{"id":2839,"date":"2014-06-15T19:57:50","date_gmt":"2014-06-15T19:57:50","guid":{"rendered":"https:\/\/carsp.ca.vs4.korax.net\/carsp-acpser\/?page_id=2839"},"modified":"2025-02-19T01:58:40","modified_gmt":"2025-02-19T01:58:40","slug":"pay-by-cheque-request-form","status":"publish","type":"page","link":"https:\/\/carsp.ca\/en\/membership\/membership-options\/pay-by-cheque-request-form\/","title":{"rendered":"Pay by Cheque Request Form"},"content":{"rendered":"<div class=\"form-box\">\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_10_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_contact3\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"10\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_10\" id=\"frm_hide_fields_10\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"contact3\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_10\" name=\"frm_submit_entry_10\" value=\"63ad8c3e67\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/2839\" \/><div id=\"frm_field_202_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_evzgi9\" class=\"frm_primary_label\">Username\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_evzgi9\" name=\"item_meta[202]\" value=\"\"  data-reqmsg=\"Username cannot be blank.\" aria-required=\"true\" data-invmsg=\"Username is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_195_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first_half\">\r\n    <label for=\"field_qh4icy3\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qh4icy3\" name=\"item_meta[195]\" value=\"\"  data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy3\" \/>\r\n    <div id=\"frm_desc_field_qh4icy3\" class=\"frm_description\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_196_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_last_half\">\r\n    <label for=\"field_ocfup13\" class=\"frm_primary_label\">Last\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ocfup13\" name=\"item_meta[196]\" value=\"\"  data-reqmsg=\"Last cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup13\" \/>\r\n    <div id=\"frm_desc_field_ocfup13\" class=\"frm_description\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_197_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n    <label for=\"field_29yf4d3\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d3\" name=\"item_meta[197]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_d6266j\" class=\"frm_primary_label\">Membership\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[203]\" id=\"field_d6266j\"  data-reqmsg=\"Membership cannot be blank.\" aria-required=\"true\" data-invmsg=\"Membership is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Regular Membership ($125 for 1 year)\">Regular Membership ($125 for 1 year)<\/option><option  value=\"Regular Membership ($225 for 2 years)\">Regular Membership ($225 for 2 years)<\/option><option  value=\"Student Membership ($15 for 1 year)\">Student Membership ($15 for 1 year)<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_4161_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\n    <label for=\"field_toip\" id=\"field_toip_label\" class=\"frm_primary_label\">Province\/State\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_toip\" name=\"item_meta[4161]\" value=\"\"  data-reqmsg=\"Province\/State cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_4162_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\n    <label for=\"field_2z3ob\" id=\"field_2z3ob_label\" class=\"frm_primary_label\">Country\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input  type=\"text\" id=\"field_2z3ob\" name=\"item_meta[4162]\" value=\"\"  data-reqmsg=\"Country cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\n    \n    \n<\/div>\n<div id=\"frm_field_4164_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12\">\n    <label for=\"field_b3o5\" id=\"field_b3o5_label\" class=\"frm_primary_label\">Which category best describes your employer\/business? \n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    \t\t<select name=\"item_meta[4164]\" id=\"field_b3o5\"  data-reqmsg=\"Which category best describes your employer\/business?  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Which category best describes your employer\/business?  is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"&lt;span class=&quot;en&quot;&gt;Academic &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Acad\u00e9mique &lt;\/span&gt;\">Academic<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Engineering\/Transportation - Public &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Ing\u00e9nierie\/Transport - Public &lt;\/span&gt;\">Engineering\/Transportation - Public<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Engineering\/Transportation - Private &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Ing\u00e9nierie\/Transport - Priv\u00e9 &lt;\/span&gt;\">Engineering\/Transportation - Private<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Health - Public &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Sant\u00e9 - Public &lt;\/span&gt;\">Health - Public<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Road User Research and Programs - Public &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Recherche et programmes (usagers de la route) - Public &lt;\/span&gt;\">Road User Research and Programs - Public<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Road User Research and Programs - Private &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Recherche et programmes (usagers de la route) - Priv\u00e9 &lt;\/span&gt;\">Road User Research and Programs - Private<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Insurance Organization (private or public) &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Organisation d&#039;assurance (priv\u00e9e ou publique) &lt;\/span&gt;\">Insurance Organization (private or public)<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Non-profit organization &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Organisation \u00e0 but non lucratif &lt;\/span&gt;\">Non-profit organization<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Private organization &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Organisme priv\u00e9 &lt;\/span&gt;\">Private organization<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Other &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Autre &lt;\/span&gt;\">Other<\/option>\t<\/select>\n\t\n    \n    \n<\/div>\n<div id=\"frm_field_4163_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12\">\n    <label for=\"field_6y481\" id=\"field_6y481_label\" class=\"frm_primary_label\">What road safety topic area best describes the work you are currently doing?\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    \t\t<select name=\"item_meta[4163]\" id=\"field_6y481\"  data-reqmsg=\"What road safety topic area best describes the work you are currently doing? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What road safety topic area best describes the work you are currently doing? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"&lt;span class=&quot;en&quot;&gt;Vehicles and Vehicle Systems &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;V\u00e9hicules et syst\u00e8mes de v\u00e9hicules &lt;\/span&gt;\">Vehicles and Vehicle Systems<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Traffic Engineering\/Road Design &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Ing\u00e9nierie du trafic et conception des routes &lt;\/span&gt;\">Traffic Engineering\/Road Design<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Injury Prevention &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Pr\u00e9vention des blessures &lt;\/span&gt;\">Injury Prevention<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Enforcement\/Legal Issues &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Application de la loi et questions juridiques &lt;\/span&gt;\">Enforcement\/Legal Issues<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Safety Initiatives &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Initiatives de s\u00e9curit\u00e9 &lt;\/span&gt;\">Safety Initiatives<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Policy and Program Development &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;D\u00e9veloppement de politiques et de programmes &lt;\/span&gt;\">Policy and Program Development<\/option><option  value=\"&lt;span class=&quot;en&quot;&gt;Road Users\/Behavioral Issues &lt;\/span&gt;&lt;span class=&quot;fr&quot;&gt;Usagers de la route\/Questions comportementales &lt;\/span&gt;\">Road Users\/Behavioral Issues<\/option>\t<\/select>\n\t\n    \n    \n<\/div>\n<div id=\"frm_field_200_container\" class=\"frm_form_field form-field  frm_top_container frm_full\">\r\n    <label for=\"field_9jv0r13\" class=\"frm_primary_label\">Notes\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[200]\" id=\"field_9jv0r13\" rows=\"5\"  data-invmsg=\"Notes is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_2164_container\" class=\"frm_form_field form-field  frm_none_container\">\n    <label for=\"g-recaptcha-response\" class=\"frm_primary_label\">reCAPTCHA\n        <span class=\"frm_required\"><\/span>\n    <\/label>\n    <div  id=\"field_w7by1\" class=\"g-recaptcha\" data-sitekey=\"6Lel6zUUAAAAANhbVR1u3vbeg_3XeiTJi2AczGhF\" data-size=\"normal\" data-theme=\"light\"><\/div>\n    \n    \n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_4487_container\">\n\t\t\t<label for=\"field_tgmdj\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_tgmdj\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[4487]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"SM6a5PYd5HzWgv+6HsV7kM\/yk3XS5VhoAHc4IFyIvYtBTBcwCKt5arAPd0SSA8w4\" \/><div class=\"frm_submit\">\r\n\r\n<input type=\"submit\" value=\"Submit\"  class=\"frm_final_submit\" formnovalidate=\"formnovalidate\" \/>\r\n<img decoding=\"async\" class=\"frm_ajax_loading\" src=\"https:\/\/carsp.ca\/wp-content\/plugins\/formidable\/images\/ajax_loader.gif\" alt=\"Sending\" style=\"visibility:hidden;\" \/>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":500,"featured_media":0,"parent":176,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_kad_post_transparent":"default","_kad_post_title":"default","_kad_post_layout":"default","_kad_post_sidebar_id":"","_kad_post_content_style":"default","_kad_post_vertical_padding":"default","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"class_list":["post-2839","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/pages\/2839","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/users\/500"}],"replies":[{"embeddable":true,"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/comments?post=2839"}],"version-history":[{"count":5,"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/pages\/2839\/revisions"}],"predecessor-version":[{"id":39310,"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/pages\/2839\/revisions\/39310"}],"up":[{"embeddable":true,"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/pages\/176"}],"wp:attachment":[{"href":"https:\/\/carsp.ca\/en\/wp-json\/wp\/v2\/media?parent=2839"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}