{"id":11812,"date":"2020-08-04T13:37:59","date_gmt":"2020-08-04T17:37:59","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/care\/?page_id=11812"},"modified":"2025-06-25T15:34:35","modified_gmt":"2025-06-25T19:34:35","slug":"2020-rams-program-faculty-mentor-application","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/care\/2020-rams-program-faculty-mentor-application\/","title":{"rendered":"RAMS Program Faculty Mentor Application"},"content":{"rendered":"<p><b>Application materials will be accepted until September 5, 2025. After you submit your application, you will automatically receive a confirmation email. <em><span style=\"color: #ff0000;\">If you do not receive a confirmation email, that means your application was NOT submitted and we did not receive it.<\/span> <\/em>Please ensure all required fields are filled out and resubmit your application.<\/b><\/p>\n<p><strong><span style=\"color: #ff0000;\">If Scholar applicants are unable to locate a suitable mentor to apply with at their institution, please contact<\/span>\u00a0<span style=\"color: #0000ff;\"><a href=\"mailto:jules.canfield@bmc.org\" style=\"color: #0000ff;\">jules.canfield@bmc.org<\/a>\u00a0<\/span><span style=\"color: #ff0000;\">and the RAMS program team would be happy to explore potential mentoring options.\u00a0<\/span><\/strong><\/p>\n<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 gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_84' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">2025 RAMS Program: Faculty Mentor Applications<\/h3>\n                            <p class='gform_description'>Thank you for submitting all the required application material.<PALIGN=Left> <\/i><br>\r\n<br><b>Faculty Mentor Applicants must<\/b>:<p>\r\n\r\n(1) Be a Program Director, or core fellowship or addiction program faculty;<p>\r\n(2) Have strong research experience;<p>\r\n(3) Possess research and mentor skills that would benefit Scholars through the implementation of their research project (developed throughout the RAMS Program);<p>\r\n(4) Be able to dedicate time throughout the 2-year RAMS Program period to participate in program activities as needed (e.g. your Scholar's Research-in-Progress webinar);<p>\r\n(5) Attend the 1st Fall Retreat (this year's retreat takes place in Boston from December 1 - 5, 2025; institutional mentors are required to attend the first full day of this retreat, which is December 2nd). <p><br><P\/ALIGN=center>\r\n\r\n <b>Application materials will be accepted until September 5, 2025<\/b>.<br><br><PALIGN=left> \r\n\r\n<p><i>Please note: The RAMS Program is funded by a grant from the National Institute on Drug Abuse (NIDA).  You will be asked to complete several surveys, which we will send to you. Your survey will not be available to program applicant reviewers and will not influence whether or not you are accepted<\/i>.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_84'  action='\/care\/wp-json\/wp\/v2\/pages\/11812' data-formid='84' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_84' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_84_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><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_84_1'>\n                            \n                            <span id='input_84_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_84_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_84_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_84_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_84_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_84_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_84_2\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_2\"><label class='gfield_label gform-field-label' for='input_84_2' >Preferred First Name\/Nickname (as you would like it on your badge should you get accepted to the program)<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_84_2' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_3\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_3\"><label class='gfield_label gform-field-label' for='input_84_3' >Name of Scholar you are applying with<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_84_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_4\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_4\"><h2 class=\"gsection_title\">Fellowship Program Information<\/h2><\/li><li id=\"field_84_5\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_5\"><label class='gfield_label gform-field-label' for='input_84_5' >Institution Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_84_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_6\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_6\"><label class='gfield_label gform-field-label' for='input_84_6' >Department\/Section<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_84_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_26\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_26\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Please indicate the fellowship program type.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_84_26'><li class='gchoice gchoice_84_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Addiction Medicine'  id='choice_84_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_1' id='label_84_26_1' class='gform-field-label gform-field-label--type-inline'>Addiction Medicine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_84_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Addiction Psychiatry'  id='choice_84_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_2' id='label_84_26_2' class='gform-field-label gform-field-label--type-inline'>Addiction Psychiatry<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_84_17\"  class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_17\"><label class='gfield_label gform-field-label' for='input_84_17' >Fellowship program medical school affiliation<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_84_17' type='text' value='' class='medium'  aria-describedby=\"gfield_description_84_17\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_84_17'>Write N\/A if there is none.<\/div><\/li><li id=\"field_84_7\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_7\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Fellowship Program Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \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_84_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_84_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_84_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_84_7_1' id='input_84_7_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_84_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_84_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_84_7_2' id='input_84_7_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_84_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_84_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_84_7_3' id='input_84_7_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_84_7_4_container' >\n                                        <input type='text' name='input_7.4' id='input_84_7_4' value=''      aria-required='true'    \/>\n                                        <label for='input_84_7_4' id='input_84_7_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_84_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_84_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_84_7_5' id='input_84_7_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_84_7_6_container' >\n                                        <select name='input_7.6' id='input_84_7_6'   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_84_7_6' id='input_84_7_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><\/li><li id=\"field_84_8\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_8\"><label class='gfield_label gform-field-label' for='input_84_8' >Preferred 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_8' id='input_84_8' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_84_9\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_9\"><label class='gfield_label gform-field-label' for='input_84_9' >Preferred Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_84_9' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_84_10\"  class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_10\"><label class='gfield_label gform-field-label' for='input_84_10' >Mobile Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_84_10' type='text' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_84_11\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_11\"><h2 class=\"gsection_title\">Mailing Address<\/h2><\/li><li id=\"field_84_13\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_13\"><label class='gfield_label gform-field-label'  >Same as above?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_84_13'>\n\t\t\t<li class='gchoice gchoice_84_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Yes'  id='choice_84_13_0'    \/>\n\t\t\t\t<label for='choice_84_13_0' id='label_84_13_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='No'  id='choice_84_13_1'    \/>\n\t\t\t\t<label for='choice_84_13_1' id='label_84_13_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_84_12\"  class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_12\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Mailing Address<\/label>    \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_84_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_84_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_84_12_1' value=''    aria-required='false'    \/>\n                                        <label for='input_84_12_1' id='input_84_12_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_84_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_84_12_2' value=''     aria-required='false'   \/>\n                                        <label for='input_84_12_2' id='input_84_12_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_84_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_84_12_3' value=''    aria-required='false'    \/>\n                                    <label for='input_84_12_3' id='input_84_12_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_84_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_84_12_4' value=''      aria-required='false'    \/>\n                                        <label for='input_84_12_4' id='input_84_12_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_84_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_84_12_5' value=''    aria-required='false'    \/>\n                                    <label for='input_84_12_5' id='input_84_12_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_84_12_6_container' >\n                                        <select name='input_12.6' id='input_84_12_6'   aria-required='false'    ><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_84_12_6' id='input_84_12_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><\/li><li id=\"field_84_14\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_14\"><h2 class=\"gsection_title\">Other Information<\/h2><\/li><li id=\"field_84_15\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_15\"><label class='gfield_label gform-field-label' for='input_84_15' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_84_15' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select One' >Select One<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Prefer to self-describe' >Prefer to self-describe<\/option><\/select><\/div><\/li><li id=\"field_84_31\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_31\"><label class='gfield_label gform-field-label' for='input_84_31' >If you selected &quot;Prefer to self-describe&quot;, please specify:<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_84_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_32\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_32\"><label class='gfield_label gform-field-label'  >Shirt Size<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_84_32'>\n\t\t\t<li class='gchoice gchoice_84_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Women&#039;s Small'  id='choice_84_32_0'    \/>\n\t\t\t\t<label for='choice_84_32_0' id='label_84_32_0' class='gform-field-label gform-field-label--type-inline'>Women's Small<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='Women&#039;s Medium'  id='choice_84_32_1'    \/>\n\t\t\t\t<label for='choice_84_32_1' id='label_84_32_1' class='gform-field-label gform-field-label--type-inline'>Women's Medium<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='Women&#039;s Large'  id='choice_84_32_2'    \/>\n\t\t\t\t<label for='choice_84_32_2' id='label_84_32_2' class='gform-field-label gform-field-label--type-inline'>Women's Large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='Women&#039;s X-Large'  id='choice_84_32_3'    \/>\n\t\t\t\t<label for='choice_84_32_3' id='label_84_32_3' class='gform-field-label gform-field-label--type-inline'>Women's X-Large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_4'>\n\t\t\t\t<input name='input_32' type='radio' value='Women&#039;s XX-Large'  id='choice_84_32_4'    \/>\n\t\t\t\t<label for='choice_84_32_4' id='label_84_32_4' class='gform-field-label gform-field-label--type-inline'>Women's XX-Large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_5'>\n\t\t\t\t<input name='input_32' type='radio' value='Men&#039;s Small'  id='choice_84_32_5'    \/>\n\t\t\t\t<label for='choice_84_32_5' id='label_84_32_5' class='gform-field-label gform-field-label--type-inline'>Men's Small<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_6'>\n\t\t\t\t<input name='input_32' type='radio' value='Men&#039;s Medium'  id='choice_84_32_6'    \/>\n\t\t\t\t<label for='choice_84_32_6' id='label_84_32_6' class='gform-field-label gform-field-label--type-inline'>Men's Medium<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_7'>\n\t\t\t\t<input name='input_32' type='radio' value='Men&#039;s Large'  id='choice_84_32_7'    \/>\n\t\t\t\t<label for='choice_84_32_7' id='label_84_32_7' class='gform-field-label gform-field-label--type-inline'>Men's Large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_8'>\n\t\t\t\t<input name='input_32' type='radio' value='Men&#039;s X-Large'  id='choice_84_32_8'    \/>\n\t\t\t\t<label for='choice_84_32_8' id='label_84_32_8' class='gform-field-label gform-field-label--type-inline'>Men's X-Large<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_84_32_9'>\n\t\t\t\t<input name='input_32' type='radio' value='Men&#039;s XX-Large'  id='choice_84_32_9'    \/>\n\t\t\t\t<label for='choice_84_32_9' id='label_84_32_9' class='gform-field-label gform-field-label--type-inline'>Men's XX-Large<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_84_16\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_16\"><label class='gfield_label gform-field-label' for='input_84_16' >Race\/ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_84_16' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_18\"><label class='gfield_label gform-field-label' for='input_84_18' >Present faculty 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_18' id='input_84_18' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_24\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_24\"><label class='gfield_label gform-field-label' for='input_84_24' >Number of years as faculty at your institution (enter a number in the space below).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_84_24' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_29\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_29\"><label class='gfield_label gform-field-label' for='input_84_29' >Degree(s) (e.g., MD, MPH)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_84_29' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_19\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_19\"><label class='gfield_label gform-field-label' for='input_84_19' >What is your medical specialty (subspecialty, if applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_84_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_23\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_23\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >How did you hear about the RAMS Program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_84_23'><li class='gchoice gchoice_84_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Faculty at my institution'  id='choice_84_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_23_1' id='label_84_23_1' class='gform-field-label gform-field-label--type-inline'>Faculty at my institution<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_84_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Brochure or postcard advertising the Program'  id='choice_84_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_23_2' id='label_84_23_2' class='gform-field-label gform-field-label--type-inline'>Brochure or postcard advertising the Program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_84_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Email from Program'  id='choice_84_23_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_23_3' id='label_84_23_3' class='gform-field-label gform-field-label--type-inline'>Email from Program<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_84_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Internet search'  id='choice_84_23_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_23_4' id='label_84_23_4' class='gform-field-label gform-field-label--type-inline'>Internet search<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_84_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.5' type='checkbox'  value='Other (please respond below)'  id='choice_84_23_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_23_5' id='label_84_23_5' class='gform-field-label gform-field-label--type-inline'>Other (please respond below)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_84_30\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_30\"><label class='gfield_label gform-field-label' for='input_84_30' >Please clarify &quot;other&quot;<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_84_30' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_84_25\"  class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_25\"><label class='gfield_label gform-field-label' for='input_84_25' >Please provide a ~250-300 word statement reflecting on your role as a research mentor to date (e.g. challenges you\u2019ve addressed or overcome, how you best help &amp; support mentees).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_25' id='input_84_25' type='file' class='medium' aria-describedby=\"gfield_upload_rules_84_25\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_84_25'>Accepted file types: pdf, doc, jpg, Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_84_25'><\/div><\/div><\/li><li id=\"field_84_22\"  class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_22\"><label class='gfield_label gform-field-label' for='input_84_22' >Please upload your CV or biosketch in pdf format.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_22' id='input_84_22' type='file' class='medium' aria-describedby=\"gfield_upload_rules_84_22\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_84_22'>Accepted file types: doc, pdf, jpg, Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_84_22'><\/div><\/div><\/li><li id=\"field_84_33\"  class=\"gfield gfield--type-section gsection bu_google_recaptcha_section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_84_33\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_84_34\"  class=\"gfield gfield--type-html bu_google_recaptcha 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_84_34\"><div class=\"g-recaptcha\" data-sitekey=\"6LeGxkEjAAAAAK4nzHZn3a_6jB2ELSN935WrVBfC\"><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_84' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_84\"]){return false;}  window[\"gf_submitting_84\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_84\"]){return false;} window[\"gf_submitting_84\"]=true;  jQuery(\"#gform_84\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_84' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='84' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_84' value='WyJbXSIsImQ5Y2U2OGUxNzE1OTZlYjZkN2E4MzI4YmJhNDVlODY3Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_84' id='gform_target_page_number_84' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_84' id='gform_source_page_number_84' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 84, 'https:\/\/www.bumc.bu.edu\/care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_84').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_84');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_84').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_84').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_84').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_84').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_84').val();gformInitSpinner( 84, 'https:\/\/www.bumc.bu.edu\/care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [84, current_page]);window['gf_submitting_84'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_84').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [84]);window['gf_submitting_84'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_84').text());}, 50);}else{jQuery('#gform_84').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [84, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 84, currentPage: current_page } });} );} );\n<\/script>\n\n<p style=\"text-align: center;\"><b><strong><em>If you have any questions regarding your application, please contact:<\/em><\/strong><\/b><\/p>\n<p style=\"text-align: center;\"><a href=\"mailto:jules.canfield@bmc.org\">Jules Canfield, MPH<\/a> | Senior Program Manager | 801 Massachusetts Ave, 2nd floor Boston, MA 02118 | <span class=\"baec5a81-e4d6-4674-97f3-e9220f0136c1\">617.414.6905<\/span>\u00a0(P) | <span class=\"baec5a81-e4d6-4674-97f3-e9220f0136c1\">617.414.4676<a title=\"Call: 617.414.4676\" href=\"https:\/\/www.bumc.bu.edu\/care\/wp-admin\/post.php?post=4663&amp;action=edit&amp;message=1#\"><\/a><\/span> (F)<\/p>\n<p style=\"text-align: center;\"><i>Please Note: The RAMS Program is funded by a grant from the National Institute on Drug Abuse (NIDA). <\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Application materials will be accepted until September 5, 2025. After you submit your application, you will automatically receive a confirmation email. If you do not receive a confirmation email, that means your application was NOT submitted and we did not receive it. Please ensure all required fields are filled out and resubmit your application. If [&hellip;]<\/p>\n","protected":false},"author":15762,"featured_media":0,"parent":0,"menu_order":44,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/11812"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/users\/15762"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/comments?post=11812"}],"version-history":[{"count":12,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/11812\/revisions"}],"predecessor-version":[{"id":14679,"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/pages\/11812\/revisions\/14679"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/care\/wp-json\/wp\/v2\/media?parent=11812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}