

<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta name="referrer" content="no-referrer-when-downgrade">
<link rel="stylesheet" href="/i4a/includes/css/lucee_dump_i4a_light.css">

	
							<!-- Google tag (gtag.js) -->
<script async src="https://www.googletagmanager.com/gtag/js?id=G-1NSKGPCTE5"></script>
<script>
  window.dataLayer = window.dataLayer || [];
  function gtag(){dataLayer.push(arguments);}
  gtag('js', new Date());

  gtag('config', 'G-1NSKGPCTE5');
</script>
						
					
					<style type="text/css">
						
#i4awidget_google_analytics_258 {
	position: relative;
	margin-top: 0;
	margin-right: 0;
	margin-bottom: 0;
	margin-left: 0;
	z-index: 1000;
	
	
	top: 0px;
	left: 0px;
	width: auto;
	height: auto;
	color: black;
}
						
					</style>
				
			
	<script type="text/javascript" src="/common/jquery/jquery.js?v=202608171326272"></script>

<script type="text/javascript" src="/common/jquery/jquery-migrate-3.4.0.min.js?v=202608171326272"></script>

<script type="text/javascript" src="/common/popper/popper.min.js"></script>
<script type="text/javascript" src="/common/bootstrap431/js/bootstrap.min.js"></script>
<script type="text/javascript" src="/common/bootstrap431/plugins/statefulButton.js"></script>
<link rel="stylesheet" href="/i4a/includes/css/bootstrap_i4a.css">
<link rel="stylesheet" href="/common/bootstrap431/themes/bootswatch/431/yeti.min.css">
<script type="text/javascript" src="/common/bootstrap431/plugins/bootstrap-select/js/bootstrap-select.min.js"></script>
<link rel="stylesheet" href="/common/bootstrap431/plugins/bootstrap-select/css/bootstrap-select.min.css">
<link rel="stylesheet" href="/common/bootstrap431/plugins/bootstrap-select/css/bootstrap-select-i4a.css">
<script type="text/javascript" src="/common/bootstrap431/plugins/datepicker/js/bootstrap-datepicker.min.js"></script>
<link rel="stylesheet" href="/common/bootstrap431/plugins/datepicker/css/bootstrap-datepicker.standalone.min.css">
<script type="text/javascript" src="/common/bootstrap431/plugins/bootstrap-input-spinner/bootstrap-input-spinner.js"></script>

<link rel="stylesheet" href="/common/bootstrap431/plugins/bootstrap-toggle/css/bootstrap4-toggle.min.css">

<script type="text/javascript" src="/common/bootstrap431/plugins/bootstrap-toggle/js/bootstrap4-toggle.min.js"></script>

<link rel="stylesheet" href="/common/bootstrap431/plugins/colorpicker2/css/bootstrap-colorpicker.min.css">

<script type="text/javascript" src="/common/bootstrap431/plugins/colorpicker2/js/bootstrap-colorpicker.min.js"></script>

<link rel="stylesheet" href="/common/fontawesome642/css/all.min.css">

<link rel="stylesheet" href="/common/fontawesome642/css/v4-shims.min.css">

<link rel="stylesheet" href="/common/sweetalert/sweetalert.min.css">

<script type="text/javascript" src="/common/sweetalert/sweetalert.min.js"></script>


	<script>
		$(function() {
			// add Bootstrap responsive class to all images, except those with class name of 'noResponsive'
			$('img').each(function(index) {
				if ($(this).hasClass('noResponsive') == false) {
					$(this).addClass('img-fluid');
				}
			});
		});
	</script>


	<title>ICEA Dual Certification (ICCE-BD) Exam Application | The International Childbirth Education Association</title>


<link rel="canonical" href="https://member.icea.org/i4a/pages/index.cfm?pageid=3360">

<META HTTP-EQUIV="CACHE-CONTROL" CONTENT="NO-CACHE">


	<link rel="stylesheet" type="text/css" href="/templates/common/styles_responsive.css?v=8262">


	<link rel="stylesheet" href="/i4a/css/forms_builder/forms_baseline_styles.css" type="text/css" />


<link rel="stylesheet" href="/i4a/css/widgets/font_resizer.css" type="text/css" />
<link rel="stylesheet" href="/i4a/css/widgets/login.css" type="text/css" />
<link rel="stylesheet" href="/i4a/css/widgets/search.css" type="text/css" />
<link rel="stylesheet" href="/i4a/css/widgets/i4afooterlink.css" type="text/css" />


	  	<link rel="stylesheet" type="text/css" href="/templates/1011/styles_template.css?v=186">
	  	
	  	
	  	<link rel="stylesheet" type="text/css" href="/templates/1011/styles_wysiwyg.css?v=8818">
	  	
	  	
	  	<link rel="stylesheet" type="text/css" href="/templates/1011/Forms.css?v=4744">
	  	
	  	
	  	<link rel="stylesheet" type="text/css" href="/templates/1011/Footer.css?v=4191">
	  	
	  	
	  	<link rel="stylesheet" type="text/css" href="/templates/1011/Header.css?v=3652">
	  	
	  	
<script src="/i4a/jslib/i4a/passwordToggle.js?v=4"></script>


<script>
	function MM_openBrWindow(theURL,winName,features) {
		window.open(theURL,winName,features);
	}
</script>


<link type="text/css" rel="stylesheet" href="/i4a/css/html5.css">
<script src="/i4a/jslib/consent.js?ts=0.1797378667351824"></script> <!---Lucee-Ajax-Core---> <script type="text/javascript">
				var _cf_ajaxscriptsrc = "/mapping-tag/lucee/core/ajax/JSLoader.cfc?method=get&lib=";
				var _cf_ajaxcsssrc = "/mapping-tag/lucee/core/ajax/css/";
				var _cf_loadingtexthtml = '<div style="text-align: center;"><img src="/mapping-tag/lucee/core/ajax/loader/loading.gif.cfm"/></div>';
				var _cf_params = {"GOOGLEMAPKEY":""};
			</script>
			<script type="text/javascript" src="/mapping-tag/lucee/core/ajax/JSLoader.cfc?method=get&lib=LuceeAjax"></script> <!---_Lucee_cfimageCaptcha---> <script type="text/javascript">
				var _Lucee_cfimageCaptcha = Lucee.ajaxProxy.init("/i4a/forms/captcha_remote.cfc","cfimageCaptcha");
		
				_Lucee_cfimageCaptcha.prototype.createCaptcha = function(minLength,maxLength,id,difficulty,fontSize,fonts,height,width){
					return Lucee.ajaxProxy.invokeMethod(this,'createCaptcha',{minLength:minLength,maxLength:maxLength,id:id,difficulty:difficulty,fontSize:fontSize,fonts:fonts,height:height,width:width});
				};
			
				_Lucee_cfimageCaptcha.prototype.valCaptcha = function(hashthis){
					return Lucee.ajaxProxy.invokeMethod(this,'valCaptcha',{hashthis:hashthis});
				};
			</script><script>_i4a_enableCookies(); _i4a_createCookie("i4aconsent", "true", 365);</script></head>


	<body class="page-3360 childof-0 toplevelpage-3360 theme-1011 level-1 section-3360 innerpage">
<script>checkConsentStatus();</script>


		<!DOCTYPE html>
<html lang="en-US"
    class="html_stretched responsive av-preloader-disabled av-default-lightbox  html_header_top html_logo_left html_bottom_nav_header html_menu_left html_slim html_header_sticky html_header_shrinking_disabled html_header_topbar_active html_header_transparency html_mobile_menu_tablet html_header_searchicon html_content_align_center html_header_unstick_top_disabled html_header_stretch_disabled html_minimal_header html_minimal_header_shadow html_av-submenu-hidden html_av-submenu-display-click html_av-overlay-side html_av-overlay-side-classic html_av-submenu-noclone html_entry_id_9 av-no-preview html_text_menu_active  avia_desktop  js_active  avia_transform  avia_transform3d  avia_transform  avia_transform3d  avia-webkit avia-webkit-86 avia-chrome avia-chrome-86 av_social1">

<head>
    <meta name="viewport" content="width=device-width, initial-scale=1">
  
  <link rel="preconnect" href="https://fonts.googleapis.com"><link rel="preconnect" href="https://fonts.gstatic.com" crossorigin><link href="https://fonts.googleapis.com/css2?family=Montserrat:ital,wght@0,300;0,600;0,700;1,300&display=swap" rel="stylesheet">

</head>

<body>
    <div id="wrap_all">
      <!-- Global policy banner -->
<div id="global-banner" class="no-refunds-banner" role="region" aria-label="Site policy notice">
  <div class="container">
    ICEA has a no refund policy
  </div>
</div>

        <header id="header"
            class="all_colors header_color light_bg_color av_header_top av_logo_left av_bottom_nav_header av_menu_left av_slim 
                           av_header_sticky av_header_shrinking_disabled av_header_stretch_disabled av_mobile_menu_tablet av_header_searchicon av_header_unstick_top_disabled av_seperator_big_border av_minimal_header av_minimal_header_shadow av_header_transparency"
            role="banner">

     
            <div id="header_main" class="container_wrap container_wrap_logo">

                <div class="container av-logo-container" style="">

                    <div class="inner-container">
                        <div class="logo"><a href="https://icea.org/"><img
                                    src="/templates/1009/images/Logo ICEA_white_horz.png"
                                    alt="ICEA"></a></div>

                      <div class="menu-title"><h1>Member Portal</h1></div>

                        <div class="button-group">
                            <a href="https://member.icea.org//i4a/pages/index.cfm?pageID=3322"
                                class="logoutbutton">Log Out</a>
                       
                  
                          	<a class="button-white button"
                                href="https://member.icea.org/i4a/pages/index.cfm?pageID=3324"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M313.6 288c-28.7 0-42.5 16-89.6 16-47.1 0-60.8-16-89.6-16C60.2 288 0 348.2 0 422.4V464c0 26.5 21.5 48 48 48h352c26.5 0 48-21.5 48-48v-41.6c0-74.2-60.2-134.4-134.4-134.4zM416 464c0 8.8-7.2 16-16 16H48c-8.8 0-16-7.2-16-16v-41.6C32 365.9 77.9 320 134.4 320c19.6 0 39.1 16 89.6 16 50.4 0 70-16 89.6-16 56.5 0 102.4 45.9 102.4 102.4V464zM224 256c70.7 0 128-57.3 128-128S294.7 0 224 0 96 57.3 96 128s57.3 128 128 128zm0-224c52.9 0 96 43.1 96 96s-43.1 96-96 96-96-43.1-96-96 43.1-96 96-96z"/></svg> My Account</a>
                            <a class="button-outline button" href="https://icea.org/" ><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M440,256H424a8,8,0,0,0-8,8V464a16,16,0,0,1-16,16H48a16,16,0,0,1-16-16V112A16,16,0,0,1,48,96H248a8,8,0,0,0,8-8V72a8,8,0,0,0-8-8H48A48,48,0,0,0,0,112V464a48,48,0,0,0,48,48H400a48,48,0,0,0,48-48V264A8,8,0,0,0,440,256ZM500,0,364,.34a12,12,0,0,0-12,12v10a12,12,0,0,0,12,12L454,34l.7.71L131.51,357.86a12,12,0,0,0,0,17l5.66,5.66a12,12,0,0,0,17,0L477.29,57.34l.71.7-.34,90a12,12,0,0,0,12,12h10a12,12,0,0,0,12-12L512,12A12,12,0,0,0,500,0Z"/></svg>Return to Main Website</a>
                          
               
                		</div>
                            
                        </div>
                      
                    </div>
                </div>
            

            <div class="container">
                <div class="row i4a_main_content_row">
                    
                    <div class="col-12 i4a_page_content">
                        
                        
                            <div class="pageTitleDiv">
                                <h1 class="pagetitle">
                                    ICEA Dual Certification (ICCE-BD) Exam Application
                                </h1>
                            </div>
                        

                        <script>
                            function myFunction() {
                                var x = document.getElementById("myTopnav");
                                if (x.className === "topnav") {
                                    x.className += " responsive";
                                } else {
                                    x.className = "topnav";
                                }
                            }
                        </script>
                        <script>
$(document).ready(function () {
	var windowURL = window.location.href;

if (windowURL.indexOf('login.cfm') > -1) {
	$('#i4awidget_widget_responsivelogin_253').css('display', 'none');

	}

});
                        </script>
                      
                      <script>
$(document).ready(function () {
	var windowURL = window.location.href;

if (windowURL.indexOf('amslogin.cfm') > -1) {
	$('#i4awidget_widget_responsivelogin_253').css('display', 'none');

	}

});
                        </script>
              
<script>
$(document).ready(function () {
	var windowURL = window.location.href;

if (windowURL.indexOf('public') > -1) {
	$('#i4awidget_widget_responsivelogin_253').css('display', 'none');

	}

});
                        </script>
		
	
<div id="i4acontent_area_outer">

	
<NOSCRIPT>
	<META HTTP-EQUIV="Refresh" CONTENT="0;URL=https://>member.icea.org/i4a/nojavascript.cfm">
</NOSCRIPT>

		
<div id="frm_wrapper" style="">

	
			<p class="form-instructions"><p data-end="323" data-start="78"><strong data-end="323" data-start="78">Please complete the exam application. Once it&rsquo;s approved, we&rsquo;ll process your selected payment method or send an invoice.</strong></p>

<p data-end="518" data-start="221"><strong>To access the exam application, visit <a href="https://icea.org/get-certified/dual-cert/">https://icea.org/get-certified/dual-cert/</a>, scroll down, and click the <em data-end="570" data-start="510">&lsquo;Dual Certification: Traditional Study Guide &amp; Packet&rsquo;</em> button next to the pathway instructions. You will need to log in to your account to view the application.</strong></p>

<p data-end="691" data-start="325"></p>
</p>
		

	<form action="index.cfm?id=61&popup=false" method="POST" id="iform" name="iform" enctype="multipart/form-data">
		
		<input type="hidden" id="num_questions" name="num_questions" value="16">
		<input type="hidden" name="form_id" value="61">
		<input type="hidden" name="report_id" value="">
		<input type="hidden" name="AllowedUploads" value="doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png">
		
		
<script>
	$(function () {
		// reset payment token in case user clicked Back button in browser
		$('#paymentToken').val('');
		
		//$('#business_radio').trigger('change');
		
		
	});
	
	function limitText(limitField, limitCount, limitNum) {
		if (limitField.value.length > limitNum) {
			limitField.value = limitField.value.substring(0, limitNum);
		} else {
			limitCount.value = limitNum - limitField.value.length;
		}
	}

	function enable(obj) {
		obj.disabled = false;
		obj.style.backgroundColor = "white";
		obj.style.color = "black";
	}

	var validForm = false;
	var sent = 0;
	
	// Thibault 2/11/06 added init function called at page load, plus validation that required fields are completed before submit.  should help with problems with the back button and credit cards,  issue 30102
	function init() {
		frm = document.iform;

		
	}

	window.onload = new Function("init()"); //set init function to run at page load

	function lcase(mystring)  {
		return mystring.toLowerCase()
	}

	function listfind(list,value,delimiters) {
		if(!delimiters){var delimiters=','}
		_TempListSplitArray = list.split(delimiters)
		FoundIdx = 0;
		for(i=0;i<_TempListSplitArray.length;i++) {
			if(_TempListSplitArray[i]==value){
				FoundIdx= i+1;
				break
			}
		}
		return FoundIdx;
	}

	function startValidate() {
		// this will kick off validation, but since we need to validate the captcha
		// we have to wait for that to finish first...
		var iForm = document.getElementById('iform');
		var fld_ss_form_testid = document.getElementById('fld_ss_form_testid');
		var mainV = validateFrm();
		fld_ss_form_testid.value = 1;
		if (mainV) {
			
				
					iForm.submit();
				
			
		}
	}

	function validateFrm() {
		if(!sent) sent = 0;  //make sure we have this!
		if (!validForm) validForm = false;
		arrReqMissing = new Array();
		
			
			var jsDesc = "Exam Application (ICCE-BD)";
			
			
			var jsDesc = "First Name";
			
				obj = document.iform.response_2;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Last Name";
			
				obj = document.iform.response_3;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Address ";
			
				obj = document.iform.response_4;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "City";
			
				obj = document.iform.response_5;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "State";
			
				obj = document.iform.response_6;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Zip";
			
				obj = document.iform.response_7;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Country";
			
				obj = document.iform.response_8;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Email";
			
				obj = document.iform.response_9;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Phone";
			
				obj = document.iform.response_10;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "Please attach the exam application and any required verification documents.";
			
				obj = document.iform.response_11;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
				docfilename = document.iform.response_11.value.toLowerCase();
				list = "doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png";
				if (docfilename != '') {
					x = docfilename.length;
					y = docfilename.lastIndexOf(".") + 1;
					ext = docfilename.substr(y, x);
					extfound = listfind(list, ext, ',');
					if (extfound == 0) {
						allowedUploadsList = 'doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png';
						allowedUploadsList = allowedUploadsList.replace(/,/g, ', ');

						swal({
				  			title: 'File types',
				  			html: true,
				  			text: 'Sorry, you can only upload files of the following types: ' + allowedUploadsList,
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						return false;
					}
				// Leaving this disabled since I am going to relax security checks a bit, but leaving here
				// in case we need to add specific strings to exlusion for file uploads.
				//if ( docfilename.toLowerCase().indexOf("sp_") > -1 ) {
				//	alert("Sorry, you cannot upload files that contain the string 'sp_', please rename your file before uploading it.");
				//	return false;
				//	}
				}
			
		
			var jsDesc = "Additional Files";
			
			
				docfilename = document.iform.response_12.value.toLowerCase();
				list = "doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png";
				if (docfilename != '') {
					x = docfilename.length;
					y = docfilename.lastIndexOf(".") + 1;
					ext = docfilename.substr(y, x);
					extfound = listfind(list, ext, ',');
					if (extfound == 0) {
						allowedUploadsList = 'doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png';
						allowedUploadsList = allowedUploadsList.replace(/,/g, ', ');

						swal({
				  			title: 'File types',
				  			html: true,
				  			text: 'Sorry, you can only upload files of the following types: ' + allowedUploadsList,
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						return false;
					}
				// Leaving this disabled since I am going to relax security checks a bit, but leaving here
				// in case we need to add specific strings to exlusion for file uploads.
				//if ( docfilename.toLowerCase().indexOf("sp_") > -1 ) {
				//	alert("Sorry, you cannot upload files that contain the string 'sp_', please rename your file before uploading it.");
				//	return false;
				//	}
				}
			
		
			var jsDesc = "Additional Files";
			
			
				docfilename = document.iform.response_13.value.toLowerCase();
				list = "doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png";
				if (docfilename != '') {
					x = docfilename.length;
					y = docfilename.lastIndexOf(".") + 1;
					ext = docfilename.substr(y, x);
					extfound = listfind(list, ext, ',');
					if (extfound == 0) {
						allowedUploadsList = 'doc,docx,docm,dotx,dotm,eps,epub,htm,ics,lit,mobi,msg,pdf,potx,potm,ppam,ppsx,ppsm,pps,ppt,pptm,pptx,pub,txt,xls,zip,xlsx,xlsm,xltx,xltm,xlsb,xlam,vcf,sgf,gif,jpg,jpeg,jpe,png';
						allowedUploadsList = allowedUploadsList.replace(/,/g, ', ');

						swal({
				  			title: 'File types',
				  			html: true,
				  			text: 'Sorry, you can only upload files of the following types: ' + allowedUploadsList,
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						return false;
					}
				// Leaving this disabled since I am going to relax security checks a bit, but leaving here
				// in case we need to add specific strings to exlusion for file uploads.
				//if ( docfilename.toLowerCase().indexOf("sp_") > -1 ) {
				//	alert("Sorry, you cannot upload files that contain the string 'sp_', please rename your file before uploading it.");
				//	return false;
				//	}
				}
			
		
			var jsDesc = "Philosophy Statement\r\n\r\n&ldquo;I support the natural process of childbirth and the right of the expectant parent to make informed decisions based on the knowledge of alternatives. As an ICEA certified educator, I will work with other healthcare professionals and consumers to promote family-centered maternity care, breastfeeding, and parent-infant bonding. I advocate parental participation in childbirth and the avoidance of medical intervention in uncomplicated labors. I accept as my primary responsibility the preparation of expectant parents, both mentally and physically, to participate in an individually satisfying pregnancy, labor, birth, and introduction to parenthood.&quot;";
			
			
			var jsDesc = "Please type your name and the date below to confirm your acceptance of the Philosophy Statement.";
			
				obj = document.iform.response_15;
				val = "";
				
				val = obj.value;
				if (obj.value == "") {
					arrReqMissing[arrReqMissing.length] = jsDesc;
				}
				
			
			var jsDesc = "\n\nOnce exam paperwork has been submitted, our office will review your documents. Please allow up to 2 weeks&nbsp;for the review process to be completed.";
			
			
		if(arrReqMissing.length > 0) {
			//errStr = "We're sorry, but the following fields are required before you can submit this form. Please click OK, then correct these entries.<br>";
			errStr = "";
			for(i=0; i<arrReqMissing.length; i++) {
				errStr += arrReqMissing[i] + "<br>";
			}
			swal({
	  			title: 'Missing required fields',
	  			html: true,
	  			text: errStr,
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			return false;
		}

		for(i=0; i<document.iform.elements.length; i++) {
		 	if (document.iform.elements[i].type == 'textarea' || document.iform.elements[i].type == 'text') {
		 		if (document.iform.elements[i].value.length > 2147483647) {
		 			swal({
			  			title: 'Maximum allowable length',
			  			html: true,
			  			text: "One or more field responses exceeds the maximum allowable length of 2147483647 characters. Please adjust your responses and re-submit.",
			  			animation: 'slide-from-top',
			  			type: 'info',
			  			confirmButtonText: 'Ok',
			  			confirmButtonColor: '#337ab7'
			  		});
		 			return false;
		 		}
		 	}
		}

		if (sent == 1) {
	          swal({
	  			title: 'Processing..',
	  			html: true,
	  			text: "Your request is processing. Please do not click Submit more than once.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		  });
	          return false;
	    }
		
			bOK = true;
		
		if (bOK) {
			var btn = $('#submitBtn');
			btn.button('loading');
			btn.prop('disabled', true);
			sent = 1;
			validForm = true;
			return true;
		}
		else {
			return false;
		}
	}

	function IsNumeric(sText) {
	   var ValidChars = "0123456789.";
	   var IsNumber=true;
	   var Char;

	   for (i = 0; i < sText.length && IsNumber == true; i++) {
	      Char = sText.charAt(i);
	      if (ValidChars.indexOf(Char) == -1) {
	         IsNumber = false;
	      }
	   }
	   return IsNumber;
	}

	function setButtonVal(el, itemID, price) {
		// first set the price attribute on the element
		el.price = price;
		// now set the value of a hidden field for the associated radio button
		document.getElementById(itemID).price = price;
		document.getElementById(itemID).value = 1;
		// now call the calcTotalFix function to recaculate the total amount due
		calcTotalFix();
	}

	function getRadioButtonValForTotal(radioName){
		var rads = document.getElementsByName(radioName);
		var selectedPrice = 0;
		for(i=0; i < rads.length; i++) {
		  if(rads[i].checked == true){
		    selectedPrice = rads[i].getAttribute('price');
		  }
		}

		selectedPrice = parseFloat(selectedPrice);
		return selectedPrice;
	}

	function calcTotalFix() {
		var priceFields = $(".calculateTotal");
		// console.log('priceFields length: ' + priceFields.length);
		var updateTotal = 0; // initialize total before looping over array
		var processedRadioButtons = [];	/// reset array every time this function is called
		for (var i=0; i < priceFields.length; i++) {
			myFieldObj = priceFields[i];
			if (myFieldObj.value == '') { myFieldObj.value = 0; }
			fieldName = myFieldObj.name;
			value = myFieldObj.value;
			fieldID = myFieldObj.getAttribute('id');
			price = myFieldObj.getAttribute('price');

			// check to see if this is a radioVal by the item id
			if(fieldID != undefined){
				var nRadioVal = fieldID.indexOf("radioVal");
				if(nRadioVal > -1){
					fieldtype = 'radioval';
				} else {
					fieldtype = 'notradioval';
				}
			} else {
				fieldtype = 'nofieldid';
			}

			// if this is just an open price field, there is no notion of quantity times price, so the price to the value of the field
			if(fieldtype === 'radioval'){
				// radio price field - use "price" attribute since we have funky stuff in the "value" attribute that we can't parse easily
				arrNum = $.inArray(fieldName, processedRadioButtons);
				if(arrNum > -1) {
					// set price and calcualted value to zero for the rest of the checkboxes in this array because don't want to keep adding to price
					price = 0;
					calculatedValue = parseFloat(0);
				} else {
					price = getRadioButtonValForTotal(fieldName);
					calculatedValue = parseFloat(price);
					// add radio button field name to array of radio fields processed so we don't check again
					processedRadioButtons.push(fieldName);
				}
				// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
			} else {
				if (price === undefined || price === null) {
				// check to see if it's a radio price field first
					// open price field - use "value" attribute
					if (!IsNumeric(value)) {
						//alert("Open Prices must be numbers only, no formatting is allowed.");
						swal({
				  			title: 'Numbers only',
				  			html: true,
				  			text: "Open Prices must be numbers only, no formatting is allowed.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					calculatedValue = parseFloat(value);
					// console.log('fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / calculatedValue: ' + calculatedValue);
				} else {
					if (!IsNumeric(value)) {
						//alert("Price fields only allow numbers.");
						swal({
				  			title: 'Price fields',
				  			html: true,
				  			text: "Price fields only allow numbers.",
				  			animation: 'slide-from-top',
				  			type: 'info',
				  			confirmButtonText: 'Ok',
				  			confirmButtonColor: '#337ab7'
				  		});
						myFieldObj.value = 0;
						return;
					}
					myVal = parseFloat(value);
					// console.log('in parseint with 10 - fieldName: ' + fieldName + ' / value: ' + value + ' fieldID: ' + fieldID + ' / price: ' + price + ' / myVal: ' + myVal);
					calculatedValue = myVal * parseFloat(price);

				}
			}


			// console.log('Field id: ' + fieldID + ' / Fieldtype: ' + fieldtype + ' / Field name: ' + fieldName + ' / value: ' + value + ' / Price: ' + price + ' / Calculated Field Total: ' + calculatedValue);
			updateTotal = updateTotal + calculatedValue;
		}

		// update hidden total amount
		if (document.iform.hiddentotal) { document.iform.hiddentotal.value = updateTotal; }
		// console.log('The updateTotal is now: ' + updateTotal);
		
		
		// update total value with formatted amount
		if (typeof(formatCurrency) == "function") { document.iform.total.value = formatCurrency(updateTotal); }
		
		if ($('#ordertotal_work').length > 0) {
            $('#ordertotal_work').val(updateTotal.toFixed(2));
        }
        
        if ($('#pmt_method').length > 0) {
        	$('#pmt_method').val('');
        }
        $('.paymentProfileRadio').prop('checked', false);
        $('.card').removeClass('active');
        
		// need to update the cc_info tag fields...
		if (typeof(checkTotal) == "function") { checkTotal(); }
	}

	/* remove after confirming ok without it - 8/8/13 CJV */
	function calcTotal(myField){
		thisVal = myField.value;
		// alert(thisVal);
		if (thisVal == '') {
			thisVal = 0;
			myField.value = 0;
			}
			if (!IsNumeric(myField.value)) {
				//alert('Please enter only numbers or decimal points in a price field');
				swal({
		  			title: 'Price field',
		  			html: true,
		  			text: "Please enter only numbers or decimal points in a price field.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				myField.value = 0;
				thisVal = 0;
				}
				// get the current total
				var origTotal = document.iform.hiddentotal.value;
				// now backout the prior value from the total
				var priorTotal = origTotal - myField.priorval;
				if(priorTotal == ''){
					priorTotal = 0;
					}
				// add the open price to the total
				updateTotal = parseFloat(eval(priorTotal)) + parseFloat(eval(thisVal));
				// update hidden total amount
				document.iform.hiddentotal.value = updateTotal;
				
					
				// update total value with formatted amount
				document.iform.total.value = formatCurrency(updateTotal);
		checkTotal(); // need to update the cc_info tag fields...
	}
	/* */

	function setOpenPriceInput(thisField,thisPrice){
		if(thisPrice == ''){
			thisField.priorval = 0;
		} else {
			thisField.priorval = thisPrice;
		}
	}

	
		var div_bottom_moved = false;

		function addLoadEvent(func) {
 			var oldonload = window.onload;
  			if (typeof window.onload != 'function') {
    			window.onload = func;
  			}
  			else {
    			window.onload = function() {
      				if (oldonload) {
        				oldonload();
      				}
      				func();
    			}
  			}
 		}

		addLoadEvent(calcTotalFix);
	
</script>

	
<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
</style>


<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
		iTemp = strFileName.indexOf(":");
		
		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
		}
		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
		  			confirmButtonColor: '#337ab7'
		  		});
				obj.value = '';
				return false;
			}
		}
	}
	function clearRadio(rd) {
		if (document.iform) {
			var v;
			var ln;
			var ev;
			submitted = 0;
			v = "document.iform." + rd + ".length";
			ln = eval(v);
			// This will ensure we uncheck if there is only 1 radio button..
			v = "document.iform." + rd + ".checked = false;";
			ev = eval(v);
			// Now loop through the list of radio buttons and uncheck them all
			for (i=0;i<ln;i++) {
				v = "document.iform." + rd + "[" + i + "].checked = false;";
				//console.log(v);
				ev = eval(v);
			}
			calcTotalFix();
		}
	}
</script>


<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1122" class="layout form item outer row-1 item-1122 row_num-20 row_pos-320 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<h2>Exam Application (ICCE-BD)</h2>
					

				<input type="hidden" name="question_1" value="&lt;h2&gt;Exam Application (ICCE-BD)&lt;/h2&gt;">
				<INPUT TYPE="hidden" NAME="response_1_question_id" VALUE="1122">
				<INPUT TYPE="hidden" NAME="question_type_1" value="None">
				<INPUT TYPE="hidden" NAME="label_1" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1123" class="layout form item outer row-2 item-1123 row_num-40 row_pos-320 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							First Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_2"
									name="response_2"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-2 item-1123"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_2_required"
							VALUE="The field First Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_2" value="First Name">
				<INPUT TYPE="hidden" NAME="response_2_question_id" VALUE="1123">
				<INPUT TYPE="hidden" NAME="question_type_2" value="Text">
				<INPUT TYPE="hidden" NAME="label_2" value="First Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-1124" class="layout form item outer row-3 item-1124 row_num-40 row_pos-640 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Last Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-3 item-1124"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_3_required"
							VALUE="The field Last Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_3" value="Last Name">
				<INPUT TYPE="hidden" NAME="response_3_question_id" VALUE="1124">
				<INPUT TYPE="hidden" NAME="question_type_3" value="Text">
				<INPUT TYPE="hidden" NAME="label_3" value="Last Name">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1125" class="layout form item outer row-4 item-1125 row_num-60 row_pos-320 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Address<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-4 item-1125"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_4_required"
							VALUE="The field Address is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_4" value="Address ">
				<INPUT TYPE="hidden" NAME="response_4_question_id" VALUE="1125">
				<INPUT TYPE="hidden" NAME="question_type_4" value="Text">
				<INPUT TYPE="hidden" NAME="label_4" value="Address ">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1126" class="layout form item outer row-5 item-1126 row_num-80 row_pos-320 rowlength-3 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							City<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_5"
									name="response_5"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-5 item-1126"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_5_required"
							VALUE="The field City is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_5" value="City">
				<INPUT TYPE="hidden" NAME="response_5_question_id" VALUE="1126">
				<INPUT TYPE="hidden" NAME="question_type_5" value="Text">
				<INPUT TYPE="hidden" NAME="label_5" value="City">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-1127" class="layout form item outer row-6 item-1127 row_num-80 row_pos-352 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							State<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_6"
									name="response_6"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-6 item-1127"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_6_required"
							VALUE="The field State is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_6" value="State">
				<INPUT TYPE="hidden" NAME="response_6_question_id" VALUE="1127">
				<INPUT TYPE="hidden" NAME="question_type_6" value="Text">
				<INPUT TYPE="hidden" NAME="label_6" value="State">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-1128" class="layout form item outer row-7 item-1128 row_num-80 row_pos-368 rowlength-3 type-Text" style=";position:relative;">

			<div class="inner">

				
							Zip<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_7"
									name="response_7"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-7 item-1128"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_7_required"
							VALUE="The field Zip is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_7" value="Zip">
				<INPUT TYPE="hidden" NAME="response_7_question_id" VALUE="1128">
				<INPUT TYPE="hidden" NAME="question_type_7" value="Text">
				<INPUT TYPE="hidden" NAME="label_7" value="Zip">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1129" class="layout form item outer row-8 item-1129 row_num-100 row_pos-320 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Country<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_8"
									name="response_8"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-8 item-1129"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_8_required"
							VALUE="The field Country is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_8" value="Country">
				<INPUT TYPE="hidden" NAME="response_8_question_id" VALUE="1129">
				<INPUT TYPE="hidden" NAME="question_type_8" value="Text">
				<INPUT TYPE="hidden" NAME="label_8" value="Country">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1131" class="layout form item outer row-9 item-1131 row_num-120 row_pos-320 rowlength-2 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Email<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_9"
									name="response_9"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-9 item-1131"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_9_required"
							VALUE="The field Email is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_9" value="Email">
				<INPUT TYPE="hidden" NAME="response_9_question_id" VALUE="1131">
				<INPUT TYPE="hidden" NAME="question_type_9" value="Text">
				<INPUT TYPE="hidden" NAME="label_9" value="Email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
		<div id="form-item-1130" class="layout form item outer row-10 item-1130 row_num-120 row_pos-640 rowlength-2 type-Text" style=";position:relative;">

			<div class="inner">

				
							Phone<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_10"
									name="response_10"
								
								
								 style="width:200px;"
								
									
                                            value=""
									    
										
								class="form-control type-Text row-10 item-1130"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_10_required"
							VALUE="The field Phone is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_10" value="Phone">
				<INPUT TYPE="hidden" NAME="response_10_question_id" VALUE="1130">
				<INPUT TYPE="hidden" NAME="question_type_10" value="Text">
				<INPUT TYPE="hidden" NAME="label_10" value="Phone">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1133" class="layout form item outer row-11 item-1133 row_num-140 row_pos-320 rowlength-1 type-File" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Please attach the exam application and any required verification documents.<span class="text-danger"> *</span>
					

							<input type="file" accept="*" 
								
									id="response_11"
									name="response_11"
								
								
									onchange="checkInvalidCharacter('response_11');"
								

                                            value=""
									    
										
								class="type-File row-11 item-1133"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_11_required"
							VALUE="The field Please attach the exam application and any required verification documents. is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_11" value="Please attach the exam application and any required verification documents.">
				<INPUT TYPE="hidden" NAME="response_11_question_id" VALUE="1133">
				<INPUT TYPE="hidden" NAME="question_type_11" value="File">
				<INPUT TYPE="hidden" NAME="label_11" value="Exam Application">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1137" class="layout form item outer row-12 item-1137 row_num-160 row_pos-320 rowlength-1 type-File" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Additional Files
					

							<input type="file" accept="*" 
								
									id="response_12"
									name="response_12"
								
								
									onchange="checkInvalidCharacter('response_12');"
								

                                            value=""
									    
										
								class="type-File row-12 item-1137"
							><!-- input -->

							
				<input type="hidden" name="question_12" value="Additional Files">
				<INPUT TYPE="hidden" NAME="response_12_question_id" VALUE="1137">
				<INPUT TYPE="hidden" NAME="question_type_12" value="File">
				<INPUT TYPE="hidden" NAME="label_12" value="Additional Files">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1138" class="layout form item outer row-13 item-1138 row_num-180 row_pos-320 rowlength-1 type-File" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Additional Files
					

							<input type="file" accept="*" 
								
									id="response_13"
									name="response_13"
								
								
									onchange="checkInvalidCharacter('response_13');"
								

                                            value=""
									    
										
								class="type-File row-13 item-1138"
							><!-- input -->

							
				<input type="hidden" name="question_13" value="Additional Files">
				<INPUT TYPE="hidden" NAME="response_13_question_id" VALUE="1138">
				<INPUT TYPE="hidden" NAME="question_type_13" value="File">
				<INPUT TYPE="hidden" NAME="label_13" value="Additional Files">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1135" class="layout form item outer row-14 item-1135 row_num-200 row_pos-320 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<h6><span style="left: 120.04px; top: 549.567px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.939872);">Philosophy Statement</span></h6>

<h6><span style="left: 120.04px; top: 593.967px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.927695);">&ldquo;I support the natural process of childbirth and the right of the expectant parent to make informed </span><span style="left: 120.04px; top: 616.4px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.910127);">decisions based on the knowledge of alternatives. As an ICEA certified educator, I will work with other </span><span style="left: 120.04px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.906108);">he</span><span style="left: 138.44px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.915049);">althcare professionals and consumers to promote family</span><span style="left: 556.233px; top: 638.8px; font-size: 18.4px; font-family: sans-serif;">-</span><span style="left: 561.833px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.916449);">centered maternity care, breastfeeding, and </span><span style="left: 120.04px; top: 661.2px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.953419);">parent</span><span style="left: 169.683px; top: 661.2px; font-size: 18.4px; font-family: sans-serif;">-</span><span style="left: 175.283px; top: 661.2px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.926322);">infant bonding. I advocate parental participation in childbirth and the avoidance of medical </span><span style="left: 120.04px; top: 683.6px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.916108);">intervention in uncomplicated labors. I accept as my prim</span><span style="left: 544.6px; top: 683.6px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.924882);">ary responsibility the preparation of expectant </span><span style="left: 120.04px; top: 706px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.92796);">parents, both mentally and physically, to participate in an individually satisfying pregnancy, labor, birth, </span><span style="left: 120.04px; top: 728.4px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.947571);">and introduction to parenthood.&quot;</span></h6>
					

				<input type="hidden" name="question_14" value="&lt;h6&gt;&lt;span style=&quot;left: 120.04px; top: 549.567px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.939872);&quot;&gt;Philosophy Statement&lt;/span&gt;&lt;/h6&gt;

&lt;h6&gt;&lt;span style=&quot;left: 120.04px; top: 593.967px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.927695);&quot;&gt;&amp;ldquo;I support the natural process of childbirth and the right of the expectant parent to make informed &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 616.4px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.910127);&quot;&gt;decisions based on the knowledge of alternatives. As an ICEA certified educator, I will work with other &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.906108);&quot;&gt;he&lt;/span&gt;&lt;span style=&quot;left: 138.44px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.915049);&quot;&gt;althcare professionals and consumers to promote family&lt;/span&gt;&lt;span style=&quot;left: 556.233px; top: 638.8px; font-size: 18.4px; font-family: sans-serif;&quot;&gt;-&lt;/span&gt;&lt;span style=&quot;left: 561.833px; top: 638.8px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.916449);&quot;&gt;centered maternity care, breastfeeding, and &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 661.2px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.953419);&quot;&gt;parent&lt;/span&gt;&lt;span style=&quot;left: 169.683px; top: 661.2px; font-size: 18.4px; font-family: sans-serif;&quot;&gt;-&lt;/span&gt;&lt;span style=&quot;left: 175.283px; top: 661.2px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.926322);&quot;&gt;infant bonding. I advocate parental participation in childbirth and the avoidance of medical &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 683.6px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.916108);&quot;&gt;intervention in uncomplicated labors. I accept as my prim&lt;/span&gt;&lt;span style=&quot;left: 544.6px; top: 683.6px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.924882);&quot;&gt;ary responsibility the preparation of expectant &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 706px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.92796);&quot;&gt;parents, both mentally and physically, to participate in an individually satisfying pregnancy, labor, birth, &lt;/span&gt;&lt;span style=&quot;left: 120.04px; top: 728.4px; font-size: 18.4px; font-family: sans-serif; transform: scaleX(0.947571);&quot;&gt;and introduction to parenthood.&amp;quot;&lt;/span&gt;&lt;/h6&gt;">
				<INPUT TYPE="hidden" NAME="response_14_question_id" VALUE="1135">
				<INPUT TYPE="hidden" NAME="question_type_14" value="None">
				<INPUT TYPE="hidden" NAME="label_14" value="">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1136" class="layout form item outer row-15 item-1136 row_num-220 row_pos-320 rowlength-1 type-Textarea" style="clear:both;;position:relative;">

			<div class="inner">

				
							Please type your name and the date below to confirm your acceptance of the Philosophy Statement.<span class="text-danger"> *</span>
					

							<textarea
								
								id="response_15"
								name="response_15"
								rows="5"
								class="form-control type-Textarea row-15 item-1136"
								
								
									style="width:200px;"
								

								></textarea>
								
						
						<INPUT
							TYPE="hidden"
							NAME="response_15_required"
							VALUE="The field Please type your name and the date below to confirm your acceptance of the Philosophy Statement. is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_15" value="Please type your name and the date below to confirm your acceptance of the Philosophy Statement.">
				<INPUT TYPE="hidden" NAME="response_15_question_id" VALUE="1136">
				<INPUT TYPE="hidden" NAME="question_type_15" value="Textarea">
				<INPUT TYPE="hidden" NAME="label_15" value="Philosophy Statement">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-1139" class="layout form item outer row-16 item-1139 row_num-240 row_pos-320 rowlength-1 type-None" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
						<p><span style="font-size:11.0pt">Once exam paperwork has been submitted, our office will review your documents. Please allow up to <b>2 weeks</b>&nbsp;for the review process to be completed.</span></p>
					

				<input type="hidden" name="question_16" value="&lt;p&gt;&lt;span style=&quot;font-size:11.0pt&quot;&gt;Once exam paperwork has been submitted, our office will review your documents. Please allow up to &lt;b&gt;2 weeks&lt;/b&gt;&amp;nbsp;for the review process to be completed.&lt;/span&gt;&lt;/p&gt;">
				<INPUT TYPE="hidden" NAME="response_16_question_id" VALUE="1139">
				<INPUT TYPE="hidden" NAME="question_type_16" value="None">
				<INPUT TYPE="hidden" NAME="label_16" value="  ">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
</div><!-- /form_layout_wrapper -->


		<div id="_ssdiv2" style="display:none">
			<input type="hidden" id="fld_uploadfields" name="UploadFields" value="11,12,13">
			<input type="hidden" id="fld_id_column" name="id_column" value="ID">
			<input type="hidden" id="fld_id_value" name="id_value" value="">
			<input type="hidden" id="fld_form_overrideid" name="form_overrideID" value="0">
			
			<input type="hidden" id="fld_ss_form_testid" name="ss_form_testid" value="0" />
			<div id="_ssdiv">
				<p style="background-color: blue"><input type="text" name="ss_city" value="" /></p>
			</div>
		</div>
		
			<input type="hidden" name="form_isEdit" value="0">
		
	
		<div id="div_bottom" style="clear:both;">
			
			
				<br /><br />
				
					<style>
						iframe[title="reCAPTCHA"] {
							height: 78px !important;
							margin-top: 0px !important;
						}
					</style>
					

				<style>
				div.g-recaptcha > div > div > iframe {
					height: 78px !important;
				}
				
				@media screen and (max-width: 575px) {
					#rc-imageselect, .g-recaptcha  {
						transform:scale(0.77);
						-webkit-transform:scale(0.77);transform-origin:0 0;
						-webkit-transform-origin:0 0;
					}
				}
				</style>
				
				<script src="https://www.recaptcha.net/recaptcha/api.js" async defer></script>
				<div class="g-recaptcha" data-sitekey="6LfdajYaAAAAAInm0_dQ-hEGQ5igC8Mc5iT4gM8Q"></div>
			
			
					<br/>
					<input type="hidden" name="use_ssl" value="1">
				
			
				<INPUT TYPE="hidden" NAME="send_mail_ind" VALUE="0">
				<INPUT TYPE="hidden" NAME="no_opt_out" VALUE="1">
			
	
			<div id="frm_submit_button">
				<br />
				<button class="btn btn-primary" type="button" data-loading-text="Please wait..." id="submitBtn"
					
						onclick="startValidate();"
					
				>Submit Form</button>
				<br /><br />
			</div>
	
			
			<div id="frm_verisign_seal_box">
				
				
			</div>
			
	
				<div id="frm_required_copy_bottom">
					<p>Fields marked with <span class="text-danger">*</span> are required.</p>
				</div>
			
	
				<div id="frm_ssl_copy_bottom"><p>Your form submission WILL be encrypted using SSL to ensure your privacy.</p></div>
			
	
		</div><!-- div_bottom -->
	
		
	</form>
</div>


	</div>


				</div> 
    </div> 
</div> 	

<div class="container_wrap_footer footer_color" id="footer">
  
  <div class="footer-text">
    <p>  © 2022 International Childbirth Education Association | All Rights Reserved</p>
  </div>

				<div class="button-group">
                  <div class="social">
              
                    
                    <a class="svg-icon facebook" href="https://www.facebook.com/ICEApage" target="_blank"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M279.14 288l14.22-92.66h-88.91v-60.13c0-25.35 12.42-50.06 52.24-50.06h40.42V6.26S260.43 0 225.36 0c-73.22 0-121.08 44.38-121.08 124.72v70.62H22.89V288h81.39v224h100.17V288z"/></svg></a>
                    
                    <a class="svg-icon twitter" href="https://twitter.com/ICEA_org" target="_blank"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M459.37 151.716c.325 4.548.325 9.097.325 13.645 0 138.72-105.583 298.558-298.558 298.558-59.452 0-114.68-17.219-161.137-47.106 8.447.974 16.568 1.299 25.34 1.299 49.055 0 94.213-16.568 130.274-44.832-46.132-.975-84.792-31.188-98.112-72.772 6.498.974 12.995 1.624 19.818 1.624 9.421 0 18.843-1.3 27.614-3.573-48.081-9.747-84.143-51.98-84.143-102.985v-1.299c13.969 7.797 30.214 12.67 47.431 13.319-28.264-18.843-46.781-51.005-46.781-87.391 0-19.492 5.197-37.36 14.294-52.954 51.655 63.675 129.3 105.258 216.365 109.807-1.624-7.797-2.599-15.918-2.599-24.04 0-57.828 46.782-104.934 104.934-104.934 30.213 0 57.502 12.67 76.67 33.137 23.715-4.548 46.456-13.32 66.599-25.34-7.798 24.366-24.366 44.833-46.132 57.827 21.117-2.273 41.584-8.122 60.426-16.243-14.292 20.791-32.161 39.308-52.628 54.253z"/></svg></a>
                    
                    <a class="svg-icon linkedin" href="https://www.linkedin.com/company/international-childbirth-education-association/" target="_blank"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M100.28 448H7.4V148.9h92.88zM53.79 108.1C24.09 108.1 0 83.5 0 53.8a53.79 53.79 0 0 1 107.58 0c0 29.7-24.1 54.3-53.79 54.3zM447.9 448h-92.68V302.4c0-34.7-.7-79.2-48.29-79.2-48.29 0-55.69 37.7-55.69 76.7V448h-92.78V148.9h89.08v40.8h1.3c12.4-23.5 42.69-48.3 87.88-48.3 94 0 111.28 61.9 111.28 142.3V448z"/></svg></a>
                    
                          <a class="svg-icon instagram" href="https://www.instagram.com/iceachildbirth/" target="_blank"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z"/></svg></a>
                    
                  </div>  
                 
                        
                            <a class="button-outline button" href="https://icea.org/" ><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><!-- Font Awesome Pro 5.15.4 by @fontawesome - https://fontawesome.com License - https://fontawesome.com/license (Commercial License) --><path d="M440,256H424a8,8,0,0,0-8,8V464a16,16,0,0,1-16,16H48a16,16,0,0,1-16-16V112A16,16,0,0,1,48,96H248a8,8,0,0,0,8-8V72a8,8,0,0,0-8-8H48A48,48,0,0,0,0,112V464a48,48,0,0,0,48,48H400a48,48,0,0,0,48-48V264A8,8,0,0,0,440,256ZM500,0,364,.34a12,12,0,0,0-12,12v10a12,12,0,0,0,12,12L454,34l.7.71L131.51,357.86a12,12,0,0,0,0,17l5.66,5.66a12,12,0,0,0,17,0L477.29,57.34l.71.7-.34,90a12,12,0,0,0,12,12h10a12,12,0,0,0,12-12L512,12A12,12,0,0,0,500,0Z"/></svg>Return to Main Website</a>
                          
               
                		</div>
					</div>


				<!-- ####### END FOOTER CONTAINER ####### -->
				</div>
		
	
			<div id="i4awidget_google_analytics_258" class="google_analytics"  >
				
					
			</div>
			
				
				<script type="text/javascript">
					
					_getComputedStyle = function(_elem, _style) {
  						var computedStyle;
  						if (typeof _elem.currentStyle != 'undefined') {
  							computedStyle = _elem.currentStyle; }
  						else {
  							computedStyle = document.defaultView.getComputedStyle(_elem, null);
  							}
						return computedStyle[_style];
						}
					
					var _widget_parentDiv = document.getElementById('Document');
					if (_widget_parentDiv) {
						var _wpdposition = _getComputedStyle(_widget_parentDiv,"position");
						if (_wpdposition == 'static') {
							_widget_parentDiv.style.position = 'relative';
						}
						_widget_parentDiv.appendChild(document.getElementById('i4awidget_google_analytics_258'));
					}
				</script>
				
			
</body>
</html>