{"id":2930,"date":"2025-10-29T08:02:56","date_gmt":"2025-10-29T12:02:56","guid":{"rendered":"https:\/\/lesroutesblanches.com\/west-self-guided-tours-form\/"},"modified":"2025-10-31T11:24:23","modified_gmt":"2025-10-31T15:24:23","slug":"self-guided-tours-form-west","status":"publish","type":"page","link":"https:\/\/lesroutesblanches.com\/en\/self-guided-tours-form-west\/","title":{"rendered":"Self-Guided Tours Form West"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2930\" class=\"elementor elementor-2930 elementor-2833\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7de1cd9 e-flex e-con-boxed e-con e-parent\" data-id=\"7de1cd9\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2793dd3 elementor-widget elementor-widget-spacer\" data-id=\"2793dd3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9225b74 elementor-widget elementor-widget-heading\" data-id=\"9225b74\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Individual package purchase form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e557c1a e-con-full e-flex e-con e-child\" data-id=\"e557c1a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5c891f7 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class=\"gform_title\">Self-Guided Tours West<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/en\/wp-json\/wp\/v2\/pages\/2930#gf_10' data-formid='10' novalidate><div id=\"payments-sdk__contingency-lightbox\"><\/div>\n        <div id='gf_progressbar_wrapper_10' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'> - Package deal and acceptance of risks<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blues' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blues percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_10_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_above description_above validation_below' data-column-layout='fill'><div id=\"field_10_28\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_10_28' class='gfield_label gform-field-label' for='input_10_28'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='gfield_description' id='gfield_description_10_28'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_28' id='input_10_28' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_10_1\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_10_1 gfield_product_10_1 gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"31aea450\" data-field-span=\"12\"><label id='gfield_label_10_1' class='gfield_label gform-field-label gfield_label_before_complex' for='input_10_1_1'><span class='gform-field-label__text'>Self-guided tour package - 1 person<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_1'>Each person must purchase their own package and sign their documents individually.<\/div><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_1.1' value='Self-guided tour package - 1 person' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_10_1' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_10_1' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_1.2' id='ginput_base_price_10_1' value='$ 60.00 CAD' aria-label='Self-guided tour package - 1 person Price' aria-describedby=\"gfield_description_10_1\" \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_1.3' value='1' class='ginput_quantity_10_1 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_10_22\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"a5d56271\" data-field-span=\"12\"><label id='gfield_label_10_22' class='gfield_label gform-field-label' for='gform_browse_button_10_22'><span class='gform-field-label__text'>Download the SIGNED risk acceptance document<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_22'><a href=\"https:\/\/lesroutesblanches.com\/wp-content\/uploads\/2025\/10\/Routes-Blanches-Waiver-ENG-1.pdf\" target=\"_blank\">Link to the document<\/a><\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_10_22' 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style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/lesroutesblanches.com\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_10_21_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_10_21_resetbutton' 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style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_10_21_data' name='input_10_21_data' value=''><\/div><\/div><fieldset id=\"field_10_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"096b1303\" data-field-span=\"12\"><legend id='gfield_label_10_20' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I have read the rules.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_10_20'>I consent to this site storing my information in order to respond to my request.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_20'><div class='gchoice gchoice_10_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='I have read the risk acceptance document (link above).'  id='choice_10_20_1'   aria-describedby=\"gfield_description_10_20\" aria-labelledby=\"label_10_20_1 gfield_label_10_20\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_10_20_1' id='label_10_20_1' class='gform-field-label gform-field-label--type-inline'>I have read the risk acceptance document (link above).<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_10_10' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_above description_above validation_below' data-column-layout='fill'><fieldset id=\"field_10_7\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"2a2cb23e\" data-field-span=\"12\"><legend id='gfield_label_10_7' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_10_7'>\n                            \n                            <span id='input_10_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_10_7_3' id='input_10_7_3_label' class='gform-field-label gform-field-label--type-sub '>First name<\/label>\n                                                    <input type='text' name='input_7.3' id='input_10_7_3' value=''   aria-required='true'    autocomplete=\"given-name\" aria-labelledby=\"input_10_7_3_label gfield_label_10_7\"\/>\n                                                <\/span>\n                            \n                            <span id='input_10_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_10_7_6' id='input_10_7_6_label' class='gform-field-label gform-field-label--type-sub '>Last name<\/label>\n                                                            <input type='text' name='input_7.6' id='input_10_7_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"6884a6d5\" data-field-span=\"12\"><label id='gfield_label_10_9' class='gfield_label gform-field-label' for='input_10_9'><span class='gform-field-label__text'>E-mail<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_10_9' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_10_23\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"01e70478\" data-field-span=\"6\"><label id='gfield_label_10_23' class='gfield_label gform-field-label' for='input_10_23'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_10_23' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_10_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"01e70478\" data-field-span=\"6\"><label id='gfield_label_10_24' class='gfield_label gform-field-label' for='input_10_24'><span class='gform-field-label__text'>Age<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_10_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_25\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"4066ce5a\" data-field-span=\"12\"><legend id='gfield_label_10_25' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_10_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_25_1_container' >\n                                        <label for='input_10_25_1' id='input_10_25_1_label' class='gform-field-label gform-field-label--type-sub '>Mailing address<\/label>\n                                        <input type='text' name='input_25.1' id='input_10_25_1' value=''    aria-required='true'    aria-labelledby=\"input_10_25_1_label gfield_label_10_25\"\/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_25_3_container' >\n                                    <label for='input_10_25_3' id='input_10_25_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_25.3' id='input_10_25_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_25_4_container' >\n                                        <label for='input_10_25_4' id='input_10_25_4_label' class='gform-field-label gform-field-label--type-sub '>State\/Province\/Region<\/label>\n                                        <input type='text' name='input_25.4' id='input_10_25_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_25_5_container' >\n                                    <label for='input_10_25_5' id='input_10_25_5_label' class='gform-field-label gform-field-label--type-sub '>Zip code<\/label>\n                                    <input type='text' name='input_25.5' id='input_10_25_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_10_25_6_container' >\n                                        <label for='input_10_25_6' id='input_10_25_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_25.6' id='input_10_25_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_10_12' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_10_12' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_3' class='gform_page' data-js='page-field-id-12' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_3' class='gform_fields top_label form_sublabel_above description_above validation_below' data-column-layout='fill'><div id=\"field_10_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"ba756f9d\" data-field-span=\"12\"><label id='gfield_label_10_26' class='gfield_label gform-field-label' for='input_10_26'><span class='gform-field-label__text'>Promotion code<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_10_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_27\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_10_27 gfield_product_10_27 field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"2d4cec90\" data-field-span=\"12\"><label id='gfield_label_10_27' class='gfield_label gform-field-label gfield_label_before_complex' for='input_10_27_1'><span class='gform-field-label__text'>Total with promotion<\/span><\/label><div class='gfield_description' id='gfield_description_10_27'>FREE !<\/div><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_27.1' value='Total with promotion' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_10_27' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_10_27' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_27.2' id='ginput_base_price_10_27' value='$ 0.00 CAD' aria-label='Total with promotion Price' aria-describedby=\"gfield_description_10_27\" \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_27.3' value='1' class='ginput_quantity_10_27 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_10_3\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-half gfield_price gfield_price_10_ gfield_total gfield_total_10_ field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" aria-atomic=\"true\" aria-live=\"polite\" data-group-id=\"04984a61\" data-field-span=\"6\" data-currency-format='1'><label id='gfield_label_10_3' class='gfield_label gform-field-label' for='input_10_3'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_3' id='input_10_3' value='$ 0.00 CAD' class='gform-text-input-reset ginput_total ginput_total_10'  \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_10_18\" class=\"gfield gfield--type-paypal gfield--input-type-paypal gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gform_ppcp_custom_card_fields\" data-field-class=\"gform_ppcp_custom_card_fields\" data-group-id=\"04984a61\" data-field-span=\"6\"><legend class='gfield_label gfield_label_before_complex gform-field-label' for='input_10_18_1' ><label class='gfield_label gform-field-label'>Payment Method<span class='gfield_required'><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/legend><div class='ginput_container ginput_container_select gform_ppcp_payment_method' style=\"display:none;\"><select name='input_18.6' id='input_18_6' class='medium gfield_select' ><option value='PayPal Checkout' selected='selected'>PayPal Checkout<\/option><\/select><\/div><div class='ginput_complex ginput_container ginput_container_custom_card_fields gform-grid-row' id='input_10_18' style=\"display:none;\"><span class='ginput_full gform-grid-col' id='input_10_18_1_container' >\n                                    <div class='gform_card_icon_container gform_card_icon_style1'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_10_18_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <label for='input_10_18_1' id='input_10_18_1_label'  class='gform-field-label gform-field-label--type-sub'>Card Number<\/label>\n                                    <span id='input_10_18_1' class='ginput_card_field ginput_card_number gform-theme-field-control'><\/span>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_10_18_2_container'>\n                                            <span class='ginput_cardinfo_left gform-grid-col' id='input_10_18_2_cardinfo_left'>\n                                                <label for='input_10_18_2'  class='gform-field-label gform-field-label--type-sub'>Expiration Date<\/label>\n                                                <span id='input_10_18_2' class='ginput_card_field ginput_card_expiration gform-theme-field-control'><\/span>\n                                            <\/span><span class='ginput_cardinfo_right gform-grid-col' id='input_10_18_2_cardinfo_right'>\n                                                <label for='input_10_18_3'  class='gform-field-label gform-field-label--type-sub'>Security Code<\/label>\n                                                <span id='input_10_18_3' class='ginput_card_field ginput_card_security_code gform-theme-field-control'><\/span>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                             <\/span>\n                                        <\/span><span class='ginput_full gform-grid-col' id='input_10_18_5_container'>\n                                            <label for='input_10_18_5' id='input_10_18_5_label'  class='gform-field-label gform-field-label--type-sub'>Cardholder Name<\/label>\n                                            <input type='text' name='input_18.5' id='input_10_18_5' value=''  \/>\n                                        <\/span> <\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_10' class='gform_previous_button gform-theme-button gform-theme-button--secondary 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