23_4' type='email' value='' class='medium' tabindex='38'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_23_5\"  class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_5\"><label class='gfield_label gform-field-label' for='input_23_5' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_23_5' type='tel' value='' class='medium' tabindex='39'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_23_6\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_6\"><legend class='gfield_label gform-field-label'  >I WANT TO BE INFORMED ABOUT SIMILAR POLISH AMERICAN INITIATIVES IN THE FUTURE<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_23_6'>\n\t\t\t<div class='gchoice gchoice_23_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_23_6_0' onchange='gformToggleRadioOther( this )'  tabindex='40'  \/>\n\t\t\t\t\t<label for='choice_23_6_0' id='label_23_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_23_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_23_6_1' onchange='gformToggleRadioOther( this )'  tabindex='41'  \/>\n\t\t\t\t\t<label for='choice_23_6_1' id='label_23_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_23_7\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_7\"><input type=\"button\" id=\"appeal_find_dist_rep\" class=\"gform_button button\" value=\"Find District and Representatives\" style=\"background-color:#61CE70\">\n<\/div><div id=\"field_23_21\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_21\"><div id=\"ErrorSearchAppeal\" class=\"gfield_description validation_message gfield_validation_message\" style=\"display:none\"><\/div><\/div><div id=\"field_23_8\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_8\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_23_8' >Congressional District Number<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_23_8' type='text' value='' class='small'   tabindex='42'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_9\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_9\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_23_9' >Congressman<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_23_9' type='text' value='' class='medium'   tabindex='43'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_10\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_10\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_23_10' >Senator<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_23_10' type='text' value='' class='medium'   tabindex='44'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_11\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_23_11\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_23_11' >Senator<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_23_11' type='text' value='' class='medium'   tabindex='45'   aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_23_12\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_12\"><div class='ginput_container ginput_container_text'><input name='input_12' id='input_23_12' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_23_13\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_13\"><div class='ginput_container ginput_container_text'><input name='input_13' id='input_23_13' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_23_14\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_14\"><div class='ginput_container ginput_container_text'><input name='input_14' id='input_23_14' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_23_15\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_15\"><div class='ginput_container ginput_container_text'><input name='input_15' id='input_23_15' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_23_25\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_25\"><div class='ginput_container ginput_container_text'><input name='input_25' id='input_23_25' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0' \/><\/div><\/div><div id=\"field_23_26\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_26\"><div class='ginput_container ginput_container_text'><input name='input_26' id='input_23_26' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_23_27\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_27\"><div class='ginput_container ginput_container_text'><input name='input_27' id='input_23_27' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Confirmation of new signature' \/><\/div><\/div><div id=\"field_23_28\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_28\"><div class='ginput_container ginput_container_text'><input name='input_28' id='input_23_28' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Hello' \/><\/div><\/div><div id=\"field_23_29\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_29\"><div class='ginput_container ginput_container_text'><input name='input_29' id='input_23_29' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Thank you for signing the Declaration of Support. If you sign it on behalf of your organization than your organization&#039;s name will be listed on our letter to Congress to support the 117th US Congress Social Security Fairness Act of 2021 (H.R. 82 &amp; S. 1302).' \/><\/div><\/div><div id=\"field_23_30\"  class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_30\"><div class='ginput_container ginput_container_text'><input name='input_30' id='input_23_30' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Toll-Free' \/><\/div><\/div><div id=\"field_23_31\"  class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_23_31\"><label class='gfield_label gform-field-label' for='input_23_31' >CAPTCHA<\/label><div id='input_23_31' class='ginput_container ginput_recaptcha' data-sitekey='6Lf0KtkhAAAAAO9xduktqvCIyLAHdpVV8DRHBEi3'  data-theme='light' data-tabindex='46'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_23' class='gform_button button' value='Sign' tabindex='47' onclick='if(window[\"gf_submitting_23\"]){return false;}  if( !jQuery(\"#gform_23\")[0].checkValidity || jQuery(\"#gform_23\")[0].checkValidity()){window[\"gf_submitting_23\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_23\"]){return false;} if( !jQuery(\"#gform_23\")[0].checkValidity || jQuery(\"#gform_23\")[0].checkValidity()){window[\"gf_submitting_23\"]=true;}  jQuery(\"#gform_23\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=23&amp;title=&amp;description=&amp;tabindex=1' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_23' value='1' \/>\n            <input type='hidden' class='gform_hidden' 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jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_17_2\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('change', '#input_23_17_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_17_3\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('change', '#input_23_17_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_17_5\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('change', '#input_23_18_1', function () {\n        jQuery(\"#input_23_3_1\").val(jQuery(\"#input_23_18_1\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('change', '#input_23_18_2', function () {\n        jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_18_2\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('change', '#input_23_18_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_18_3\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('change', '#input_23_18_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_18_5\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('change', '#input_23_19_1', function () {\n        jQuery(\"#input_23_3_1\").val(jQuery(\"#input_23_19_1\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('change', '#input_23_19_2', function () {\n        jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_19_2\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('change', '#input_23_19_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_19_3\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('change', '#input_23_19_4', function () {\n        jQuery(\"#input_23_3_4\").val(jQuery(\"#input_23_19_4\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('change', '#input_23_19_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_19_5\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('keyup', '#input_23_17_1', function () {\n        jQuery(\"#input_23_3_1\").val(jQuery(\"#input_23_17_1\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_17_2', function () {\n        jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_17_2\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_17_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_17_3\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('change', '#input_23_17_4', function () {\n        jQuery(\"#input_23_3_4\").val(jQuery(\"#input_23_17_4\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_17_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_17_5\").val());\n        changeselectedcountry(\"United States\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_18_1', function () {\n        jQuery(\"#input_23_3_1\").val(jQuery(\"#input_23_18_1\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_18_2', function () {\n        jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_18_2\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_18_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_18_3\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('change', '#input_23_18_4', function () {\n        jQuery(\"#input_23_3_4\").val(jQuery(\"#input_23_18_4\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_18_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_18_5\").val());\n        changeselectedcountry(\"Canada\");\n    });\n\n    jQuery(document).on('keyup', '#input_23_19_1', function () {\n        jQuery(\"#input_23_3_1\").val(jQuery(\"#input_23_19_1\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('keyup', '#input_23_19_2', function () {\n        jQuery(\"#input_23_3_2\").val(jQuery(\"#input_23_19_2\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('keyup', '#input_23_19_3', function () {\n        jQuery(\"#input_23_3_3\").val(jQuery(\"#input_23_19_3\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('keyup', '#input_23_19_4', function () {\n        jQuery(\"#input_23_3_4\").val(jQuery(\"#input_23_19_4\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('keyup', '#input_23_19_5', function () {\n        jQuery(\"#input_23_3_5\").val(jQuery(\"#input_23_19_5\").val());\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n    });\n\n    jQuery(document).on('change', '#input_23_19_6', function () {\n        changeselectedcountry(jQuery(\"#input_23_19_6\").val());\n\n        var country = jQuery(\"#input_23_3_6\").val();\n\n        if (country == \"United States\") {\n            jQuery(\"#appeal_find_dist_rep\").show();\n\n            var errorExists = $(\"#ErrorSearchAppeal\").html();\n\n            if (errorExists != \"\") {\n                jQuery(\"#field_23_21\").show();\n            }\n\n            jQuery(\"#field_23_22\").show();\n        }\n        else {\n            jQuery(\"#appeal_find_dist_rep\").hide();\n\n            jQuery(\"#field_23_21\").hide();\n\n            jQuery(\"#field_23_22\").hide();\n        }\n    });\n\n    function clickCountry() {\n        if (jQuery(\"#choice_23_16_0\").is(\":checked\")) {\n            jQuery(\"#choice_23_16_0\").click();\n        }\n\n        if (jQuery(\"#choice_23_16_1\").is(\":checked\")) {\n            jQuery(\"#choice_23_16_1\").click();\n        }\n\n        if (jQuery(\"#choice_23_16_2\").is(\":checked\")) {\n            jQuery(\"#choice_23_16_2\").click();\n        }\n    }\n\n    function setaddressappealfields() {\n        clickCountry();\n\n        if (jQuery(\"#validation_message_23_3\").length > 0) {\n\n            var ErrorHtml = jQuery(\"#validation_message_23_3\").html();\n\n            jQuery(\"#validation_message_23_3_1\").html(ErrorHtml);\n\n            jQuery(\"#validation_message_23_3_1\").show();\n        }\n    }\n\n    jQuery(document).on('mouseover', '#appeal_find_dist_rep', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_1', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_2', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_3', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_4', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_5', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('mouseover', '#input_23_3_6', function () {\n        setaddressappealfields();\n    });\n\n    jQuery(document).on('click', '#choice_23_23_0', function () {\n        var Element = $(\"#field_23_1\");\n\n        Element = Element.children().eq(0);\n\n        if ($(\"#appealenglish\").css(\"display\") == \"none\") {\n            Element.html(\"Nazwa Organizacji \/ Stanowisko<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n        }\n\n        if ($(\"#appealpolish\").css(\"display\") == \"none\") {\n            Element.html(\"Organization Name \/ Position<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n        }\n    });\n\n    jQuery(document).on('click', '#choice_23_23_1', function () {\n        var Element = $(\"#field_23_1\");\n\n        Element = Element.children().eq(0);\n\n        if ($(\"#appealenglish\").css(\"display\") == \"none\") {\n            Element.html(\"Stanowisko lub Zaw\u00f3d<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n        }\n\n        if ($(\"#appealpolish\").css(\"display\") == \"none\") {\n            Element.html(\"Person's Position or Profession<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n        }\n    });\n\n    jQuery(window).load(function () {\n        jQuery(\"#field_23_3\").hide();\n\n        var noclick = jQuery(\"#input_23_25\").val();\n\n        if (noclick == 0) {\n            jQuery(\"#choice_23_16_0\").click();\n\n            jQuery(\"#choice_23_23_0\").click();\n\n            jQuery(\"#choice_23_6_0\").click();\n\n            jQuery(\"#input_23_25\").val(1);\n        }\n        else {\n            setaddressappealfields();\n\n            red_validation();\n\n            setvalidationerrors();\n        }\n\n        setappealenglishpolish();\n\n        changeOrientation();\n    });\n\n    function setappealenglishpolish() {\n        var labelelement = $(\"#field_23_2\");\n\n        labelelement = labelelement.children().eq(\"0\");\n\n        setlabelnamestar(labelelement, \"Name\", \"Imi\u0119 i Nazwisko\");\n\n        labelelement = $(\"#field_23_23\");\n\n        labelelement = labelelement.children().eq(\"0\");\n\n        setlabelname(labelelement, \"Are you signing the Declaration of Support  on behalf of your organization?\", \"Czy podpisuje Pan\/Pani Deklaracj\u0119 Poparcia z ramienia organizacji?\");\n\n        labelelement = $(\"#field_23_16\");\n\n        labelelement = labelelement.children().eq(\"0\");\n\n        setlabelname(labelelement, \"Choose Address Type\", \"Wybierz Rodzaj Adresu\");\n\n        labelelement = $(\"#field_23_17\");\n\n        labelelement = labelelement.children().eq(\"1\");\n\n        setlabelnamestar(labelelement, \"Address\", \"Adres\");\n\n        labelelement = $(\"#field_23_18\");\n\n        labelelement = labelelement.children().eq(\"1\");\n\n        setlabelnamestar(labelelement, \"Address\", \"Adres\");\n\n        labelelement = $(\"#field_23_19\");\n\n        labelelement = labelelement.children().eq(\"1\");\n\n        setlabelnamestar(labelelement, \"Address\", \"Adres\");\n\n        labelelement = $(\"#field_23_5\");\n\n        labelelement = labelelement.children().eq(\"0\");\n\n        setlabelnamestar(labelelement, \"Phone\", \"Telefon\");\n\n        labelelement = $(\"#field_23_6\");\n\n        labelelement = labelelement.children().eq(\"0\");\n\n        setlabelname(labelelement, \"I WANT TO BE INFORMED ABOUT SIMILAR POLISH AMERICAN INITIATIVES IN THE FUTURE\", \"W PRZYSZ\u0141O\u015aCI CHC\u0118 BY\u0106 INFORMOWANY O PODOBNYCH POLSKO-AMERYKA\u0143SKICH INICJATYWACH\");\n\n        labelelement = $(\"#field_23_8\");\n\n        labelelement = labelelement.children().eq(\"1\");\n\n        setlabelname(labelelement, \"Congressional District Number\", \"Numer Kongresowego Dystryktu\");\n\n        labelelement = $(\"#field_23_9\");\n\n        labelelement = labelelement.children().eq(\"1\");\n\n        setlabelname(labelelement, \"Congressman\", \"Kongresmen\");\n\n        $(\"div[data-name='appealgravity']\").show();\n    }\n\n    jQuery(document).on('click', '.switchenglish', function () {\n        $(\"#label_23_23_0\").html(\"Yes\");\n        $(\"#label_23_23_1\").html(\"No\");\n\n        $(\"#appeal_find_dist_rep\").val(\"Find District and Representatives\");\n\n        $(\"#gform_submit_button_23\").val(\"Sign\");\n\n        var Element = $(\"#field_23_1\");\n\n        Element = Element.children().eq(0);\n\n        var elementtext = Element.html();\n\n        if (elementtext != undefined) {\n            if (elementtext.indexOf(\"Stanowisko lub Zaw\u00f3d\") != -1) {\n                Element.html(\"Person's Position or Profession<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n            }\n\n            if (elementtext.indexOf(\"Nazwa Organizacji \/ Stanowisko\") != -1) {\n                Element.html(\"Organization Name \/ Position<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n            }\n        }\n\n        $(\"#label_23_6_0\").html(\"Yes\");\n        $(\"#label_23_6_1\").html(\"No\");\n\n        $(\"#input_23_27\").val(\"Confirmation of new signature\");\n        $(\"#input_23_28\").val(\"Hello\");\n        $(\"#input_23_29\").val(\"Thank you for signing the Declaration of Support. If you sign it on behalf of your organization than your organization's name will be listed on our letter to Congress to support the 117th US Congress Social Security Fairness Act of 2021 (H.R. 82 &amp; S. 1302).\");\n        $(\"#input_23_30\").val(\"Toll-Free\");\n    });\n\n    jQuery(document).on('click', '.switchpolish', function () {\n        $(\"#label_23_23_0\").html(\"Tak\");\n        $(\"#label_23_23_1\").html(\"Nie\");\n\n        $(\"#appeal_find_dist_rep\").val(\"Znajd\u017a Okr\u0119g Wyborczy i Reprezentant\u00f3w\");\n\n        $(\"#gform_submit_button_23\").val(\"Podpisz\");\n\n        var Element = $(\"#field_23_1\");\n\n        Element = Element.children().eq(0);\n\n        var elementtext = Element.html();\n\n        if (elementtext != undefined) {\n            if (elementtext.indexOf(\"Person's Position or Profession\") != -1) {\n                Element.html(\"Stanowisko lub Zaw\u00f3d<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n            }\n\n            if (elementtext.indexOf(\"Organization Name \/ Position\") != -1) {\n                Element.html(\"Nazwa Organizacji \/ Stanowisko<span class='gfield_required'><span class='gfield_required gfield_required_asterisk'>*<\/span><\/span>\");\n            }\n        }\n\n        $(\"#label_23_6_0\").html(\"Tak\");\n        $(\"#label_23_6_1\").html(\"Nie\");\n\n        $(\"#input_23_27\").val(\"Potwierdzenie z\u0142o\u017conego podpisu\");\n        $(\"#input_23_28\").val(\"Szanowny\/a Panie\/Pani\");\n        $(\"#input_23_29\").val(\"Dzi\u0119kujemy za podpisanie Deklaracji Poparcia. Je\u015bli podpisa\u0142(a) Pan\/Pani w imieniu swojej organizacji wtedy nazwa Pana\/Pani organizacji b\u0119dzie wymieniona w li\u015bcie do Kongresu wspieraj\u0105cym 117-ty Kongres w sprawie Social Security Fairness Act of 2021 (H.R. 82 &amp; S. 1302)\");\n        $(\"#input_23_30\").val(\"Bezp\u0142atny\");\n    });\n\n    function changeOrientation() {\n\n        var is_mobile = isMobile.status;\n\n        if (is_mobile) {\n            \/\/var width = $(window).width();\n            \/\/var height = $(window).height();\n\n            \/\/if (width < 400 && height < 750) {\n            if (window.orientation === 90 || window.orientation === -90) {\n                \/\/$(\"#input_23_1\").removeClass(\"large\");\n                \/\/$(\"#input_23_1\").addClass(\"medium\");\n                $(\"#input_23_4\").removeClass(\"large\");\n                $(\"#input_23_4\").addClass(\"medium\");\n                $(\"#input_23_9\").removeClass(\"large\");\n                $(\"#input_23_9\").addClass(\"medium\");\n                $(\"#input_23_10\").removeClass(\"large\");\n                $(\"#input_23_10\").addClass(\"medium\");\n                $(\"#input_23_11\").removeClass(\"large\");\n                $(\"#input_23_11\").addClass(\"medium\");\n            }\n            else {\n                \/\/$(\"#input_23_1\").removeClass(\"medium\");\n                \/\/$(\"#input_23_1\").addClass(\"large\");\n                $(\"#input_23_4\").removeClass(\"medium\");\n                $(\"#input_23_4\").addClass(\"large\");\n                $(\"#input_23_9\").removeClass(\"medium\");\n                $(\"#input_23_9\").addClass(\"large\");\n                $(\"#input_23_10\").removeClass(\"medium\");\n                $(\"#input_23_10\").addClass(\"large\");\n                $(\"#input_23_11\").removeClass(\"medium\");\n                $(\"#input_23_11\").addClass(\"large\");\n            }\n        }\n    }\n\n    function red_validation() {\n        check_remove_error_classes(\"gform_23_validation_container\");\n    }\n\n    \/\/function doaftervalidate() {\n\n    \/\/    if (jQuery(\"div.validation_message\").length > 0) {\n\n    \/\/        changeOrientation();\n\n    \/\/        setaddressappealfields();\n\n    \/\/        red_validation();\n\n    \/\/        setappealenglishpolish();\n\n    \/\/        setvalidationerrors();\n    \/\/    }\n\n    \/\/    if ($(\"#appealenglish\").css(\"display\") == \"none\") {\n    \/\/        $(\".switchpolish\").click();\n    \/\/    }\n    \/\/    else if ($(\"#appealpolish\").css(\"display\") == \"none\") {\n    \/\/        $(\".switchenglish\").click();\n    \/\/    }\n    \/\/}\n\n    \/\/function doaftervalidatefirst() {\n    \/\/    doaftervalidate();\n\n    \/\/    clearInterval(waitforerrorfirst);\n    \/\/}\n\n    \/\/function doaftervalidatesecond() {\n    \/\/    doaftervalidate();\n\n    \/\/    clearInterval(waitforerrorsecond);\n    \/\/}\n\n    jQuery(document).on('click', '#gform_submit_button_23', function () {\n        validation_messages_remove();\n\n    \/\/    waitforerrorfirst = setInterval(doaftervalidatefirst, 3000);\n    \/\/    waitforerrorsecond = setInterval(doaftervalidatesecond, 5000);\n    });\n\n    jQuery(document).on('mouseover', '#gform_submit_button_23', function () {\n\n        var phone = jQuery(\"#input_23_5\").val();\n\n        phone = phone.trim();\n\n        if (phone != \"\") {\n\n            var linkphone = phone.replace(\"(\", \"\");\n\n            linkphone = linkphone.replace(\")\", \"-\");\n\n            linkphone = linkphone.replace(\" \", \"\");\n\n            jQuery(\"#input_23_26\").val(linkphone);\n        }\n        else {\n            jQuery(\"#input_23_26\").val(\"\");\n        }\n    });\n\n    function changelanguage() {\n        if ($(\"#appealenglish\").css(\"display\") == \"none\") {\n            $(\".switchpolish\").click();\n        }\n        else if ($(\"#appealpolish\").css(\"display\") == \"none\") {\n            $(\".switchenglish\").click();\n        }\n    }\n\n    gform.initializeOnLoaded(function () {\n        $('#gform_ajax_frame_23').on('load', function () {\n            var contents = $(this).contents().find('*').html();\n            var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;\n            if (!is_postback) {\n                return;\n            }\n            var form_content = $(this).contents().find('#gform_wrapper_23');\n            var is_confirmation = $(this).contents().find('#gform_confirmation_wrapper_23').length > 0;\n            var is_redirect = contents.indexOf('gformRedirect(){') >= 0;\n            var is_form = form_content.length > 0 && !is_redirect && !is_confirmation;\n            if (is_form) {\n                clear_errors();\n\n                waitfor_clear_errors_after = setInterval(clear_errors_after, 500);\n                waitfor_clear_errors_after_while = setInterval(clear_errors_after_while, 2000);\n            }\n            else {\n                waitfor_set_proper_language_after = setInterval(set_proper_language_after, 200);\n                waitfor_set_proper_language_after_while = setInterval(set_proper_language_after_while, 500);\n            }\n        });\n    });\n\n    function set_proper_language_after() {\n        changelanguage();\n\n        clearInterval(waitfor_set_proper_language_after);\n    }\n\n    function set_proper_language_after_while() {\n        changelanguage();\n\n        clearInterval(waitfor_set_proper_language_after_while);\n    }\n\n    function clear_errors_after_while() {\n        clear_errors();\n\n        clearInterval(waitfor_clear_errors_after_while);\n    }\n\n    function clear_errors_after() {\n        clear_errors();\n\n        clearInterval(waitfor_clear_errors_after);\n    }\n\n    function clear_errors() {\n        changeOrientation();\n\n        setaddressappealfields();\n\n        red_validation();\n\n        setappealenglishpolish();\n\n        setvalidationerrors();\n\n        changelanguage();\n    }\n<\/script>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>DECLARATION OF SUPPORT DEKLARACJA POPARCIA I SUPPORT THE 117th US CONGRESSSOCIAL SECURITY FAIRNESS ACT OF 2021 &#8211; H.R. 82 &amp; S. 1302 POPIERAM USTAW\u0118 O UCZCIWO\u015aCI ZABEZPIECZENIA SPO\u0141ECZNEGO Z 2021 R. &#8211; H.R. 82 &amp; S. 1302 po polsku english &quot;*&quot; indicates required fields Name* FirstImi\u0119 LastNazwisko Are you signing the Declaration of Support on &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/joinpasidev.org\/index.php\/appeal\/\"> <span class=\"screen-reader-text\">Appeal<\/span> Read More 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