{"id":1016,"date":"2024-04-23T00:05:32","date_gmt":"2024-04-23T00:05:32","guid":{"rendered":"https:\/\/9thmasonicdistga.org\/?page_id=1016"},"modified":"2024-10-29T22:49:37","modified_gmt":"2024-10-29T22:49:37","slug":"gwinnett-widows-fund-sign-up","status":"publish","type":"page","link":"https:\/\/9thmasonicdistga.org\/?page_id=1016","title":{"rendered":"Gwinnett Widows Fund Enrollment"},"content":{"rendered":"<style id=\"wpforms-css-vars-1022\">\n\t\t\t\t#wpforms-1022 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1022\"><form id=\"wpforms-form-1022\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1022\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1016\" data-token=\"38b3906c67b2ff91fd5e52da1cdd1d42\" data-token-time=\"1776431170\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1022-field_6-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"6\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_7-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_7\">Date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1022-field_7\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][7][date]\" aria-errormessage=\"wpforms-1022-field_7-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1022-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_8\">Certificate No. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1022-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-1022-field_8-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_9-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_9\">Name: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1022-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-1022-field_9-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1022-field_10-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_10\">Telephone: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1022-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][10]\" aria-label=\"Telephone:\" aria-errormessage=\"wpforms-1022-field_10-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_13-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1022-field_13\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][13][address1]\" aria-errormessage=\"wpforms-1022-field_13-error\" required><label for=\"wpforms-1022-field_13\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1022-field_13-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][13][address2]\" aria-errormessage=\"wpforms-1022-field_13-address2-error\" ><label for=\"wpforms-1022-field_13-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1022-field_13-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][13][city]\" aria-errormessage=\"wpforms-1022-field_13-city-error\" required><label for=\"wpforms-1022-field_13-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1022-field_13-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][13][state]\" aria-errormessage=\"wpforms-1022-field_13-state-error\" required><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\"  selected='selected'>Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1022-field_13-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1022-field_13-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][13][postal]\" aria-errormessage=\"wpforms-1022-field_13-postal-error\" required><label for=\"wpforms-1022-field_13-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_14\">Lodge#: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1022-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-1022-field_14-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_15-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_15\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1022-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1022-field_15-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1022-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1022-field_17\">Recipients: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1022-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-1022-field_17-error\" aria-describedby=\"wpforms-1022-field_17-description\" required><\/textarea><div id=\"wpforms-1022-field_17-description\" class=\"wpforms-field-description\">Put as many beneficiaries as you would like. Also explain if they should be paid sequentially (so #1 if alive, will get all. If not, then #2, and so on) or if they should be paid according to a percentage. Please enter all data to explain how you would want the benefit paid out.<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1022\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/pages\/1016\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1022\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" data-src=\"https:\/\/9thmasonicdistga.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner lazyload\" style=\"--smush-placeholder-width: 26px; --smush-placeholder-aspect-ratio: 26\/26;display: none;\" width=\"26\" height=\"26\" alt=\"Loading\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","neve_meta_reading_time":"","_themeisle_gutenberg_block_has_review":false,"footnotes":""},"class_list":["post-1016","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/pages\/1016","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1016"}],"version-history":[{"count":4,"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/pages\/1016\/revisions"}],"predecessor-version":[{"id":1073,"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=\/wp\/v2\/pages\/1016\/revisions\/1073"}],"wp:attachment":[{"href":"https:\/\/9thmasonicdistga.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1016"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}