Travel questions or comments? Email [email protected].
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Travel Authorization Request (TAR)
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Travel arrangements can be made after you are notified that the applicable approvals have been received.\n\nEvents include conferences, meetings, retreats, seminars, symposiums, or certain activities that include travel.\nLBL\u002FDOE approvals are required if you answer "Yes" to any ONE of the questions below-\n\nWill LBL\u002FDOE pay for any portion of the costs for the trip?\nWill LBL\u002FDOE cover the travelers salary during any portion of the time on the trip?\nWill you in any way be discussing work or representing LBL\u002FDOE during the trip?\n\n\nLBL Travel Policy\n","type":"control_text"},null,null,null,null,null,null,null,null,null,null,null,null,null,{"description":"","name":"email23","qid":"23","subLabel":"[email protected]","text":"Email","type":"control_email"},{"description":"","name":"listDates","qid":"24","subLabel":"","text":"List date(s) of personal days","type":"control_textbox"},null,{"description":"","name":"isThis","qid":"26","subLabel":"","text":"Is this a DOE sponsored Event?","type":"control_dropdown"},{"description":"Example-ACS, DOE, Gordon Conference......","name":"sponsor","qid":"27","subLabel":"","text":"Sponsor","type":"control_textbox"},{"description":"","name":"eventName28","qid":"28","subLabel":"","text":"Event Name","type":"control_textbox"},{"description":"","name":"eventUrl","qid":"29","subLabel":"If URL isn't available yet please indicate or N\u002FA if applicable","text":"Event URL","type":"control_textbox"},null,null,null,{"description":"","name":"eventLocation","qid":"33","text":"Event Location","type":"control_address"},{"description":"This can be located on the Event web page","name":"descriptionOf","qid":"34","subLabel":"","text":"Description of Event","type":"control_textarea"},null,null,{"description":"","name":"businessPurpose","qid":"37","subLabel":"","text":"Business Purpose","type":"control_dropdown"},null,{"description":"","name":"titleOf","qid":"39","subLabel":"","text":"Title of Poster and\u002For Abstract","type":"control_textbox"},{"description":"This statement should be between 230 and 1500 characters briefly explaining how this trip is going to benefit the Laboratory and DOE.","name":"benefitStatement","qid":"40","subLabel":"","text":"Benefit Statement","type":"control_textarea"},{"description":"Lodging, airfare, meals & ground transportation\nPer Diem Rates\nhttps:\u002F\u002Ftravel.lbl.gov\u002Freimbursements\u002Freimbursement_perdiem.html","name":"estimatedCost","qid":"41","subLabel":"","text":"Estimated Cost of Travel","type":"control_textbox"},{"description":"","name":"registrationAmount","qid":"42","subLabel":"","text":"Registration Amount","type":"control_textbox"},{"description":"","name":"preferredFlights43","qid":"43","subLabel":"","text":"Preferred Flights (Airline Flight# w\u002FDates & Times)","type":"control_textbox"},{"description":"","name":"airportDeparture44","qid":"44","subLabel":"","text":"Airport Departure","type":"control_textbox"},{"description":"","name":"airportArrival","qid":"45","subLabel":"","text":"Airport Arrival","type":"control_textbox"},{"description":"","name":"isThis46","qid":"46","subLabel":"","text":"Is this Foreign Travel?","type":"control_dropdown"},{"name":"foreignTrip","qid":"47","text":"Foreign Trip Details","type":"control_head"},{"description":"","name":"citizenship","qid":"48","subLabel":"","text":"Citizenship","type":"control_textbox"},{"description":"","name":"internationallyEnabled","qid":"49","subLabel":"","text":"Internationally enabled cell phone","type":"control_textbox"},{"description":"","name":"plannedItinerary","qid":"50","text":"Planned itinerary for each day of travel must be listed, including personal days","type":"control_matrix"},{"description":"Complete itinerary w\u002Faddresses of excursions from main business location","name":"dayTrips","qid":"51","subLabel":"","text":"Day Trips ","type":"control_textarea"},{"description":"Explain to DOE what you will be doing at each business point while on travel. 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This training is required for anyone traveling on behalf of LBNL. \nThe U.S. Department of State requires all travelers (Federal and Federal contractors) visiting any foreign country are to complete the HTSOS Training. (This personal security training requirement is a recommendation of the Accountability Review Board convened by the Secretary of the U.S.)Foreign travel of less than 45 cumulative days in a calendar year requires completion of a 5-hour online course, see additional information in the HTSOS section belowThis seminar is designed to provide participants with threat and situational awareness training against criminal and terrorist attacks while working in high threat regions. Participants will learn risk management, health management, surveillance detection, crime and personal protection, defensive driving, kidnapping prevention, minefield awareness and awareness of threats from explosives and countermeasures. 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background-color: rgba(248, 248, 248, 0);
}
[data-type="control_dropdown"] .form-input,
[data-type="control_dropdown"] .form-input-wide {
width: 150px;
}
.form-label {
font-family: "Open Sans", sans-serif;
}
li[data-type="control_image"] div {
text-align: left;
}
li[data-type="control_image"] img {
border: none;
border-width: 0px !important;
border-style: solid !important;
border-color: false !important;
}
.form-line-column {
width: auto;
width: 50%;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
}
.form-line-column.form-col-1 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-0 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-3 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-2 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-5 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-4 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-7 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-6 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-9 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-8 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-11 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-10 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-13 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-12 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-15 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-14 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-17 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-16 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-19 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-18 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-column.form-col-21 {
padding-left: 34px;
padding-right: 17px;
}
.form-line-column.form-col-20 {
padding-left: 17px;
padding-right: 34px;
}
.form-line-error {
background-color: #d9ceb2;
-webkit-box-shadow: inset 0px 3px 11px -7px #ff3200;
-moz-box-shadow: inset 0px 3px 11px -7px #ff3200;
box-shadow: inset 0px 3px 11px -7px #ff3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
-webkit-transition-property: none;
-moz-transition-property: none;
-ms-transition-property: none;
-o-transition-property: none;
transition-property: none;
-webkit-transition-duration: 0.3s;
-moz-transition-duration: 0.3s;
-ms-transition-duration: 0.3s;
-o-transition-duration: 0.3s;
transition-duration: 0.3s;
-webkit-transition-timing-function: ease;
-moz-transition-timing-function: ease;
-ms-transition-timing-function: ease;
-o-transition-timing-function: ease;
transition-timing-function: ease;
border: 1px solid #fff4f4;
-moz-box-shadow: 0 0 3px #fff4f4;
-webkit-box-shadow: 0 0 3px #fff4f4;
box-shadow: 0 0 3px #fff4f4;
}
.form-line-error .form-error-message {
margin: 0;
position: absolute;
color: #fff;
display: inline-block;
right: 0;
font-size: 10px;
position: absolute!important;
box-shadow: none;
top: 0px;
line-height: 20px;
color: #FFF;
background: #ff3200;
padding: 0px 5px;
bottom: auto;
min-width: 105px;
-webkit-border-radius: 0;
-moz-border-radius: 0;
border-radius: 0;
}
.form-line-error .form-error-message img,
.form-line-error .form-error-message .form-error-arrow {
display: none;
}
.form-all {
position: relative;
}
.form-all:before {
content: "";
background-image: url("//www.jotform.com/images/form-cover-default.png");
display: inline-block;
height: 100px;
position: absolute;
background-size: 206px 100px;
background-repeat: no-repeat;
width: 100%;
}
.form-all {
margin-top: 111px !important;
}
.form-all:before {
top: -111px;
background-position: top center;
}
.ie-8 .form-all {
margin-top: auto;
margin-top: initial;
}
.ie-8 .form-all:before {
display: none;
}
[data-type="control_clear"] {
display: none;
}
/* | */
@media screen and (max-width: 480px), screen and (max-device-width: 767px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {
.testOne {
letter-spacing: 0;
}
.form-all {
border: 0;
max-width: initial;
}
.form-sub-label-container {
width: 100%;
margin: 0;
margin-right: 0;
float: left;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
}
span.form-sub-label-container + span.form-sub-label-container {
margin-right: 0;
}
.form-sub-label {
white-space: normal;
}
.form-address-table td,
.form-address-table th {
padding: 0 1px 10px;
}
.form-submit-button,
.form-submit-print,
.form-submit-reset {
width: 100%;
margin-left: 0!important;
}
div[id*=at_] {
font-size: 14px;
font-weight: 700;
height: 8px;
margin-top: 6px;
}
.showAutoCalendar {
width: 20px;
}
img.form-image {
max-width: 100%;
height: auto;
}
.form-matrix-row-headers {
width: 100%;
word-break: break-all;
min-width: 40px;
}
.form-collapse-table,
.form-header-group {
margin: 0;
}
.form-collapse-table {
height: 100%;
display: inline-block;
width: 100%;
}
.form-collapse-hidden {
display: none !important;
}
.form-input {
width: 100%;
}
.form-label {
width: 100% !important;
}
.form-label-left,
.form-label-right {
display: block;
float: none;
text-align: left;
width: auto!important;
}
.form-line,
.form-line.form-line-column {
padding: 2% 5%;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
}
input[type=text],
input[type=email],
input[type=tel],
textarea {
width: 100%;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
max-width: initial !important;
}
.form-radio-other-input,
.form-checkbox-other-input {
max-width: 55% !important;
}
.form-dropdown,
.form-textarea,
.form-textbox {
width: 100%!important;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
}
.form-input,
.form-input-wide,
.form-textarea,
.form-textbox,
.form-dropdown {
max-width: initial!important;
}
.form-checkbox-item:not(#foo),
.form-radio-item:not(#foo) {
width: 100%;
}
.form-address-city,
.form-address-line,
.form-address-postal,
.form-address-state,
.form-address-table,
.form-address-table .form-sub-label-container,
.form-address-table select,
.form-input {
width: 100%;
}
div.form-header-group {
padding: 160px 36px !important;
padding-left: 5%!important;
padding-right: 5%!important;
margin: 0 0px 2% !important;
-moz-box-sizing: border-box;
-webkit-box-sizing: border-box;
box-sizing: border-box;
}
div.form-header-group.hasImage img {
max-width: 100%;
}
[data-type="control_button"] {
margin-bottom: 0 !important;
}
[data-type=control_fullname] .form-sub-label-container {
width: 48%;
}
[data-type=control_fullname] .form-sub-label-container:first-child {
margin-right: 4%;
}
[data-type=control_phone] .form-sub-label-container {
width: 65%;
margin-right: 0;
margin-left: 0;
float: left;
}
[data-type=control_phone] .form-sub-label-container:first-child {
width: 31%;
margin-right: 4%;
}
[data-type=control_datetime] .allowTime-container {
width: 100%;
}
[data-type=control_datetime] .form-sub-label-container:first-child {
width: 10%!important;
margin-left: 0;
margin-right: 0;
}
[data-type=control_datetime] .form-sub-label-container + .form-sub-label-container {
width: 24%!important;
margin-left: 6%;
margin-right: 0;
}
[data-type=control_datetime] span + span + span > span:first-child {
display: block;
width: 100% !important;
}
[data-type=control_birthdate] .form-sub-label-container,
[data-type=control_time] .form-sub-label-container {
width: 27.3%!important;
margin-right: 6% !important;
}
[data-type=control_time] .form-sub-label-container:last-child {
width: 33.3%!important;
margin-right: 0 !important;
}
.form-pagebreak-back-container,
.form-pagebreak-next-container {
min-height: 1px;
width: 50% !important;
}
.form-pagebreak-back,
.form-pagebreak-next,
.form-product-item.hover-product-item {
width: 100%;
}
.form-pagebreak-back-container {
padding: 0;
text-align: right;
}
.form-pagebreak-next-container {
padding: 0;
text-align: left;
}
.form-pagebreak {
margin: 0 auto;
}
.form-buttons-wrapper {
margin: 0!important;
margin-left: 0!important;
}
.form-buttons-wrapper button {
width: 100%;
}
.form-buttons-wrapper .form-submit-print {
margin: 0 !important;
}
table {
width: 100%!important;
max-width: initial!important;
}
table td + td {
padding-left: 3%;
}
.form-checkbox-item,
.form-radio-item {
white-space: normal!important;
}
.form-checkbox-item input,
.form-radio-item input {
width: auto;
}
.form-collapse-table {
margin: 0 5%;
display: block;
zoom: 1;
width: auto;
}
.form-collapse-table:before,
.form-collapse-table:after {
display: table;
content: '';
line-height: 0;
}
.form-collapse-table:after {
clear: both;
}
.fb-like-box {
width: 98% !important;
}
.form-error-message {
clear: both;
bottom: -10px;
}
.date-separate,
.phone-separate {
display: none;
}
.custom-field-frame,
.direct-embed-widgets,
.signature-pad-wrapper {
width: 100% !important;
}
}
/* | */
/*PREFERENCES STYLE*/
.form-all {
font-family: Open Sans, sans-serif;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-family: Open Sans, sans-serif;
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-family: Open Sans, sans-serif;
}
.form-header-group {
font-family: Open Sans, sans-serif;
}
.form-label {
font-family: Open Sans, sans-serif;
}
.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
.form-line {
margin-top: 5px;
margin-bottom: 5px;
}
.form-all {
max-width: 690px;
width: 100%;
}
.form-label.form-label-left,
.form-label.form-label-right,
.form-label.form-label-left.form-label-auto,
.form-label.form-label-right.form-label-auto {
width: 150px;
}
.form-all {
font-size: 16px
}
.form-all .qq-upload-button,
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-size: 16px
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-size: 16px
}
.supernova .form-all, .form-all {
background-color: #D9CEB2;
border: 1px solid transparent;
}
.form-all {
color: #3a270e;
}
.form-header-group .form-header {
color: rgb(255, 255, 255);
}
.form-header-group .form-subHeader {
color: #3a270e;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html,
.form-checkbox-item label,
.form-radio-item label {
color: #3a270e;
}
.form-sub-label {
color: #544128;
}
.supernova {
background-color: #948C75;
}
.supernova body {
background: transparent;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: #fff;
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-image: none;
}
.ie-8 .form-all:before { display: none; }
.ie-8 {
margin-top: auto;
margin-top: initial;
}
.form-all:before { display : none; } .form-all { margin-top: 0 !important; }
/*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/
/* Injected CSS Code */
</style>
<form class="jotform-form" action="https://lbl.jotform.com/submit/92476523824160/" method="post" enctype="multipart/form-data" name="form_92476523824160" id="92476523824160" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="92476523824160" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-small">
<div class="header-text httac htvam">
<h3 id="header_1" class="form-header" data-component="header">
Travel Authorization Request (TAR)
</h3>
<div id="subHeader_1" class="form-subHeader">
Chemical Sciences Division
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_9">
<div id="cid_9" class="form-input-wide">
<div id="text_9" class="form-html" data-component="text">
<p><span style="font-size: 8pt; color: #000000;"><strong>Updated 1/4/2021</strong></span></p>
<ul>
<li style="text-align: left;">
<span style="font-size: 18pt; color: #0000ff;">
<strong><a style="color: #0000ff;" href="https://drive.google.com/file/d/1XvdWeB_vCsEUJ8yGJqEehWpD3ETCaR-H/view" target="_blank" rel="nofollow">COVID-19 WPC TRAVEL Process</a></strong>
</span>
</li>
<li style="text-align: left;">
<span style="font-size: 18pt; color: #ff0000;">
<strong><span style="color: #0000ff;"><a style="color: #0000ff;" href="https://travel.lbl.gov/" target="_blank" rel="nofollow">Travel Services</a> </span>Updates</strong>
</span>
</li>
<li style="text-align: left;">
<span style="font-size: 18pt; color: #ff0000;">
<strong>All Virtual events </strong>
<strong>with or without</strong>
<strong>expenses must be submitted on a TAR</strong>
</span>
</li>
</ul>
<p>A travel authorization (TA) and approval is required for all travel that will be reimbursed by LBNL. The information will then be input for the required applicable DOE approval(s). Travel arrangements can be made after you are notified that the applicable approvals have been received.</p>
<ul>
<li>
Events include conferences, meetings, retreats, seminars, symposiums, or certain activities that include travel.
</li>
<li>
LBL/DOE approvals are required if you answer "Yes" to any ONE of the questions below-
<ul>
<li>
Will LBL/DOE pay for any portion of the costs for the trip?
</li>
<li>
Will LBL/DOE cover the travelers salary during any portion of the time on the trip?
</li>
<li>
Will you in any way be discussing work or representing LBL/DOE during the trip?
<span style="color: #ff0000;">
<em><br /></em>
</span>
</li>
</ul>
</li>
<li>
<span style="color: #ff0000;">
<a href="https://commons.lbl.gov/display/rpm2/Travel+Policy+and+Reference+Guide#TravelPolicyandReferenceGuide-64452698" target="_blank" rel="nofollow">LBL Travel Policy</a>
</span>
</li>
</ul>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_108">
<label class="form-label form-label-top form-label-auto" id="label_108" for="input_108"> Type of Event </label>
<div id="cid_108" class="form-input-wide">
<div class="form-single-column" role="group" aria-labelledby="label_108" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_108_0" name="q108_typeOf108" value="Virtual Conference" />
<label id="label_input_108_0" for="input_108_0"> Virtual Conference </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_108_1" name="q108_typeOf108" value="Local/Domestic User Facility" />
<label id="label_input_108_1" for="input_108_1"> Local/Domestic User Facility </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_108_2" name="q108_typeOf108" value="Foreign Travel" />
<label id="label_input_108_2" for="input_108_2"> Foreign Travel </label>
</span>
</div>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_98">
<label class="form-label form-label-top form-label-auto" id="label_98" for="input_98">
Please list the country in which the virtual conference is being hosted?
<span class="form-required">
*
</span>
</label>
<div id="cid_98" class="form-input-wide jf-required">
<input type="text" id="input_98" name="q98_pleaseList" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_98" required="" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_fullname" id="id_3">
<label class="form-label form-label-top form-label-auto" id="label_3" for="first_3">
Name
<span class="form-required">
*
</span>
</label>
<div id="cid_3" class="form-input-wide jf-required">
<div data-wrapper-react="true">
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="first">
<input type="text" id="first_3" name="q3_name[first]" class="form-textbox validate[required]" size="10" value="" data-component="first" aria-labelledby="label_3 sublabel_3_first" required="" />
<label class="form-sub-label" for="first_3" id="sublabel_3_first" style="min-height:13px" aria-hidden="false"> First </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="last">
<input type="text" id="last_3" name="q3_name[last]" class="form-textbox validate[required]" size="15" value="" data-component="last" aria-labelledby="label_3 sublabel_3_last" required="" />
<label class="form-sub-label" for="last_3" id="sublabel_3_last" style="min-height:13px" aria-hidden="false"> Last </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_4">
<label class="form-label form-label-top form-label-auto" id="label_4" for="input_4">
Employee ID#
<span class="form-required">
*
</span>
</label>
<div id="cid_4" class="form-input-wide jf-required">
<input type="text" id="input_4" name="q4_employeeId4" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_4" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-2 jf-required form-field-hidden" style="display:none;" data-type="control_email" id="id_23">
<label class="form-label form-label-top" id="label_23" for="input_23">
Email
<span class="form-required">
*
</span>
</label>
<div id="cid_23" class="form-input-wide jf-required">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="email" id="input_23" name="q23_email23" class="form-textbox validate[required, Email]" size="30" value="" data-component="email" aria-labelledby="label_23 sublabel_input_23" required="" />
<label class="form-sub-label" for="input_23" id="sublabel_input_23" style="min-height:13px" aria-hidden="false"> [email protected] </label>
</span>
</div>
</li>
<li class="form-line form-line-column form-col-3 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_76">
<label class="form-label form-label-top form-label-auto" id="label_76" for="input_76">
Cell Phone Number w/Area Code
<span class="form-required">
*
</span>
</label>
<div id="cid_76" class="form-input-wide jf-required">
<input type="text" id="input_76" name="q76_cellPhone" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_76" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-4 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_77">
<label class="form-label form-label-top form-label-auto" id="label_77" for="input_77"> Office Phone Number </label>
<div id="cid_77" class="form-input-wide">
<input type="text" id="input_77" name="q77_officePhone" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_77" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_57">
<label class="form-label form-label-top form-label-auto" id="label_57" for="input_57">
Supervisor Name & Email
<span class="form-required">
*
</span>
</label>
<div id="cid_57" class="form-input-wide jf-required">
<input type="text" id="input_57" name="q57_supervisorName" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_57" required="" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_phone" id="id_87">
<label class="form-label form-label-top form-label-auto" id="label_87" for="input_87_area">
Supervisor's Phone Numbers
<span class="form-required">
*
</span>
</label>
<div id="cid_87" class="form-input-wide jf-required">
<div data-wrapper-react="true">
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode">
<input type="tel" id="input_87_area" name="q87_supervisorsPhone[area]" class="form-textbox validate[required]" value="" data-component="areaCode" aria-labelledby="label_87 sublabel_87_area" required="" />
<span class="phone-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="input_87_area" id="sublabel_87_area" style="min-height:13px" aria-hidden="false"> Office </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone">
<input type="tel" id="input_87_phone" name="q87_supervisorsPhone[phone]" class="form-textbox validate[required]" value="" data-component="phone" aria-labelledby="label_87 sublabel_87_phone" required="" />
<label class="form-sub-label" for="input_87_phone" id="sublabel_87_phone" style="min-height:13px" aria-hidden="false"> Cell </label>
</span>
</div>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_100">
<label class="form-label form-label-top form-label-auto" id="label_100" for="input_100">
Is there a registration fee?
<span class="form-required">
*
</span>
</label>
<div id="cid_100" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_100" name="q100_isThere" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_100">
<option value=""> </option>
<option value="Yes"> Yes </option>
<option value="No"> No </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_42">
<label class="form-label form-label-top form-label-auto" id="label_42" for="input_42">
Registration Amount
<span class="form-required">
*
</span>
</label>
<div id="cid_42" class="form-input-wide jf-required">
<input type="text" id="input_42" name="q42_registrationAmount" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_42" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-2 form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_89">
<label class="form-label form-label-top form-label-auto" id="label_89" for="input_89"> Source of Funding </label>
<div id="cid_89" class="form-input-wide">
<select class="form-dropdown" id="input_89" name="q89_sourceOf89" style="width:150px" data-component="dropdown" aria-labelledby="label_89">
<option value=""> </option>
<option value="DOE"> DOE </option>
<option value="NIH"> NIH </option>
<option value="ROYALTY"> ROYALTY </option>
<option value="SPP/WFO"> SPP/WFO </option>
<option value="CSR"> CSR </option>
<option value="SPSA"> SPSA </option>
<option value="NNSA"> NNSA </option>
<option value="DOD"> DOD </option>
<option value="LDRD"> LDRD </option>
<option value="CRADA"> CRADA </option>
<option value="GIFTS"> GIFTS </option>
<option value="OTHER"> OTHER </option>
<option value=""> </option>
</select>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_107">
<label class="form-label form-label-top form-label-auto" id="label_107" for="input_107"> Misc. Costs </label>
<div id="cid_107" class="form-input-wide">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_107" name="q107_miscCosts" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_107 sublabel_input_107" />
<label class="form-sub-label" for="input_107" id="sublabel_input_107" style="min-height:13px" aria-hidden="false"> List any reimbursable costs and their amount </label>
</span>
</div>
</li>
<li class="form-line form-line-column form-col-1 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_8">
<label class="form-label form-label-top form-label-auto" id="label_8" for="input_8"> Will you have multiple sources of funding? </label>
<div id="cid_8" class="form-input-wide">
<input type="text" id="input_8" name="q8_willYou" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_8" />
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_7">
<label class="form-label form-label-top form-label-auto" id="label_7" for="input_7"> Name of Funding Project ID(s) & Activity Code(s) </label>
<div id="cid_7" class="form-input-wide">
<input type="text" id="input_7" name="q7_nameOf" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_7" />
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_58">
<label class="form-label form-label-top form-label-auto" id="label_58" for="input_58"> Project ID/Activity Code </label>
<div id="cid_58" class="form-input-wide">
<input type="text" id="input_58" name="q58_Project" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_58" />
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_74">
<label class="form-label form-label-top form-label-auto" id="label_74" for="input_74">
What is your position?
<span class="form-required">
*
</span>
</label>
<div id="cid_74" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_74" name="q74_whatIs74" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_74">
<option value=""> </option>
<option value="Staff"> Staff </option>
<option value="Postdoc"> Postdoc </option>
<option value="GSRA"> GSRA </option>
<option value="Undergraduate"> Undergraduate </option>
<option value="Affiliate"> Affiliate </option>
<option value="Other"> Other </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-2 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_75">
<label class="form-label form-label-top form-label-auto" id="label_75" for="input_75"> If "other" please explain </label>
<div id="cid_75" class="form-input-wide">
<input type="text" id="input_75" name="q75_ifother" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_75" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-line-column-clear jf-required form-field-hidden" style="display:none;" data-type="control_datetime" id="id_83">
<label class="form-label form-label-right" id="label_83" for="lite_mode_83">
Travel Start Date
<span class="form-required">
*
</span>
</label>
<div id="cid_83" class="form-input jf-required">
<div data-wrapper-react="true">
<div style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="month_83" name="q83_travelStart[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_83 sublabel_83_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_83" id="sublabel_83_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="day_83" name="q83_travelStart[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_83 sublabel_83_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_83" id="sublabel_83_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="year_83" name="q83_travelStart[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" required="" autoComplete="off" aria-labelledby="label_83 sublabel_83_year" />
<label class="form-sub-label" for="year_83" id="sublabel_83_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_83" size="12" data-maxlength="12" maxLength="12" data-age="" value="" required="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" autoComplete="off" aria-labelledby="label_83" />
<img class="showAutoCalendar newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_83_pick" src="https://lbl.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="lite_mode_83" id="sublabel_83_litemode" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-2 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_95">
<label class="form-label form-label-top form-label-auto" id="label_95" for="input_95">
Total Trip Days Including Travel
<span class="form-required">
*
</span>
</label>
<div id="cid_95" class="form-input-wide jf-required">
<input type="text" id="input_95" name="q95_totalTrip95" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_95" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-line-column-clear jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_96">
<label class="form-label form-label-top form-label-auto" id="label_96" for="input_96">
How many personal days will be taken?
<span class="form-required">
*
</span>
</label>
<div id="cid_96" class="form-input-wide jf-required">
<input type="text" id="input_96" name="q96_howMany96" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_96" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-2 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_24">
<label class="form-label form-label-top" id="label_24" for="input_24"> List date(s) of personal days </label>
<div id="cid_24" class="form-input-wide">
<input type="text" id="input_24" name="q24_listDates" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_24" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-line-column-clear jf-required form-field-hidden" style="display:none;" data-type="control_datetime" id="id_85">
<label class="form-label form-label-right" id="label_85" for="lite_mode_85">
Event Start Date
<span class="form-required">
*
</span>
</label>
<div id="cid_85" class="form-input jf-required">
<div data-wrapper-react="true">
<div style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="month_85" name="q85_eventStart[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_85 sublabel_85_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_85" id="sublabel_85_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="day_85" name="q85_eventStart[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_85 sublabel_85_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_85" id="sublabel_85_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="year_85" name="q85_eventStart[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" required="" autoComplete="off" aria-labelledby="label_85 sublabel_85_year" />
<label class="form-sub-label" for="year_85" id="sublabel_85_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_85" size="12" data-maxlength="12" maxLength="12" data-age="" value="" required="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" autoComplete="off" aria-labelledby="label_85" />
<img class="showAutoCalendar newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_85_pick" src="https://lbl.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="lite_mode_85" id="sublabel_85_litemode" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-2 jf-required form-field-hidden" style="display:none;" data-type="control_datetime" id="id_86">
<label class="form-label form-label-right" id="label_86" for="lite_mode_86">
Event End Date
<span class="form-required">
*
</span>
</label>
<div id="cid_86" class="form-input jf-required">
<div data-wrapper-react="true">
<div style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="month_86" name="q86_eventEnd86[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_86 sublabel_86_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_86" id="sublabel_86_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="day_86" name="q86_eventEnd86[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" required="" autoComplete="off" aria-labelledby="label_86 sublabel_86_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_86" id="sublabel_86_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[required, limitDate]" id="year_86" name="q86_eventEnd86[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" required="" autoComplete="off" aria-labelledby="label_86 sublabel_86_year" />
<label class="form-sub-label" for="year_86" id="sublabel_86_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[required, limitDate, validateLiteDate]" id="lite_mode_86" size="12" data-maxlength="12" maxLength="12" data-age="" value="" required="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" autoComplete="off" aria-labelledby="label_86" />
<img class="showAutoCalendar newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_86_pick" src="https://lbl.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="lite_mode_86" id="sublabel_86_litemode" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_105">
<label class="form-label form-label-top form-label-auto" id="label_105" for="input_105"> Name and Address of User Facility </label>
<div id="cid_105" class="form-input-wide">
<input type="text" id="input_105" name="q105_nameAnd" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_105" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-line-column-clear jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_28">
<label class="form-label form-label-top" id="label_28" for="input_28">
Event Name
<span class="form-required">
*
</span>
</label>
<div id="cid_28" class="form-input-wide jf-required">
<input type="text" id="input_28" name="q28_eventName28" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_28" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-2 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_29">
<label class="form-label form-label-top" id="label_29" for="input_29">
Event URL
<span class="form-required">
*
</span>
</label>
<div id="cid_29" class="form-input-wide jf-required">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_29" name="q29_eventUrl" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_29 sublabel_input_29" required="" />
<label class="form-sub-label" for="input_29" id="sublabel_input_29" style="min-height:13px" aria-hidden="false"> If URL isn't available yet please indicate or N/A if applicable </label>
</span>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textarea" id="id_106">
<label class="form-label form-label-top form-label-auto" id="label_106" for="input_106">
Justification Statement
<span class="form-required">
*
</span>
</label>
<div id="cid_106" class="form-input-wide jf-required">
<textarea id="input_106" class="form-textarea validate[required]" name="q106_justificationStatement" cols="40" rows="20" data-component="textarea" required="" aria-labelledby="label_106"></textarea>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textarea" id="id_40">
<label class="form-label form-label-top form-label-auto" id="label_40" for="input_40">
Benefit Statement
<span class="form-required">
*
</span>
</label>
<div id="cid_40" class="form-input-wide jf-required">
<textarea id="input_40" class="form-textarea validate[required]" name="q40_benefitStatement" cols="40" rows="15" data-component="textarea" required="" aria-labelledby="label_40"></textarea>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textarea" id="id_52">
<label class="form-label form-label-top form-label-auto" id="label_52" for="input_52">
Trip Purpose
<span class="form-required">
*
</span>
</label>
<div id="cid_52" class="form-input-wide jf-required">
<textarea id="input_52" class="form-textarea validate[required]" name="q52_tripPurpose" cols="40" rows="15" data-component="textarea" required="" aria-labelledby="label_52"></textarea>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_fileupload" id="id_101">
<label class="form-label form-label-top form-label-auto" id="label_101" for="input_101"> </label>
<div id="cid_101" class="form-input-wide">
<div data-wrapper-react="true">
<span class="form-sub-label-container" style="vertical-align:top">
<div class="qq-uploader-buttonText-value">
Browse Files
</div>
<input type="file" id="input_101" name="q101_input101[]" multiple="" class="form-upload-multiple" data-imagevalidate="yes" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" data-file-maxsize="10854" data-file-minsize="0" data-file-limit="" data-component="fileupload" />
<label class="form-sub-label" for="input_101" style="min-height:13px" aria-hidden="false"> Please upload any supporting documentation for your justification letter </label>
</span>
<span style="display:none" class="cancelText">
Cancel
</span>
<span style="display:none" class="ofText">
of
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_46">
<label class="form-label form-label-top form-label-auto" id="label_46" for="input_46">
Is this Foreign Travel?
<span class="form-required">
*
</span>
</label>
<div id="cid_46" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_46" name="q46_isThis46" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_46">
<option value=""> </option>
<option value="Yes"> Yes </option>
<option value="No"> No </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-2 jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_26">
<label class="form-label form-label-top" id="label_26" for="input_26">
Is this a DOE sponsored Event?
<span class="form-required">
*
</span>
</label>
<div id="cid_26" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_26" name="q26_isThis" style="width:20px" data-component="dropdown" required="" aria-labelledby="label_26">
<option value=""> </option>
<option value="Yes "> Yes </option>
<option value="No"> No </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-3 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_90">
<label class="form-label form-label-top form-label-auto" id="label_90" for="input_90">
Country you will be traveling to
<span class="form-required">
*
</span>
</label>
<div id="cid_90" class="form-input-wide jf-required">
<input type="text" id="input_90" name="q90_countryYou" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_90" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-line-column-clear form-field-hidden" style="display:none;" data-type="control_textbox" id="id_27">
<label class="form-label form-label-top form-label-auto" id="label_27" for="input_27"> Sponsor </label>
<div id="cid_27" class="form-input-wide">
<input type="text" id="input_27" name="q27_sponsor" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_27" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_address" id="id_33" data-compound-hint=",,,,,">
<label class="form-label form-label-top form-label-auto" id="label_33" for="input_33_addr_line1">
Event Location
<span class="form-required">
*
</span>
</label>
<div id="cid_33" class="form-input-wide jf-required">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_33_addr_line1" name="q33_eventLocation[addr_line1]" class="form-textbox validate[required] form-address-line" value="" data-component="address_line_1" aria-labelledby="label_33 sublabel_33_addr_line1" />
<label class="form-sub-label" for="input_33_addr_line1" id="sublabel_33_addr_line1" style="min-height:13px" aria-hidden="false"> Name of Venue (i.e. Hotel, Conference Center) </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-street-line jsTest-address-lineField">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_33_addr_line2" name="q33_eventLocation[addr_line2]" class="form-textbox form-address-line" value="" data-component="address_line_2" aria-labelledby="label_33 sublabel_33_addr_line2" />
<label class="form-sub-label" for="input_33_addr_line2" id="sublabel_33_addr_line2" style="min-height:13px" aria-hidden="false"> Address </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-city-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_33_city" name="q33_eventLocation[city]" class="form-textbox validate[required] form-address-city" value="" data-component="city" aria-labelledby="label_33 sublabel_33_city" />
<label class="form-sub-label" for="input_33_city" id="sublabel_33_city" style="min-height:13px" aria-hidden="false"> City </label>
</span>
</span>
<span class="form-address-line form-address-state-line jsTest-address-lineField ">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_33_state" name="q33_eventLocation[state]" class="form-textbox validate[required] form-address-state" value="" data-component="state" aria-labelledby="label_33 sublabel_33_state" />
<label class="form-sub-label" for="input_33_state" id="sublabel_33_state" style="min-height:13px" aria-hidden="false"> State / Province/Country </label>
</span>
</span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField">
<span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" id="input_33_postal" name="q33_eventLocation[postal]" class="form-textbox form-address-postal" value="" data-component="zip" aria-labelledby="label_33 sublabel_33_postal" />
<label class="form-sub-label" for="input_33_postal" id="sublabel_33_postal" style="min-height:13px" aria-hidden="false"> Postal / Zip Code </label>
</span>
</span>
</div>
</div>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textarea" id="id_34">
<label class="form-label form-label-top form-label-auto" id="label_34" for="input_34">
Description of Event
<span class="form-required">
*
</span>
</label>
<div id="cid_34" class="form-input-wide jf-required">
<textarea id="input_34" class="form-textarea validate[required]" name="q34_descriptionOf" cols="40" rows="6" data-component="textarea" required="" aria-labelledby="label_34"></textarea>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_39">
<label class="form-label form-label-top form-label-auto" id="label_39" for="input_39"> Title of Poster and/or Abstract </label>
<div id="cid_39" class="form-input-wide">
<input type="text" id="input_39" name="q39_titleOf" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_39" />
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_37">
<label class="form-label form-label-top form-label-auto" id="label_37" for="input_37">
Business Purpose
<span class="form-required">
*
</span>
</label>
<div id="cid_37" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_37" name="q37_businessPurpose" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_37">
<option value=""> </option>
<option value="Conference/Workshop"> Conference/Workshop </option>
<option value="Employee Training"> Employee Training </option>
<option value="Experiment/Facility Use/Site Visit"> Experiment/Facility Use/Site Visit </option>
<option value="Interview"> Interview </option>
<option value="Meeting/Programmatic Planning"> Meeting/Programmatic Planning </option>
<option value="Non-Employee Long Term Travel"> Non-Employee Long Term Travel </option>
<option value="Other"> Other </option>
<option value="Program Peer Review"> Program Peer Review </option>
<option value="Research & Development"> Research & Development </option>
<option value="Seminar/Symposium"> Seminar/Symposium </option>
<option value="Speech or Presentation"> Speech or Presentation </option>
<option value=""> </option>
</select>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_checkbox" id="id_91">
<label class="form-label form-label-top form-label-auto" id="label_91" for="input_91"> Reason for Attending </label>
<div id="cid_91" class="form-input-wide">
<div class="form-single-column" role="group" aria-labelledby="label_91" data-component="checkbox">
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_0" name="q91_reasonFor[]" value="Attendee/Participant" />
<label id="label_input_91_0" for="input_91_0"> Attendee/Participant </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_1" name="q91_reasonFor[]" value="Invited Speaker" />
<label id="label_input_91_1" for="input_91_1"> Invited Speaker </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_2" name="q91_reasonFor[]" value="Keynote or Plenary Speaker" />
<label id="label_input_91_2" for="input_91_2"> Keynote or Plenary Speaker </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_3" name="q91_reasonFor[]" value="Poster Presenter" />
<label id="label_input_91_3" for="input_91_3"> Poster Presenter </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_4" name="q91_reasonFor[]" value="Session Chair" />
<label id="label_input_91_4" for="input_91_4"> Session Chair </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_5" name="q91_reasonFor[]" value="Organizing Committee Member" />
<label id="label_input_91_5" for="input_91_5"> Organizing Committee Member </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_91_6" name="q91_reasonFor[]" value="Beamtime" />
<label id="label_input_91_6" for="input_91_6"> Beamtime </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<input type="checkbox" class="form-checkbox-other form-checkbox" name="q91_reasonFor[other]" id="other_91" value="other" aria-label="Other" />
<label id="label_other_91" style="text-indent:0" for="other_91"> </label>
<input type="text" class="form-checkbox-other-input form-textbox" name="q91_reasonFor[other]" data-otherhint="Other" size="15" id="input_91" placeholder="Other" />
<br/>
</span>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_41">
<label class="form-label form-label-top form-label-auto" id="label_41" for="input_41">
Estimated Cost of Travel
<span class="form-required">
*
</span>
</label>
<div id="cid_41" class="form-input-wide jf-required">
<input type="text" id="input_41" name="q41_estimatedCost" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_41" required="" />
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_checkbox" id="id_72">
<label class="form-label form-label-top form-label-auto" id="label_72" for="input_72"> Do you need assistance with? </label>
<div id="cid_72" class="form-input-wide">
<div class="form-single-column" role="group" aria-labelledby="label_72" data-component="checkbox">
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_72_0" name="q72_doYou72[]" value="Flights" />
<label id="label_input_72_0" for="input_72_0"> Flights </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_72_1" name="q72_doYou72[]" value="Hotel" />
<label id="label_input_72_1" for="input_72_1"> Hotel </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_72_2" name="q72_doYou72[]" value="Rental Car" />
<label id="label_input_72_2" for="input_72_2"> Rental Car </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_72_3" name="q72_doYou72[]" value="All of the above" />
<label id="label_input_72_3" for="input_72_3"> All of the above </label>
</span>
<span class="form-checkbox-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="checkbox" class="form-checkbox" id="input_72_4" name="q72_doYou72[]" value="None" />
<label id="label_input_72_4" for="input_72_4"> None </label>
</span>
</div>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_73">
<label class="form-label form-label-top form-label-auto" id="label_73" for="input_73"> List Preferred Hotel & Rental Car Agency w/ member rewards# if applicable </label>
<div id="cid_73" class="form-input-wide">
<input type="text" id="input_73" name="q73_listPreferred" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_73" />
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_43">
<label class="form-label form-label-top form-label-auto" id="label_43" for="input_43"> Preferred Flights (Airline Flight# w/Dates & Times) </label>
<div id="cid_43" class="form-input-wide">
<input type="text" id="input_43" name="q43_preferredFlights43" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_43" />
</div>
</li>
<li class="form-line form-line-column form-col-1 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_44">
<label class="form-label form-label-top form-label-auto" id="label_44" for="input_44"> Airport Departure </label>
<div id="cid_44" class="form-input-wide">
<input type="text" id="input_44" name="q44_airportDeparture44" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_44" />
</div>
</li>
<li class="form-line form-line-column form-col-2 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_45">
<label class="form-label form-label-top form-label-auto" id="label_45" for="input_45"> Airport Arrival </label>
<div id="cid_45" class="form-input-wide">
<input type="text" id="input_45" name="q45_airportArrival" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_45" />
</div>
</li>
<li id="cid_47" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_47" class="form-header" data-component="header">
Foreign Trip Details
</h2>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-3 jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_48">
<label class="form-label form-label-top form-label-auto" id="label_48" for="input_48">
Citizenship
<span class="form-required">
*
</span>
</label>
<div id="cid_48" class="form-input-wide jf-required">
<input type="text" id="input_48" name="q48_citizenship" data-type="input-textbox" class="form-textbox validate[required]" size="20" value="" data-component="textbox" aria-labelledby="label_48" required="" />
</div>
</li>
<li class="form-line form-line-column form-col-4 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_49">
<label class="form-label form-label-top form-label-auto" id="label_49" for="input_49"> Internationally enabled cell phone </label>
<div id="cid_49" class="form-input-wide">
<input type="text" id="input_49" name="q49_internationallyEnabled" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_49" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_matrix" id="id_50">
<label class="form-label form-label-top" id="label_50" for="input_50">
Planned itinerary for each day of travel must be listed, including personal days
<span class="form-required">
*
</span>
</label>
<div id="cid_50" class="form-input-wide jf-required">
<table summary="" role="presentation" cellPadding="4" cellSpacing="0" class="form-matrix-table" style="width:620px" data-component="matrix">
<tr class="form-matrix-tr form-matrix-header-tr">
<th class="form-matrix-th" style="border:none">
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_0" style="width:200px">
<label id="label_50_col_0"> Depart Date </label>
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_1" style="width:200px">
<label id="label_50_col_1"> Depart City </label>
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_2" style="width:200px">
<label id="label_50_col_2"> Arrival Date </label>
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_3" style="width:200px">
<label id="label_50_col_3"> Arrival City </label>
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_4" style="width:200px">
<label id="label_50_col_4"> Total # Nights </label>
</th>
<th scope="col" class="form-matrix-headers form-matrix-column-headers form-matrix-column_5" style="width:200px">
<label id="label_50_col_5"> Personal Days </label>
</th>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_0">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_0"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_0_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[0][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_0_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[0][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_0_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[0][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_0_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[0][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_0_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[0][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_0_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[0][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_1">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_1"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_1_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[1][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_1_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[1][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_1_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[1][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_1_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[1][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_1_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[1][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_1_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[1][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_2">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_2"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_2_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[2][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_2_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[2][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_2_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[2][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_2_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[2][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_2_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[2][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_2_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[2][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_3">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_3"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_3_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[3][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_3_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[3][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_3_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[3][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_3_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[3][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_3_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[3][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_3_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[3][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_4">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_4"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_4_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[4][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_4_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[4][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_4_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[4][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_4_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[4][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_4_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[4][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_4_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[4][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
<tr class="form-matrix-tr form-matrix-value-tr" role="group" aria-labelledby="label_50 label_50_row_5">
<th scope="row" class="form-matrix-headers form-matrix-row-headers">
<label id="label_50_row_5"> Day </label>
</th>
<td class="form-matrix-values">
<input type="text" id="input_50_5_0" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[5][0]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_0" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_5_1" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[5][1]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_1" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_5_2" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[5][2]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_2" />
</td>
<td class="form-matrix-values">
<input type="text" id="input_50_5_3" class="form-textbox validate[required]" size="5" name="q50_plannedItinerary[5][3]" style="width:100%;box-sizing:border-box" required="" value="" aria-labelledby="label_50_col_3" />
</td>
<td class="form-matrix-values">
<select id="input_50_5_4" class="form-dropdown validate[required]" name="q50_plannedItinerary[5][4]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_4">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
<td class="form-matrix-values">
<select id="input_50_5_5" class="form-dropdown validate[required]" name="q50_plannedItinerary[5][5]" style="width:100%;box-sizing:border-box" required="" aria-labelledby="label_50_col_5">
<option> </option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3"> 3 </option>
<option value="4"> 4 </option>
<option value="5"> 5 </option>
<option value="6"> 6 </option>
<option value="7"> 7 </option>
<option value="8"> 8 </option>
<option value="9"> 9 </option>
<option value="10"> 10 </option>
<option value="11"> 11 </option>
<option value="12"> 12 </option>
<option value="13"> 13 </option>
<option value="14"> 14 </option>
<option value="15"> 15 </option>
<option value="16"> 16 </option>
<option value="17"> 17 </option>
<option value="18"> 18 </option>
<option value="19"> 19 </option>
<option value="20"> 20 </option>
</select>
</td>
</tr>
</table>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textarea" id="id_51">
<label class="form-label form-label-top form-label-auto" id="label_51" for="input_51"> Day Trips </label>
<div id="cid_51" class="form-input-wide">
<textarea id="input_51" class="form-textarea" name="q51_dayTrips" cols="40" rows="6" data-component="textarea" aria-labelledby="label_51"></textarea>
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textarea" id="id_53">
<label class="form-label form-label-top form-label-auto" id="label_53" for="input_53">
Host Information
<span class="form-required">
*
</span>
</label>
<div id="cid_53" class="form-input-wide jf-required">
<textarea id="input_53" class="form-textarea validate[required]" name="q53_hostInformation" cols="40" rows="6" data-component="textarea" required="" aria-labelledby="label_53"></textarea>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textbox" id="id_78">
<label class="form-label form-label-top form-label-auto" id="label_78" for="input_78"> Emergency Contact in U.S </label>
<div id="cid_78" class="form-input-wide">
<input type="text" id="input_78" name="q78_emergencyContact" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_78" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_textbox" id="id_54">
<label class="form-label form-label-top form-label-auto" id="label_54" for="input_54">
After Hours Point of Contact
<span class="form-required">
*
</span>
</label>
<div id="cid_54" class="form-input-wide jf-required">
<input type="text" id="input_54" name="q54_afterHours" data-type="input-textbox" class="form-textbox validate[required]" size="100" value="" data-component="textbox" aria-labelledby="label_54" required="" />
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textarea" id="id_55">
<label class="form-label form-label-top form-label-auto" id="label_55" for="input_55"> Personal Time Lodging if applicable </label>
<div id="cid_55" class="form-input-wide">
<textarea id="input_55" class="form-textarea" name="q55_personalTime55" cols="40" rows="6" data-component="textarea" aria-labelledby="label_55"></textarea>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_textarea" id="id_56">
<label class="form-label form-label-top form-label-auto" id="label_56" for="input_56"> Team Members </label>
<div id="cid_56" class="form-input-wide">
<textarea id="input_56" class="form-textarea" name="q56_teamMembers" cols="40" rows="6" data-component="textarea" aria-labelledby="label_56"></textarea>
</div>
</li>
<li class="form-line form-line-column form-col-1 jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_60">
<label class="form-label form-label-top form-label-auto" id="label_60" for="input_60">
Will LBNL Equipment be traveling with you?
<span class="form-required">
*
</span>
</label>
<div id="cid_60" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_60" name="q60_willLbnl" style="width:150px" data-component="dropdown" required="" aria-labelledby="label_60">
<option value=""> </option>
<option value="No"> No </option>
<option value="Cell Phone"> Cell Phone </option>
<option value="Laptop"> Laptop </option>
<option value="Cell Phone & Laptop"> Cell Phone & Laptop </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-2 form-field-hidden" style="display:none;" data-type="control_textbox" id="id_61">
<label class="form-label form-label-top form-label-auto" id="label_61" for="input_61"> Provide laptop DOE # </label>
<div id="cid_61" class="form-input-wide">
<input type="text" id="input_61" name="q61_Provide61" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_61" />
</div>
</li>
<li class="form-line jf-required form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_88">
<label class="form-label form-label-top form-label-auto" id="label_88" for="input_88">
DOE Program Manager
<span class="form-required">
*
</span>
</label>
<div id="cid_88" class="form-input-wide jf-required">
<select class="form-dropdown validate[required]" id="input_88" name="q88_doeProgram" style="width:149px" data-component="dropdown" required="" aria-labelledby="label_88">
<option value=""> </option>
<option value=""> </option>
<option value="Atomic,Molecular & Optical-Tom Settersten [email protected](301)903-428 "> Atomic,Molecular & Optical-Tom Settersten [email protected](301)903-428 </option>
<option value=""> </option>
<option value="Catalysis-Chris Bradley [email protected] (301) 903-2047 AND Viviane Schwartz [email protected] (301) 903-0448 "> Catalysis-Chris Bradley [email protected] (301) 903-2047 AND Viviane Schwartz [email protected] (301) 903-0448 </option>
<option value=""> </option>
<option value="Condensed Phase and Interfacial Molecular-Gregory Fiechtner [email protected] (301) 903-5809"> Condensed Phase and Interfacial Molecular-Gregory Fiechtner [email protected] (301) 903-5809 </option>
<option value=""> </option>
<option value="Gas Phase Chemical Physic-Wade Sisk [email protected] (301) 903-5692 "> Gas Phase Chemical Physic-Wade Sisk [email protected] (301) 903-5692 </option>
<option value=""> </option>
<option value="Heavy Element Chemistry-Phillip Wilk [email protected] (301) 903-4537"> Heavy Element Chemistry-Phillip Wilk [email protected] (301) 903-4537 </option>
<option value=""> </option>
<option value="JCAP-Christopher Fecko [email protected] (301) 903-1303 "> JCAP-Christopher Fecko [email protected] (301) 903-1303 </option>
</select>
</div>
</li>
<li class="form-line form-field-hidden" style="display:none;" data-type="control_text" id="id_71">
<div id="cid_71" class="form-input-wide">
<div id="text_71" class="form-html" data-component="text">
<p style="text-align: center;"><strong><span style="font-size: 8pt;">HIGH THREAT SECURITY OVERSEAS SEMINAR (HTSOS)</span></strong></p>
<p style="text-align: justify;"><span style="font-size: 8pt;">In response to evolving threats, the U.S. Department of State has increased required security training requirements to better educate and prepare travelers who are on foreign travel. This training is required for anyone traveling on behalf of LBNL. </span></p>
<p style="text-align: justify;"><span style="font-size: 8pt;">The U.S. Department of State requires all travelers (Federal and Federal contractors) visiting any foreign country are to complete the HTSOS Training. (This personal security training requirement is a recommendation of the Accountability Review Board convened by the Secretary of the U.S.)</span><br /><span style="font-size: 8pt;">Foreign travel of less than 45 cumulative days in a calendar year requires completion of a 5-hour online course, see additional information in the HTSOS section below</span><br /><span style="font-size: 8pt;">This seminar is designed to provide participants with threat and situational awareness training against criminal and terrorist attacks while working in high threat regions. Participants will learn risk management, health management, surveillance detection, crime and personal protection, defensive driving, kidnapping prevention, minefield awareness and awareness of threats from explosives and countermeasures. It is an interactive e-Learning seminar available via the Internet, using a computer or mobile device.</span></p>
<p style="text-align: justify;"><span style="font-size: 8pt;">8-module online course (estimated 5-hour duration)</span><br /><span style="font-size: 8pt;">No tuition fee for HTSOS</span><br /><span style="font-size: 8pt;">Training certificate is valid for 5 years (for most countries)</span></p>
<p style="text-align: justify;"><span style="font-size: 8pt;">To successfully complete this course, the traveler must pass every exam (exam after each module) with a score of 80% or better. </span></p>
<p style="text-align: left;"><strong><em><span style="color: #ff0000;">To obtain login credentials, send an email to Debbie Warner at [email protected] with the traveler's name and email address. </span></em></strong>An email will be sent to the traveler with information on this training, followed by an additional email with the link from the DOE Portal for the traveler to begin this training.</p>
<p style="text-align: justify;"><span style="font-size: 8pt;">Once the traveler has completed the HTSOS course, they are to provide a copy of the certificate documenting the course is completed to Debbie Warner @ [email protected] . At this time, the trip can then be submitted in the DOE system and a cable request can then be sent to the Embassy (Department of State). Once the cable is submitted for review and approvals, the copy of the certificate must be emailed to Department of State contacts for that country for their review process. Employees should carry a copy of their completion certificates with them on travel, as they may need to provide a copy upon request.</span></p>
</div>
</div>
</li>
<li class="form-line form-line-column form-col-1 always-hidden form-field-hidden" style="display:none;" data-type="control_dropdown" id="id_69">
<label class="form-label form-label-top form-label-auto" id="label_69" for="input_69"> Division Director Approval </label>
<div id="cid_69" class="form-input-wide always-hidden">
<select class="form-dropdown" id="input_69" name="q69_divisionDirector" style="width:150px" data-component="dropdown" aria-labelledby="label_69">
<option value=""> </option>
<option value="Yes, by Bruce Garrett"> Yes, by Bruce Garrett </option>
<option value="No, by Bruce Garrett"> No, by Bruce Garrett </option>
<option value=""> </option>
</select>
</div>
</li>
<li class="form-line form-line-column form-col-2 always-hidden form-field-hidden" style="display:none;" data-type="control_datetime" id="id_68">
<label class="form-label form-label-right" id="label_68" for="lite_mode_68"> Date </label>
<div id="cid_68" class="form-input always-hidden">
<div data-wrapper-react="true">
<div style="display:none">
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="month_68" name="q68_date[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_68 sublabel_68_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_68" id="sublabel_68_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="day_68" name="q68_date[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_68 sublabel_68_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_68" id="sublabel_68_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="year_68" name="q68_date[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" autoComplete="off" aria-labelledby="label_68 sublabel_68_year" />
<label class="form-sub-label" for="year_68" id="sublabel_68_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
</div>
<span class="form-sub-label-container" style="vertical-align:top">
<input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_68" size="12" data-maxlength="12" maxLength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" autoComplete="off" aria-labelledby="label_68" />
<img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_68_pick" src="https://lbl.jotform.com/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="lite_mode_68" id="sublabel_68_litemode" style="min-height:13px" aria-hidden="false"> </label>
</span>
</div>
</div>
</li>
<li class="form-line always-hidden form-field-hidden" style="display:none;" data-type="control_widget" id="id_79">
<div id="cid_79" class=" always-hidden">
<div style="width:100%;text-align:Left" data-component="widget-directEmbed">
<div class="direct-embed-widgets get-form-page-url-widget " data-type="direct-embed" style="width:1px;min-height:50px">
<input type='hidden' id='input_79' name='q79_typeA' class='form-hidden getParentURL'>
<script type='text/javascript' src='//widgets.jotform.io/getParentUrl/min/scripts.min.js'></script>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_70">
<div id="cid_70" class="form-input-wide">
<div style="text-align:center" data-align="center" class="form-buttons-wrapper form-buttons-center jsTest-button-wrapperField">
<button id="input_70" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="">
Submit
</button>
</div>
</div>
</li>
<li style="clear:both">
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<script>
JotForm.showJotFormPowered = "0";
</script>
<script>
JotForm.poweredByText = "Powered by JotForm";
</script>
<input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="92476523824160" />
<script type="text/javascript">
var all_spc = document.querySelectorAll("form[id='92476523824160'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++)
{
all_spc[i].value = "92476523824160-92476523824160";
}
</script>
</form>
<script type="text/javascript">window.GOOGLE_SIGNON = "172124630376-qk1qmdfmur2ojaf39e070iqhpt2foaip.apps.googleusercontent.com"</script>
<script type="text/javascript">window.FACEBOOK_SIGNON_APP_ID = "1140740696088074"</script>
<script>window.JotFormAPIEndpoint = "/API"; </script>
<script>window.JFForm = { id: '92476523824160', skippable: true, isHipaa: '' };</script>
<script src="/common/FormUserScripts.js"></script>
<link rel="stylesheet" type="text/css" href="https://cdn.jotfor.ms/assets/fonts/circularStd/circular.css">
<style>
#sacl-modal {
font-family: "Circular Std Book";
}
.jfFormUser-header {
position: fixed;
top: 0;
height: 70px;
width: 100%;
text-align: right;
color: #fff;
background: #30374A;
font-family: -apple-system, "BlinkMacSystemFont", "Segoe UI", "Roboto", "Oxygen-Sans", "Ubuntu", "Cantarell", "Helvetica Neue", sans-serif;
display: flex;
justify-content: space-between;
align-items: center;
}
.jfFormUser-header .jfFormUser-header-panel {
max-height: 54px;
padding-left: 15px;
padding-right: 15px;
}
.jfFormUser-header .jfFormUser-header-panel.jfFormUser-header-panel-left {
}
.jfFormUser-header .jfFormUser-header-panel.jfFormUser-header-panel-right {
display: flex;
align-items: center;
}
.jfFormUser-header .jfFormUser-header-panel.jfFormUser-header-panel-right > .jfFormUser-header-product,
.jfFormUser-header .jfFormUser-header-panel.jfFormUser-header-panel-right > .jfFormUser-header-accountBox {
display: inline-block;
}
.jfFormUser-header .jfFormUser-header-logo {
max-width: 156px;
}
.jfFormUser-header .jfFormUser-header-saveAndContinueLater {
display: none;
margin-right: 28px;
}
.jfFormUser-header .jfFormUser-header-saveAndContinueLater .jfFormUser-header-saveAndContinueLater-button {
height: 36px;
border-radius: 4px;
box-shadow: 0 0 14px 0 rgba(0, 0, 0, 0.26);
background-color: #01bd6f;
color: #fff;
font-family: Circular Std Book;
font-size: 16px;
line-height: 1.19;
letter-spacing: -0.2px;
font-weight: 400;
display: flex;
align-items: center;
border: none;
padding: 0 10px;
outline: none;
transition: .25s;
cursor: pointer;
}
.jfFormUser-header .jfFormUser-header-saveAndContinueLater .jfFormUser-header-saveAndContinueLater-button:hover {
background-color: #009e5d;
}
.jotform-form {
margin-top: 70px !important;
}
.jfFormUser-header-panel-right {
display: flex;
}
.jfFormUser-header-saveAndContinueLater-button-icon {
width: 22px;
height: 22px;
background-size: 100%;
background-image: url("data:image/svg+xml,%0A%3Csvg xmlns='http://www.w3.org/2000/svg' width='22' height='22'%3E%3Cpath fill='%23FFF' d='M16.362.074a.82.82 0 0 1 .577.217l4.356 4.05c.182.17.254.389.254.632V19.47c0 .926-.71 1.695-1.627 1.695H2.17c-.922 0-1.712-.776-1.712-1.696V1.717C.458.8 1.242.074 2.168.074h14.194zM4.09 1.798H2.182V19.44H2.17h.012v.028c0-.017.002-.025.002-.027h17.642V5.347L16.304 2.06v7.322c0 .47-.328.889-.82.889H4.994c-.475 0-.904-.41-.904-.889V1.798zm11.395 14.565l.099.007a.724.724 0 0 1-.099 1.442H4.987a.725.725 0 0 1 0-1.449h10.498zm0-3.85l.099.006a.724.724 0 0 1 0 1.435l-.099.007H4.987a.724.724 0 0 1-.098-1.442l.098-.007h10.498zM14.58 1.797H5.813v6.75h8.767v-6.75zm-1.398 1.41v3.667h-1.724V3.208h1.724z'/%3E%3C/svg%3E");
}
.jfFormUser-header-saveAndContinueLater-button-icon + .jfFormUser-header-saveAndContinueLater-button-text {
margin-left: 10px;
}
.jfFormUser-header-avatar {
display: block;
border-radius: 50%;
width: 40px;
height: 40px;
background-size: cover;
background-repeat: no-repeat;
background-position: center;
position: relative;
cursor: pointer;
}
.jfFormUser-header-accountBox {
position: absolute;
bottom: 0;
right: 0;
background: #fff;
transform: translateY(calc(100% + 30px));
opacity: 0;
box-shadow: 0 0 6px 0 rgba(0, 0, 0, 0.5);
border-radius: 3px;
color: #404146;
display: flex;
padding: 20px 0;
font-family: Circular Std Book;
pointer-events: none;
transition: 0.4s;
}
.jfFormUser-header-accountBox.isVisible {
transform: translateY(calc(100% + 10px));
opacity: 1;
pointer-events: auto;
}
.jfFormUser-header-accountBox:after {
bottom: 100%;
right: 12px;
border: solid transparent;
content: " ";
height: 0;
width: 0;
position: absolute;
pointer-events: none;
border-color: rgba(255, 255, 255, 0);
border-bottom-color: #fff;
border-width: 8px;
margin-left: -8px;
}
.jfFormUser-header-accountBox-text {
margin-top: 10px;
}
.jfFormUser-header-accountBox-text-hello {
font-size: 13px;
color: #a7a7a7;
}
.jfFormUser-header-accountBox-splitter {
width: 100%;
height: 1px;
background-color: #d7d8e3;
margin: 10px 0;
}
.jfFormUser-header-accountBox-logout a {
font-size: 16px;
color: #0070f5;
text-decoration: none;
}
.jfFormUser-header-accountBox-logout a:hover {
text-decoration: underline;
}
.jfFormUser-header-accountBox-avatar {
width: 54px;
height: 54px;
background-size: cover;
background-repeat: no-repeat;
background-position: center;
border-radius: 50%;
}
.jfFormUser-header-accountBox-panel-left {
width: 80px;
min-height: 1px;
display: flex;
justify-content: center;
}
.jfFormUser-header-accountBox-panel-right {
width: 190px;
min-height: 1px;
text-align: left;
margin-right: 14px;
}
@media (max-width: 640px) {
.jfFormUser-header-saveAndContinueLater-button-text {
display: none;
}
.jfFormUser-header .jfFormUser-header-saveAndContinueLater {
margin-right: 19px;
}
}
</style>
<div class="jfFormUser-header">
<div class="jfFormUser-header-panel jfFormUser-header-panel-left">
<img class="jfFormUser-header-logo" src="https://lbl.jotform.com/enterprise/logo.png" />
</div>
<div class="jfFormUser-header-panel jfFormUser-header-panel-right">
<div class="jfFormUser-header-saveAndContinueLater">
<button class="jfFormUser-header-saveAndContinueLater-button jfProgress-sacl">
<div class="jfFormUser-header-saveAndContinueLater-button-icon"></div>
<div class="jfFormUser-header-saveAndContinueLater-button-text">
Save and Continue Later
</div>
</button>
</div>
<div id="jfFormUser-header-avatar" class="jfFormUser-header-avatar" style="background-image: url('');">
<div id="jfFormUser-header-accountBox" class="jfFormUser-header-accountBox">
<div class="jfFormUser-header-accountBox-panel-left">
<div class="jfFormUser-header-accountBox-avatar" style="background-image: url('')"></div>
</div>
<div class="jfFormUser-header-accountBox-panel-right">
<div class="jfFormUser-header-accountBox-text">
<div class="jfFormUser-header-accountBox-text-hello">Hello,</div>
<div class="jfFormUser-header-accountBox-text-mail">[email protected]</div>
</div>
<div class="jfFormUser-header-accountBox-splitter"></div>
<div class="jfFormUser-header-accountBox-logout">
<a href="/logout.php">Log out</a>
</div>
</div>
</div>
</div>
</div>
</div>
<script>
window.formUserHeader = true;
var avatarURL = '';
if (avatarURL) {
var avatar = document.getElementById('jfFormUser-header-avatar');
var accountBox = document.getElementById('jfFormUser-header-accountBox');
avatar.addEventListener('click', function(e) {
if (e.target !== avatar) {
return;
}
var isVisible = accountBox.getAttribute('class').indexOf('isVisible') !== -1;
if (isVisible) {
accountBox.setAttribute('class', 'jfFormUser-header-accountBox');
} else {
accountBox.setAttribute('class', 'jfFormUser-header-accountBox isVisible');
}
});
}
if (window.FORM_MODE === 'cardform' && window.CardForm && window.CardForm.initSaveAndContinueLater) { // CardForm
if (!CardForm.saveAndContinueLater) {
CardForm.initSaveAndContinueLater();
} else {
var saveAndContinueLaterButton = document.querySelector(".jfFormUser-header-saveAndContinueLater-button");
saveAndContinueLaterButton.addEventListener('click', CardForm.saveAndContinueLater.openSaveAndContinueLaterModal);
}
CardForm.saveAndContinueLater.emailInput.value = '[email protected]';
} else if (window.JotForm && window.CardFields && window.CardFields.saveAndContinueLater && window.CardFields.saveAndContinueLater.default) { // Classic Form
var sendEmail = true;
var saveInterval = false;
var saveAndContinueLaterManager = {};
function findEmailAnswer() {
return '[email protected]';
}
function getInputNamesAndValues(jotformForm) {
var formData = [];
var formInputs = jotformForm.serialize().split('&');
for (var i = 0; i < formInputs.length; i++) {
var inputValParts = formInputs[i].split('=');
formData[i] = {
name: decodeURIComponent(inputValParts[0]),
value: decodeURIComponent(inputValParts[1])
};
}
var questionLines = document.querySelectorAll('li.form-line');
for (var i = 0; i < questionLines.length; i++) {
var questionLine = questionLines[i];
var questionType = questionLine.dataset.type;
if (['control_radio', 'control_checkbox'].indexOf(questionType) > -1) {
var inputs = questionLine.querySelectorAll('input');
var empty = true;
for (var j = 0; j < inputs.length; j++) {
var input = inputs[j];
if (input.checked) {
empty = false;
}
if(empty && input.hasAttribute('data-otherhint')) {
for (var k = 0; k < formData.length; k++) {
if (formData[k].name === input.name) {
formData[k].empty = true;
break;
}
}
}
}
if (empty) {
formData.push({
name: inputs[0].name,
value: '',
empty: true
});
}
}
}
return formData;
}
function getFormDataDiff(currentData, previousData, jotformForm) {
if (!previousData) {
return currentData;
}
var diff = [];
var regexOneDim = /\[.*?\]$/g; // 1D array like inputs include '[*]' in their names
var regexTempFile = /temp_upload\[.*?]\[.*?]$/g; // file upload input name format
var regexTwoDim = /\[.*?\]\[.*?\]$/g; // 2D array like inputs include '[*][]' in their names
for (var i = 0; i < currentData.length; i++) {
var current = currentData[i];
var isOneDim = current.name.match(regexOneDim);
var isTempFile = current.name.match(regexTempFile);
var isTwoDim = current.name.match(regexTwoDim);
if (isOneDim && !isTempFile) {
// if it is a two dimensional array input like 'control_matrix', always return all of them although it has no value. otherwise the order of inputs will be changed
if (isTwoDim) {
diff.push(current);
continue;
} else if (current.name.include('[other]')) {
var checkboxOther = jotformForm.querySelector(`input[type="checkbox"][name="${current.name}"]`);
if ((checkboxOther && !checkboxOther.checked) || (!current.value)) {
continue;
}
}
}
var isChanged = true;
for (var j = 0; j < previousData.length; j++) {
if (previousData[j].name === current.name && previousData[j].value === current.value) {
isChanged = false;
break;
}
}
if (isChanged) {
if (isOneDim && !isTwoDim) {
diff.push(current);
var currentQid = current.name.split('_')[0];
for (var j = 0; j < previousData.length; j++) {
var data = previousData[j];
var dataQid = data.name.split('_')[0];
if (dataQid === currentQid && data.name !== current.name) {
var isExist = false;
for (var k = 0; k < diff.length; k++) {
if (diff[k].name === data.name) {
isExist = true;
break;
}
}
if (!isExist) {
diff.push(data);
}
}
}
} else {
diff.push(current);
}
}
}
return diff;
}
function mergeDiffWithStaticData(diff) {
var data = [
{ name: 'continueLater', value: '1' },
{ name: 'formID', value: "92476523824160" },
{ name: 'session_id', value: window.JotForm.sessionID },
{ name: 'submission_token', value: window.JotForm.submissionToken }
];
if (window.JotForm.submissionID) {
data.push({ name: 'submission_id', value: window.JotForm.submissionID });
}
var simpleSpc = document.getElementById('simple_spc');
if (simpleSpc) {
data.push({ name: 'simple_spc', value: simpleSpc.value });
}
const merged = diff.slice(0);
for (var i = 0; i < data.length; i++) {
var isExists = false;
for (var j = 0; j < merged.length; j++) {
if (merged[j],name === data[i],name) {
isExists = true;
break;
}
}
if (!isExists) {
merged.push(data[i]);
}
}
return merged;
}
function createInput(props) {
var keys = Object.keys(props);
var input = document.createElement('input');
for (var i = 0; i < keys.length; i++) {
var prop = keys[i];
input[prop] = props[prop];
}
return input;
}
function removeSaveIndicator() {
var saveIndicator = document.querySelector('.form-saving-indicator');
if (saveIndicator) {
saveIndicator.remove();
JotForm.saving = false;
JotForm.enableButtons();
}
}
function hiddenSubmitter(forceSubmit) {
var isSaveAndContinueActive = ((saveAndContinueLaterManager.inited && saveAndContinueLaterManager.continueLater.active) || window.JotForm.sessionID);
if (!isSaveAndContinueActive) {
return false;
}
var jotformForm = document.forms[0];
var currentValues = getInputNamesAndValues(jotformForm);
var diff = getFormDataDiff(currentValues, saveAndContinueLaterManager.continueLater.lastAnswers, jotformForm);
if ((diff.length > 0 || forceSubmit) && !window.JotForm.loadingPendingSubmission) {
saveAndContinueLaterManager.continueLater.lastAnswers = currentValues;
var merged = mergeDiffWithStaticData(diff);
if (!merged) {
return;
}
var dummyForm = jotformForm.cloneNode(false);
document.body.appendChild(dummyForm);
for (var i = 0; i < merged.length; i++) {
const p = merged[i];
const input = createInput({ type: 'hidden', name: p.name, value: p.value });
dummyForm.appendChild(input);
}
window.JotForm.hiddenSubmit(dummyForm, {
async: true,
onSuccessCb: function(response) {
if (sendEmail) {
var email = '[email protected]';
if (email) {
sendEmail = false;
saveAndContinueLaterManager.sendEmail(email, false);
}
if(!saveInterval) {
saveInterval = setInterval(function() {
hiddenSubmitter();
}, 5000);
}
}
// set the submissionId if it is not exist
if (!window.JotForm.submissionID && response.responseText) {
const resJSON = JSON.parse(response.responseText);
window.JotForm.setSubmissionID(resJSON.submissionId);
}
// if file uploaded then run makeUploadCheck to update related fields
const regexTempFile = /temp_upload\[.*?]\[.*?]$/g; // file upload input name format
const shouldUploadCheck = diff.some(d => regexTempFile.test(d.name));
if (shouldUploadCheck) {
window.JotForm.makeUploadChecks();
}
removeSaveIndicator();
},
onFailureCb: () => {
removeSaveIndicator();
},
onCompleteCb: () => {
document.body.removeChild(dummyForm);
}
});
}
}
saveAndContinueLaterManager = new window.CardFields.saveAndContinueLater.default({ active: true, useStorage: false, lastAnswers: false }, hiddenSubmitter, findEmailAnswer, "92476523824160", "/API");
window.onEditModeCompleted = function() {
if (window.JotForm.sessionID) {
sendEmail = false;
saveAndContinueLaterManager.continue();
saveAndContinueLaterManager.continueLater.lastAnswers = getInputNamesAndValues(document.forms[0]);
saveInterval = setInterval(function() {
hiddenSubmitter();
}, 5000);
}
};
}
</script> |