{"id":1654,"date":"2022-10-19T16:46:53","date_gmt":"2022-10-19T21:46:53","guid":{"rendered":"https:\/\/culverbd.com\/?page_id=1654"},"modified":"2022-10-20T08:47:33","modified_gmt":"2022-10-20T13:47:33","slug":"whn-sample-subscription-form","status":"publish","type":"page","link":"https:\/\/culverbd.com\/whn-sample-subscription-form\/","title":{"rendered":"WHN sample subscription form"},"content":{"rendered":"\n\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/culverbd.com\/wp-content\/uploads\/2019\/08\/Start-Something.png\" alt=\"Start Something\" itemprop=\"image\" height=\"112\" width=\"400\" title=\"Start Something\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<form data-form_id=\"10\" id=\"fluentform_10\" data-form_instance=\"ff_form_instance_10_1\" method=\"POST\"><input type='hidden' name='__fluent_form_embded_post_id' value='1654' \/><input type=\"hidden\" id=\"_fluentform_10_fluentformnonce\" name=\"_fluentform_10_fluentformnonce\" value=\"cf3dfff2b5\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/?page_id=1654&amp;fl_builder\" \/><label for=&#039;ff_10_email&#039;>Email<\/label> <input type=\"email\" name=\"email\" id=\"ff_10_email\" data-name=\"email\"\/><label for=&#039;ff_10_names_first_name_&#039;>First Name<\/label> <input type=\"text\" name=\"names[first_name]\" id=\"ff_10_names_first_name_\"\/><label for=&#039;ff_10_names_last_name_&#039;>Last Name<\/label> <input type=\"text\" name=\"names[last_name]\" id=\"ff_10_names_last_name_\"\/><hr \/><label for=&#039;ff_10_dropdown&#039;>If you would ALSO like a PRINTED COPY by mail pick an option below<\/label> <select name=\"dropdown\" id=\"ff_10_dropdown\" data-name=\"dropdown\" data-calc_value=\"0\"><option value=\"\">Digital Only<\/option><option value=\"US Mailing Address (FREE)\">US Mailing Address (FREE)<\/option><option value=\"Mexico Mailing Address.....$119\/Year (6 Issues)\">Mexico Mailing Address&#8230;..$119\/Year (6 Issues)<\/option><option value=\"International Mailing Address.....$119\/Year (6 Issues)\">International Mailing Address&#8230;..$119\/Year (6 Issues)<\/option><\/select><label for=&#039;ff_10_input_text&#039;>Job Title<\/label> <input type=\"text\" name=\"input_text\" data-name=\"input_text\" id=\"ff_10_input_text\"\/><label for=&#039;ff_10_input_text_1&#039;>Company Name<\/label> <input type=\"text\" name=\"input_text_1\" data-name=\"input_text_1\" id=\"ff_10_input_text_1\"\/><label>Shipping Address<\/label><label for=&#039;ff_10_address_1_address_line_1_&#039;>Address Line 1<\/label> <input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_10_address_1_address_line_1_\" data-key_name=\"address_line_1\"\/><label for=&#039;ff_10_address_1_address_line_2_&#039;>Address Line 2<\/label> <input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_10_address_1_address_line_2_\" data-key_name=\"address_line_2\"\/><label for=&#039;ff_10_address_1_city_&#039;>City<\/label> <input type=\"text\" name=\"address_1[city]\" id=\"ff_10_address_1_city_\" data-key_name=\"city\"\/><label for=&#039;ff_10_address_1_state_&#039;>State<\/label> <input type=\"text\" name=\"address_1[state]\" id=\"ff_10_address_1_state_\" data-key_name=\"state\"\/><label for=&#039;ff_10_address_1_zip_&#039;>Zip Code<\/label> <input type=\"text\" name=\"address_1[zip]\" id=\"ff_10_address_1_zip_\" data-key_name=\"zip\"\/><label for=&#039;ff_10_address_1_country_&#039;>Country<\/label> <select name=\"address_1[country]\" id=\"ff_10_address_1_country_\" placeholder=\"Select Country\" data-key_name=\"country\"><option value=''>Select Country<\/option><optgroup label=\"\"><\/optgroup><optgroup label=\"\"><option value='AF'>Afghanistan<\/option><option value='AX'>Aland Islands<\/option><option value='AL'>Albania<\/option><option value='DZ'>Algeria<\/option><option value='AS'>American Samoa<\/option><option value='AD'>Andorra<\/option><option value='AO'>Angola<\/option><option value='AI'>Anguilla<\/option><option value='AQ'>Antarctica<\/option><option value='AG'>Antigua and Barbuda<\/option><option value='AR'>Argentina<\/option><option value='AM'>Armenia<\/option><option value='AW'>Aruba<\/option><option value='AU'>Australia<\/option><option value='AT'>Austria<\/option><option value='AZ'>Azerbaijan<\/option><option value='BS'>Bahamas<\/option><option value='BH'>Bahrain<\/option><option value='BD'>Bangladesh<\/option><option value='BB'>Barbados<\/option><option value='BY'>Belarus<\/option><option value='PW'>Belau<\/option><option value='BE'>Belgium<\/option><option value='BZ'>Belize<\/option><option value='BJ'>Benin<\/option><option value='BM'>Bermuda<\/option><option value='BT'>Bhutan<\/option><option value='BO'>Bolivia<\/option><option value='BQ'>Bonaire, Saint Eustatius and Saba<\/option><option value='BA'>Bosnia and Herzegovina<\/option><option value='BW'>Botswana<\/option><option value='BV'>Bouvet Island<\/option><option value='BR'>Brazil<\/option><option value='IO'>British Indian Ocean Territory<\/option><option value='VG'>British Virgin Islands<\/option><option value='BN'>Brunei<\/option><option value='BG'>Bulgaria<\/option><option value='BF'>Burkina Faso<\/option><option value='BI'>Burundi<\/option><option value='KH'>Cambodia<\/option><option value='CM'>Cameroon<\/option><option value='CA'>Canada<\/option><option value='CV'>Cape Verde<\/option><option value='KY'>Cayman Islands<\/option><option value='CF'>Central African Republic<\/option><option value='TD'>Chad<\/option><option value='CL'>Chile<\/option><option value='CN'>China<\/option><option value='CX'>Christmas Island<\/option><option value='CC'>Cocos (Keeling) Islands<\/option><option value='CO'>Colombia<\/option><option value='KM'>Comoros<\/option><option value='CG'>Congo (Brazzaville)<\/option><option value='CD'>Congo (Kinshasa)<\/option><option value='CK'>Cook Islands<\/option><option value='CR'>Costa Rica<\/option><option value='HR'>Croatia<\/option><option value='CU'>Cuba<\/option><option value='CW'>Cura&ccedil;ao<\/option><option value='CY'>Cyprus<\/option><option value='CZ'>Czech Republic<\/option><option value='DK'>Denmark<\/option><option value='DJ'>Djibouti<\/option><option value='DM'>Dominica<\/option><option value='DO'>Dominican Republic<\/option><option value='EC'>Ecuador<\/option><option value='EG'>Egypt<\/option><option value='SV'>El Salvador<\/option><option value='GQ'>Equatorial Guinea<\/option><option value='ER'>Eritrea<\/option><option value='EE'>Estonia<\/option><option value='ET'>Ethiopia<\/option><option value='FK'>Falkland Islands<\/option><option value='FO'>Faroe Islands<\/option><option value='FJ'>Fiji<\/option><option value='FI'>Finland<\/option><option value='FR'>France<\/option><option value='GF'>French Guiana<\/option><option value='PF'>French Polynesia<\/option><option value='TF'>French Southern Territories<\/option><option value='GA'>Gabon<\/option><option value='GM'>Gambia<\/option><option value='GE'>Georgia<\/option><option value='DE'>Germany<\/option><option value='GH'>Ghana<\/option><option value='GI'>Gibraltar<\/option><option value='GR'>Greece<\/option><option value='GL'>Greenland<\/option><option value='GD'>Grenada<\/option><option value='GP'>Guadeloupe<\/option><option value='GU'>Guam<\/option><option value='GT'>Guatemala<\/option><option value='GG'>Guernsey<\/option><option value='GN'>Guinea<\/option><option value='GW'>Guinea-Bissau<\/option><option value='GY'>Guyana<\/option><option value='HT'>Haiti<\/option><option value='HM'>Heard Island and McDonald Islands<\/option><option value='HN'>Honduras<\/option><option value='HK'>Hong Kong<\/option><option value='HU'>Hungary<\/option><option value='IS'>Iceland<\/option><option value='IN'>India<\/option><option value='ID'>Indonesia<\/option><option value='IR'>Iran<\/option><option value='IQ'>Iraq<\/option><option value='IE'>Ireland<\/option><option value='IM'>Isle of Man<\/option><option value='IL'>Israel<\/option><option value='IT'>Italy<\/option><option value='CI'>Ivory Coast<\/option><option value='JM'>Jamaica<\/option><option value='JP'>Japan<\/option><option value='JE'>Jersey<\/option><option value='JO'>Jordan<\/option><option value='KZ'>Kazakhstan<\/option><option value='KE'>Kenya<\/option><option value='KI'>Kiribati<\/option><option value='XK'>Kosovo<\/option><option value='KW'>Kuwait<\/option><option value='KG'>Kyrgyzstan<\/option><option value='LA'>Laos<\/option><option value='LV'>Latvia<\/option><option value='LB'>Lebanon<\/option><option value='LS'>Lesotho<\/option><option value='LR'>Liberia<\/option><option value='LY'>Libya<\/option><option value='LI'>Liechtenstein<\/option><option value='LT'>Lithuania<\/option><option value='LU'>Luxembourg<\/option><option value='MO'>Macao S.A.R., China<\/option><option value='MK'>Macedonia<\/option><option value='MG'>Madagascar<\/option><option value='MW'>Malawi<\/option><option value='MY'>Malaysia<\/option><option value='MV'>Maldives<\/option><option value='ML'>Mali<\/option><option value='MT'>Malta<\/option><option value='MH'>Marshall Islands<\/option><option value='MQ'>Martinique<\/option><option value='MR'>Mauritania<\/option><option value='MU'>Mauritius<\/option><option value='YT'>Mayotte<\/option><option value='MX'>Mexico<\/option><option value='FM'>Micronesia<\/option><option value='MD'>Moldova<\/option><option value='MC'>Monaco<\/option><option value='MN'>Mongolia<\/option><option value='ME'>Montenegro<\/option><option value='MS'>Montserrat<\/option><option value='MA'>Morocco<\/option><option value='MZ'>Mozambique<\/option><option value='MM'>Myanmar<\/option><option value='NA'>Namibia<\/option><option value='NR'>Nauru<\/option><option value='NP'>Nepal<\/option><option value='NL'>Netherlands<\/option><option value='NC'>New Caledonia<\/option><option value='NZ'>New Zealand<\/option><option value='NI'>Nicaragua<\/option><option value='NE'>Niger<\/option><option value='NG'>Nigeria<\/option><option value='NU'>Niue<\/option><option value='NF'>Norfolk Island<\/option><option value='KP'>North Korea<\/option><option value='MP'>Northern Mariana Islands<\/option><option value='NO'>Norway<\/option><option value='OM'>Oman<\/option><option value='PK'>Pakistan<\/option><option value='PS'>Palestinian Territory<\/option><option value='PA'>Panama<\/option><option value='PG'>Papua New Guinea<\/option><option value='PY'>Paraguay<\/option><option value='PE'>Peru<\/option><option value='PH'>Philippines<\/option><option value='PN'>Pitcairn<\/option><option value='PL'>Poland<\/option><option value='PT'>Portugal<\/option><option value='PR'>Puerto Rico<\/option><option value='QA'>Qatar<\/option><option value='RE'>Reunion<\/option><option value='RO'>Romania<\/option><option value='RU'>Russia<\/option><option value='RW'>Rwanda<\/option><option value='ST'>S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value='BL'>Saint Barth&eacute;lemy<\/option><option value='SH'>Saint Helena<\/option><option value='KN'>Saint Kitts and Nevis<\/option><option value='LC'>Saint Lucia<\/option><option value='SX'>Saint Martin (Dutch part)<\/option><option value='MF'>Saint Martin (French part)<\/option><option value='PM'>Saint Pierre and Miquelon<\/option><option value='VC'>Saint Vincent and the Grenadines<\/option><option value='WS'>Samoa<\/option><option value='SM'>San Marino<\/option><option value='SA'>Saudi Arabia<\/option><option value='SN'>Senegal<\/option><option value='RS'>Serbia<\/option><option value='SC'>Seychelles<\/option><option value='SL'>Sierra Leone<\/option><option value='SG'>Singapore<\/option><option value='SK'>Slovakia<\/option><option value='SI'>Slovenia<\/option><option value='SB'>Solomon Islands<\/option><option value='SO'>Somalia<\/option><option value='ZA'>South Africa<\/option><option value='GS'>South Georgia\/Sandwich Islands<\/option><option value='KR'>South Korea<\/option><option value='SS'>South Sudan<\/option><option value='ES'>Spain<\/option><option value='LK'>Sri Lanka<\/option><option value='SD'>Sudan<\/option><option value='SR'>Suriname<\/option><option value='SJ'>Svalbard and Jan Mayen<\/option><option value='SZ'>Swaziland<\/option><option value='SE'>Sweden<\/option><option value='CH'>Switzerland<\/option><option value='SY'>Syria<\/option><option value='TW'>Taiwan<\/option><option value='TJ'>Tajikistan<\/option><option value='TZ'>Tanzania<\/option><option value='TH'>Thailand<\/option><option value='TL'>Timor-Leste<\/option><option value='TG'>Togo<\/option><option value='TK'>Tokelau<\/option><option value='TO'>Tonga<\/option><option value='TT'>Trinidad and Tobago<\/option><option value='TN'>Tunisia<\/option><option value='TR'>Turkey<\/option><option value='TM'>Turkmenistan<\/option><option value='TC'>Turks and Caicos Islands<\/option><option value='TV'>Tuvalu<\/option><option value='UG'>Uganda<\/option><option value='UA'>Ukraine<\/option><option value='AE'>United Arab Emirates<\/option><option value='GB'>United Kingdom (UK)<\/option><option value='US'>United States (US)<\/option><option value='UM'>United States (US) Minor Outlying Islands<\/option><option value='VI'>United States (US) Virgin Islands<\/option><option value='UY'>Uruguay<\/option><option value='UZ'>Uzbekistan<\/option><option value='VU'>Vanuatu<\/option><option value='VA'>Vatican<\/option><option value='VE'>Venezuela<\/option><option value='VN'>Vietnam<\/option><option value='WF'>Wallis and Futuna<\/option><option value='EH'>Western Sahara<\/option><option value='YE'>Yemen<\/option><option value='ZM'>Zambia<\/option><option value='ZW'>Zimbabwe<\/option><\/optgroup><\/select><button type=\"submit\">Subscribe<\/button><\/form>        \n\n","protected":false},"excerpt":{"rendered":"<p>Email First Name Last Name If you would ALSO like a PRINTED COPY by mail pick an option below Digital OnlyUS Mailing Address (FREE)Mexico Mailing Address&#8230;..$119\/Year (6 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