{"id":214,"date":"2015-06-25T21:10:25","date_gmt":"2015-06-25T21:10:25","guid":{"rendered":"http:\/\/www.iths.org\/fact\/?page_id=214"},"modified":"2015-08-04T15:18:32","modified_gmt":"2015-08-04T22:18:32","slug":"submit","status":"publish","type":"page","link":"https:\/\/www.iths.org\/participate\/researchers\/submit\/","title":{"rendered":"Submit a Study"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;1\/1&#8243;][vc_column_text]<\/p>\n<h2>Submit a Study<\/h2>\n<p>[\/vc_column_text][vc_empty_space height=&#8221;32px&#8221; image_repeat=&#8221;no-repeat&#8221;][\/vc_column][\/vc_row][vc_row][vc_column width=&#8221;1\/1&#8243;]<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n<script type=\"text\/javascript\">\n        var gfafPrePopfield = function(formid, fromfield, tofield, inputid) {\n            if (!inputid) {\n                document.getElementById(\"input_\" + formid + \"_\" + tofield).value = document.getElementById(\"input_\" + formid + \"_\" + fromfield).value ? 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Please do not enter your internal short name for the project.<\/div><div class='ginput_container ginput_container_post_title'>\n\t\t\t\t\t<input name='input_20' id='input_1_20' type='text' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_20\" \/>\n\t\t\t\t<\/div><\/li><li id=\"field_1_64\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_64'>Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_1_64' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Western Washington' >Western Washington<\/option><option value='Eastern Washington' >Eastern Washington<\/option><option value='Idaho' >Idaho<\/option><option value='Wyoming' >Wyoming<\/option><option value='Montana' >Montana<\/option><option value='Alaska' >Alaska<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_1_65\" class=\"gfield gfield--type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_65'>Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_1_65' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='3M Oral Care' >3M Oral Care<\/option><option value='Alaska Family Medicine Residency' >Alaska Family Medicine Residency<\/option><option value='Alaska Native Medical Center' >Alaska Native Medical Center<\/option><option value='American Indian or Alaska Native-Affiliated Entity or Tribe' >American Indian or Alaska Native-Affiliated Entity or Tribe<\/option><option value='Benaroya Research Institute at Virginia Mason' >Benaroya Research Institute at Virginia Mason<\/option><option value='Billings Clinic' >Billings Clinic<\/option><option value='Bloodworks Northwest' >Bloodworks Northwest<\/option><option value='Boise State University' >Boise State University<\/option><option value='Boise VA Medical Center' >Boise VA Medical Center<\/option><option value='Centers for Disease Control and Prevention' >Centers for Disease Control and Prevention<\/option><option value='Chief Andrew Isaac Health Center' >Chief Andrew Isaac Health Center<\/option><option value='Clinical Practice' >Clinical Practice<\/option><option value='Columbia Basin Health Association' >Columbia Basin Health Association<\/option><option value='Columbia Medical Associates' >Columbia Medical Associates<\/option><option value='Community Health Associates of Spokane' >Community Health Associates of Spokane<\/option><option value='Community Health of Central Washington' >Community Health of Central Washington<\/option><option value='Critical Access Hospital Network' >Critical Access Hospital Network<\/option><option value='East Pierce Family Medicine' >East Pierce Family Medicine<\/option><option value='Family Medicine of Southwest Washington' >Family Medicine of Southwest Washington<\/option><option value='Family Medicine of Yakima' >Family Medicine of Yakima<\/option><option value='Family Medicine Residency of Idaho' >Family Medicine Residency of Idaho<\/option><option value='Family Medicine Spokane' >Family Medicine Spokane<\/option><option value='Fort Peck Health Promotion and Disease Prevention' >Fort Peck Health Promotion and Disease Prevention<\/option><option value='Fred Hutchinson Cancer Research Center' >Fred Hutchinson Cancer Research Center<\/option><option value='Kaiser Permanente Washington' >Kaiser Permanente Washington<\/option><option value='Kaiser Permanente Washington Health Research Institute' >Kaiser Permanente Washington Health Research Institute<\/option><option value='Idaho State University' >Idaho State University<\/option><option value='Institute of Translational Health Sciences' >Institute of Translational Health Sciences<\/option><option value='Kootenai Health System' >Kootenai Health System<\/option><option value='Latino Community Fund' >Latino Community Fund<\/option><option value='Little Bighorn College' >Little Bighorn College<\/option><option value='McLaughlin Research Institute' >McLaughlin Research Institute<\/option><option value='Montana BioScience Alliance' >Montana BioScience Alliance<\/option><option value='Montana Cancer Consortium' >Montana Cancer Consortium<\/option><option value='Montana State University' >Montana State University<\/option><option value='MultiCare Health System' >MultiCare Health System<\/option><option value='Northwest Association for Biomedical Research' >Northwest Association for Biomedical Research<\/option><option value='Other' >Other<\/option><option value='Pacific Northwest National Laboratory' >Pacific Northwest National Laboratory<\/option><option value='Pacific Northwest University of Health Sciences' >Pacific Northwest University of Health Sciences<\/option><option value='Pocatello Family Medicine' >Pocatello Family Medicine<\/option><option value='Providence - St. Peter Family Medicine' >Providence - St. Peter Family Medicine<\/option><option value='Providence Medical Research Center' >Providence Medical Research Center<\/option><option value='Puget Sound Family Medicine' >Puget Sound Family Medicine<\/option><option value='RiverStone Health' >RiverStone Health<\/option><option value='Rockwood Health System' >Rockwood Health System<\/option><option value='Rocky Mountain Laboratories' >Rocky Mountain Laboratories<\/option><option value='Saint Patrick Hospital' >Saint Patrick Hospital<\/option><option value='Salish Kootenai College' >Salish Kootenai College<\/option><option value='SeaMar' >SeaMar<\/option><option value='Seattle Cancer Care Alliance' >Seattle Cancer Care Alliance<\/option><option value='Seattle Children&#039; s Hospital' >Seattle Children&#039; s Hospital<\/option><option value='Seattle Indian Health Board' >Seattle Indian Health Board<\/option><option value='Seattle Pacific University' >Seattle Pacific University<\/option><option value='Southcentral Foundation' >Southcentral Foundation<\/option><option value='Spokane Regional Health District' >Spokane Regional Health District<\/option><option value='St. Luke&#039;s Health System' >St. Luke&#039;s Health System<\/option><option value='St. Peter&#039;s Medical Group' >St. Peter&#039;s Medical Group<\/option><option value='Swedish Family Medicine Residency - Cherry Hill' >Swedish Family Medicine Residency - Cherry Hill<\/option><option value='Swedish Family Medicine Residency - First Hill' >Swedish Family Medicine Residency - First Hill<\/option><option value='Tacoma Family Medicine' >Tacoma Family Medicine<\/option><option value='Tanana Chiefs Conference' >Tanana Chiefs Conference<\/option><option value='University of Alaska Anchorage' >University of Alaska Anchorage<\/option><option value='University of Alaska Fairbanks' >University of Alaska Fairbanks<\/option><option value='University of Idaho' >University of Idaho<\/option><option value='University of Montana' >University of Montana<\/option><option value='University of Washington' >University of Washington<\/option><option value='University of Washington Family Medicine - UWNC Northgate' >University of Washington Family Medicine - UWNC Northgate<\/option><option value='University of Wyoming' >University of Wyoming<\/option><option value='University of Wyoming Family Medicine - Casper' >University of Wyoming Family Medicine - Casper<\/option><option value='VA Puget Sound' >VA Puget Sound<\/option><option value='Valley Family Medicine' >Valley Family Medicine<\/option><option value='Washington State University' >Washington State University<\/option><option value='Wind River Tribal Health' >Wind River Tribal Health<\/option><option value='Yakima Valley Farm Workers Clinic' >Yakima Valley Farm Workers Clinic<\/option><\/select><\/div><\/li><li id=\"field_1_78\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"clear\"><\/div><\/li><li id=\"field_1_76\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_76'>Other Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_1_76' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_77\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_77'>Other Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_1_77' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_79\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"clear\"><\/div><\/li><li id=\"field_1_67\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_67'>IRB Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_67' id='input_1_67' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Approved' >Approved<\/option><option value='Exempt' >Exempt<\/option><\/select><\/div><\/li><li id=\"field_1_66\" class=\"gfield gfield--type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_66'>Approving IRB Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_1_66' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='UW' >UW<\/option><option value='SCH &amp; UW' >SCH &amp; UW<\/option><option value='SCH' >SCH<\/option><option value='FHCRC' >FHCRC<\/option><option value='Swedish' >Swedish<\/option><option value='BRI' >BRI<\/option><option value='WIRB' >WIRB<\/option><option value='Kaiser Permanente Washington' >Kaiser Permanente Washington<\/option><option value='Kaiser Permanente Washington Health Research Institute' >Kaiser Permanente Washington Health Research Institute<\/option><option value='CIRB-NCI' >CIRB-NCI<\/option><option value='Quorum' >Quorum<\/option><option value='VA' >VA<\/option><option value='WA State' >WA State<\/option><option value='Boise State' >Boise State<\/option><option value='Idaho State' >Idaho State<\/option><option value='Montana State' >Montana State<\/option><option value='Univ. of AK - Anchorage' >Univ. of AK - Anchorage<\/option><option value='Univ. of AK - Fairbanks' >Univ. of AK - Fairbanks<\/option><option value='Univ. of Idaho' >Univ. of Idaho<\/option><option value='Univ. of Montana' >Univ. of Montana<\/option><option value='Univ. of Wyoming' >Univ. of Wyoming<\/option><option value='WSU' >WSU<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_1_86\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_86'>Other approving IRB Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_1_86' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_80\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"clear\"><\/div><\/li><li id=\"field_1_83\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_83'>IRB Approval  # or Project ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_83'>This number will be referenced in all communications.<\/div><div class='ginput_container ginput_container_text'><input name='input_83' id='input_1_83' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_83\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_68\" class=\"gfield gfield--type-text gf_right_half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_68'>ClinicalTrials.gov Identifier<\/label><div class='gfield_description' id='gfield_description_1_68'>e.g. NCT01234567<br><br><\/div><div class='ginput_container ginput_container_text'><input name='input_68' id='input_1_68' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_68\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_81\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"clear\"><\/div><\/li><li id=\"field_1_22\" class=\"gfield gfield--type-post_custom_field gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>Study Start Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_22'>Enter the IRB approval date.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_22' id='input_1_22' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_22_date_format gfield_description_1_22\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_22_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_22' class='gform_hidden' value='https:\/\/www.iths.org\/participate\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_23\" class=\"gfield gfield--type-post_custom_field gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gf_right_half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Study End Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_23'>Enter the projected end of recruitment<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_23' id='input_1_23' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_23_date_format gfield_description_1_23\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_23_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_23' class='gform_hidden' value='https:\/\/www.iths.org\/participate\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_1_82\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"clear\"><\/div><\/li><li id=\"field_1_39\" class=\"gfield gfield--type-post_category gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Clinical Trial Category\/Categories<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_39'>Please select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_39'><li class='gchoice gchoice_1_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='2'  id='choice_1_39_1'   aria-describedby=\"gfield_description_1_39\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_1' id='label_1_39_1' class='gform-field-label gform-field-label--type-inline'>*Healthy Volunteer Studies<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='14'  id='choice_1_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_2' id='label_1_39_2' class='gform-field-label gform-field-label--type-inline'>Allergies &amp; Immune System<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='3'  id='choice_1_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_3' id='label_1_39_3' class='gform-field-label gform-field-label--type-inline'>Blood-Lymphatic System<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.4' type='checkbox'  value='4'  id='choice_1_39_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_4' id='label_1_39_4' class='gform-field-label gform-field-label--type-inline'>Bones, Joints &amp; Muscles<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.5' type='checkbox'  value='5'  id='choice_1_39_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_5' id='label_1_39_5' class='gform-field-label gform-field-label--type-inline'>Brain &amp; Nervous System<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.6' type='checkbox'  value='6'  id='choice_1_39_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_6' id='label_1_39_6' class='gform-field-label gform-field-label--type-inline'>Cancer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.7' type='checkbox'  value='7'  id='choice_1_39_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_7' id='label_1_39_7' class='gform-field-label gform-field-label--type-inline'>Cardiovascular<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.8' type='checkbox'  value='8'  id='choice_1_39_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_8' id='label_1_39_8' class='gform-field-label gform-field-label--type-inline'>Child Health<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.9' type='checkbox'  value='1123'  id='choice_1_39_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_9' id='label_1_39_9' class='gform-field-label gform-field-label--type-inline'>COVID-19<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.11' type='checkbox'  value='9'  id='choice_1_39_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_11' id='label_1_39_11' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.12' type='checkbox'  value='10'  id='choice_1_39_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_12' id='label_1_39_12' class='gform-field-label gform-field-label--type-inline'>Digestive System &amp; Liver<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.13' type='checkbox'  value='11'  id='choice_1_39_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_13' id='label_1_39_13' class='gform-field-label gform-field-label--type-inline'>Ear, Nose &amp; Throat<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.14' type='checkbox'  value='12'  id='choice_1_39_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_14' id='label_1_39_14' class='gform-field-label gform-field-label--type-inline'>Eyes &amp; Vision<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.15' type='checkbox'  value='13'  id='choice_1_39_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_15' id='label_1_39_15' class='gform-field-label gform-field-label--type-inline'>Food, Nutrition &amp; Metabolism<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.16' type='checkbox'  value='15'  id='choice_1_39_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_16' id='label_1_39_16' class='gform-field-label gform-field-label--type-inline'>Kidney &amp; Urinary System<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.17' type='checkbox'  value='16'  id='choice_1_39_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_17' id='label_1_39_17' class='gform-field-label gform-field-label--type-inline'>Lungs &amp; Breathing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.18' type='checkbox'  value='17'  id='choice_1_39_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_18' id='label_1_39_18' class='gform-field-label gform-field-label--type-inline'>Mental Health &amp; Behavior<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.19' type='checkbox'  value='18'  id='choice_1_39_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_19' id='label_1_39_19' class='gform-field-label gform-field-label--type-inline'>Mouth &amp; Teeth<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.21' type='checkbox'  value='19'  id='choice_1_39_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_21' id='label_1_39_21' class='gform-field-label gform-field-label--type-inline'>Pain Management\/Anesthesiology<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.22' type='checkbox'  value='20'  id='choice_1_39_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_22' id='label_1_39_22' class='gform-field-label gform-field-label--type-inline'>Reproductive &amp; Sexual Health<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.23' type='checkbox'  value='21'  id='choice_1_39_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_23' id='label_1_39_23' class='gform-field-label gform-field-label--type-inline'>Skin, Hair &amp; Nails<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.24' type='checkbox'  value='22'  id='choice_1_39_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_24' id='label_1_39_24' class='gform-field-label gform-field-label--type-inline'>Sleep Disorders<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.25' type='checkbox'  value='23'  id='choice_1_39_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_25' id='label_1_39_25' class='gform-field-label gform-field-label--type-inline'>Wellness, Lifestyle &amp; Environmental Health<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_39_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.26' type='checkbox'  value='24'  id='choice_1_39_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_39_26' id='label_1_39_26' class='gform-field-label gform-field-label--type-inline'>Women's Health<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_45\" class=\"gfield gfield--type-post_tags gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_45'>Study Tags (optional)<\/label><div class='gfield_description' id='gfield_description_1_45'>Separate each keyword or phrase with a comma.<\/div><div class='ginput_container ginput_container_text'><input name='input_45' id='input_1_45' type='text' value='' class='large'  aria-describedby=\"input_1_45_desc gfield_description_1_45\"    aria-invalid=\"false\"   \/><p class=\"gfield_post_tags_hint gfield_description\" id=\"input_1_45_desc\">Separate tags with commas<\/p><\/div><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_1'>Summary<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_1'>Please include http:\/\/ or https:\/\/ if you are going to include a link. <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_1_1' class='textarea large'  aria-describedby=\"gfield_description_1_1\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'>Participant Eligibility<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_2' id='input_1_2' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_26\" class=\"gfield gfield--type-post_custom_field gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Healthy Volunteers?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_26'>\n\t\t\t<li class='gchoice gchoice_1_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='No'  id='choice_1_26_0'    \/>\n\t\t\t\t<label for='choice_1_26_0' id='label_1_26_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Yes'  id='choice_1_26_1'    \/>\n\t\t\t\t<label for='choice_1_26_1' id='label_1_26_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_47\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Study Primary Location<\/h2><\/li><li id=\"field_1_51\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_51'>Location Name<\/label><div class='gfield_description' id='gfield_description_1_51'>e.g. University of Washington<\/div><div class='ginput_container ginput_container_text'><input name='input_51' id='input_1_51' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_51\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_53\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_53'>Street Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_52\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_52'>Suite, Room Number, or other Descriptor<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_1_52' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_54\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gf_left_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_54'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_1_54' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_55\" class=\"gfield gfield--type-post_custom_field gfield--input-type-select gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_55'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_1_55' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><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' >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' selected='selected'>Washington<\/option><option value='WV' >West Virginia<\/option><option value='WI' >Wisconsin<\/option><option value='WY' >Wyoming<\/option><\/select><\/div><\/li><li id=\"field_1_56\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gf_right_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_56'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_59\" class=\"gfield gfield--type-checkbox gfield--type-choice hilight field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Add a second location?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_59'><li class='gchoice gchoice_1_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='Yes'  id='choice_1_59_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_59_1' id='label_1_59_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_57\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Location 2<\/h2><\/li><li id=\"field_1_58\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_58'>Location 2 Name<\/label><div class='gfield_description' id='gfield_description_1_58'>e.g. University of Washington<\/div><div class='ginput_container ginput_container_text'><input name='input_58' id='input_1_58' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_58\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_60\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_60'>Street Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_61\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gf_left_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_61'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_1_61' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_62\" class=\"gfield gfield--type-post_custom_field gfield--input-type-select gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_62'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_1_62' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><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' >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><\/div><\/li><li id=\"field_1_63\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gf_right_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_63'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_88\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Contact Options<\/h2><\/li><li id=\"field_1_90\" class=\"gfield gfield--type-post_custom_field gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What method(s) of contact should be displayed for this study?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_90'>\n\t\t\t<li class='gchoice gchoice_1_90_0'>\n\t\t\t\t<input name='input_90' type='radio' value='phone_form'  id='choice_1_90_0'    \/>\n\t\t\t\t<label for='choice_1_90_0' id='label_1_90_0' class='gform-field-label gform-field-label--type-inline'>Phone and contact form<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_90_1'>\n\t\t\t\t<input name='input_90' type='radio' value='phone_only'  id='choice_1_90_1'    \/>\n\t\t\t\t<label for='choice_1_90_1' id='label_1_90_1' class='gform-field-label gform-field-label--type-inline'>Phone only<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Study Personnel<\/h2><\/li><li id=\"field_1_28\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_28'>Study Contact Full 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_28' id='input_1_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_29\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_29'>Contact Phone<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_1_29' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-post_custom_field gfield--input-type-email gf_right_half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Study Contact Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_19'>After your study is reviewed and approved for display, this email address will be used to communicate with your team about the study, including administrative notices and, when applicable, potential participants' emails. <\/div><div class='ginput_container ginput_container_email'>\n                            <input name='input_19' id='input_1_19' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_1_19\" \/>\n                        <\/div><\/li><li id=\"field_1_32\" class=\"gfield gfield--type-post_custom_field gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>Investigator(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_32'>Please list the Principal Investigator and any Co-Investigators. Use one line for each.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_1_32' class='textarea small'  aria-describedby=\"gfield_description_1_32\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Internal Contact Information<\/h2><div class='gsection_description' id='gfield_description_1_16'>We will use this information to contact you only if we have questions about this submission. <\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >I am...<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_31'>\n\t\t\t<li class='gchoice gchoice_1_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='the Contact listed above'  id='choice_1_31_0'    \/>\n\t\t\t\t<label for='choice_1_31_0' id='label_1_31_0' class='gform-field-label gform-field-label--type-inline'>the Contact listed above<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='a PI listed above'  id='choice_1_31_1'    \/>\n\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>a PI listed above<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='a third party'  id='choice_1_31_2'    \/>\n\t\t\t\t<label for='choice_1_31_2' id='label_1_31_2' class='gform-field-label gform-field-label--type-inline'>a third party<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><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_1_17'>\n                            \n                            <span id='input_1_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_1_17_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_17_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_1_17_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_18'>Email address<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_18' id='input_1_18' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_75\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Attestations<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_1_75'><li class='gchoice gchoice_1_75_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_75.1' type='checkbox'  value='I attest to the accuracy of the information provided.'  id='choice_1_75_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_75_1' id='label_1_75_1' class='gform-field-label gform-field-label--type-inline'>I attest to the accuracy of the information provided.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_75_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_75.2' type='checkbox'  value='I understand that my file may be audited and that I may be required to provide proof of unconditional IRB approval, approved posting narrative (if applicable), and current enrollment information within 24 hours of request by the ITHS website administrator.'  id='choice_1_75_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_75_2' id='label_1_75_2' class='gform-field-label gform-field-label--type-inline'>I understand that my file may be audited and that I may be required to provide proof of unconditional IRB approval, approved posting narrative (if applicable), and current enrollment information within 24 hours of request by the ITHS website administrator.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit for Approval'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_1_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save & Continue Later<\/a><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=legacy&amp;styles=[]&amp;hash=e398051dbe6feb0e1dea1cec10cefa66' \/>\n            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contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/www.iths.org\/participate\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').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_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').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){form_content.find('form').css('opacity', 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