{"id":878,"date":"2016-09-29T00:49:06","date_gmt":"2016-09-29T00:49:06","guid":{"rendered":"http:\/\/canadianvesselregistry.ca\/?page_id=878"},"modified":"2022-06-13T14:04:21","modified_gmt":"2022-06-13T21:04:21","slug":"change-vessel-name-andor-transfer-port-registry","status":"publish","type":"page","link":"https:\/\/vesselregistrar.ca\/nvrc\/change-vessel-name-andor-transfer-port-registry\/","title":{"rendered":"Change of Vessel Name and\/or Transfer of Port of Registry"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_76' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">APPLICATION FOR CHANGE OF VESSEL NAME AND\/OR PORT OF REGISTRY<\/h3>\n                            <p class='gform_description'>A Change of Vessel Name And\/Or Port Of Registry form allows the owner or authorized representative to change a vessels name or port of registry.\r\n\r\nThis application is only applicable for vessels documented under the Large Vessel Registry system.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_76'  action='\/nvrc\/wp-json\/wp\/v2\/pages\/878' data-formid='76' novalidate><input id=\"gpnf_session_hash_76\" type=\"hidden\" name=\"gpnf_session_hash\" value=\"9daed3d0ce26\">\n                        <div class='gform-body gform_body'><ul id='gform_fields_76' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_76_1\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_1'>Official Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_76_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_97\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_97'>Confirm Official Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_76_97' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_2\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_2'>Present Name of Vessel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_76_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_3\" class=\"gfield gfield--type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_3'>Current Port of Registry<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_76_3' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select port<\/option><option value='BATHURST NB' >BATHURST NB<\/option><option value='BELLEVILLE ON' >BELLEVILLE ON<\/option><option value='BROCKVILLE ON' >BROCKVILLE ON<\/option><option value='CAP-AUX-MEULES QC' >CAP-AUX-MEULES QC<\/option><option value='CARAQUET NB' >CARAQUET NB<\/option><option value='CHARLOTTETOWN PE' >CHARLOTTETOWN PE<\/option><option value='CHATHAM ON' >CHATHAM ON<\/option><option value='CHICOUTIMI QC' >CHICOUTIMI QC<\/option><option value='CORNWALL ON' >CORNWALL ON<\/option><option value='DAWSON YT' >DAWSON YT<\/option><option value='DIGBY NS' >DIGBY NS<\/option><option value='EDMONTON AB' >EDMONTON AB<\/option><option value='GASP\u00c9 QC' >GASP\u00c9 QC<\/option><option value='GODERICH ON' >GODERICH ON<\/option><option value='GRAND MANAN NB' >GRAND MANAN NB<\/option><option value='HALIFAX NS' >HALIFAX NS<\/option><option value='HAMILTON ON' >HAMILTON ON<\/option><option value='HAY RIVER NT' >HAY RIVER NT<\/option><option value='IQALUIT NU' >IQALUIT NU<\/option><option value='KENORA ON' >KENORA ON<\/option><option value='KINGSTON ON' >KINGSTON ON<\/option><option value='LIVERPOOL NS' >LIVERPOOL NS<\/option><option value='LUNENBURG NS' >LUNENBURG NS<\/option><option value='MIDLAND ON' >MIDLAND ON<\/option><option value='MONCTON NB' >MONCTON NB<\/option><option value='MONTREAL QC' >MONTREAL QC<\/option><option value='NANAIMO BC' >NANAIMO BC<\/option><option value='NANTICOKE ON' >NANTICOKE ON<\/option><option value='OTTAWA ON' >OTTAWA ON<\/option><option value='OWEN SOUND ON' >OWEN SOUND ON<\/option><option value='PETERBOROUGH ON' >PETERBOROUGH ON<\/option><option value='PORT ALBERNI BC' >PORT ALBERNI BC<\/option><option value='PORT COLBORNE ON' >PORT COLBORNE ON<\/option><option value='PORT DOVER ON' >PORT DOVER ON<\/option><option value='PORT HAWKESBURY NS' >PORT HAWKESBURY NS<\/option><option value='PRESCOTT ON' >PRESCOTT ON<\/option><option value='PRINCE ALBERT SK' >PRINCE ALBERT SK<\/option><option value='PRINCE RUPERT BC' >PRINCE RUPERT BC<\/option><option value='QU\u00c9BEC QC' >QU\u00c9BEC QC<\/option><option value='SAINT JOHN NB' >SAINT JOHN NB<\/option><option value='SARNIA ON' >SARNIA ON<\/option><option value='SAULT STE. MARIE ON' >SAULT STE. MARIE ON<\/option><option value='SHELBURNE NS' >SHELBURNE NS<\/option><option value='SOREL QC' >SOREL QC<\/option><option value='ST. ANDREWS NB' >ST. ANDREWS NB<\/option><option value='ST. CATHARINES ON' >ST. CATHARINES ON<\/option><option value='ST. JOHN&#039;S NL' >ST. JOHN&#039;S NL<\/option><option value='SYDNEY NS' >SYDNEY NS<\/option><option value='THUNDER BAY ON' >THUNDER BAY ON<\/option><option value='TORONTO ON' >TORONTO ON<\/option><option value='TROIS RIVIERES QC' >TROIS RIVIERES QC<\/option><option value='VANCOUVER BC' >VANCOUVER BC<\/option><option value='VICTORIA BC' >VICTORIA BC<\/option><option value='WALLACEBURG ON' >WALLACEBURG ON<\/option><option value='WEYMOUTH NS' >WEYMOUTH NS<\/option><option value='WHITEHORSE YT' >WHITEHORSE YT<\/option><option value='WINDSOR ON' >WINDSOR ON<\/option><option value='WINNIPEG MB' >WINNIPEG MB<\/option><option value='YARMOUTH NS' >YARMOUTH NS<\/option><option value='YELLOWKNIFE NT' >YELLOWKNIFE NT<\/option><\/select><\/div><\/li><li id=\"field_76_4\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">A) NOTICE OF CHANGE OF NAME<\/h2><\/li><li id=\"field_76_104\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >DO YOU WISH TO CHANGE YOUR VESSEL NAME?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_76_104'>\n\t\t\t<li class='gchoice gchoice_76_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='Yes'  id='choice_76_104_0'    \/>\n\t\t\t\t<label for='choice_76_104_0' id='label_76_104_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_76_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='No' checked='checked' id='choice_76_104_1'    \/>\n\t\t\t\t<label for='choice_76_104_1' id='label_76_104_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_5\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b>It is proposed to change the name of the vessel to:<\/b><\/li><li id=\"field_76_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_6'>1st choice<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_76_6' type='text' value='' class='medium'    placeholder='Name of vessel requested'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_7\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_7'>2nd choice<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_76_7' type='text' value='' class='medium'    placeholder='Name of vessel requested'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_98\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_98'>3rd choice<\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_76_98' type='text' value='' class='medium'    placeholder='Name of vessel requested'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_28\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">B) TRANSFER OF PORT OF REGISTRY<\/h2><\/li><li id=\"field_76_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >DO YOU WISH TO TRANSFER THE PORT OF REGISTRY?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_76_106'>\n\t\t\t<li class='gchoice gchoice_76_106_0'>\n\t\t\t\t<input name='input_106' type='radio' value='Yes'  id='choice_76_106_0'    \/>\n\t\t\t\t<label for='choice_76_106_0' id='label_76_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_76_106_1'>\n\t\t\t\t<input name='input_106' type='radio' value='No' checked='checked' id='choice_76_106_1'    \/>\n\t\t\t\t<label for='choice_76_106_1' id='label_76_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_10\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_10'>I\/We, the registered owner(s), request the transfer of the registry of the vessel to:<\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_76_10' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select new port<\/option><option value='BATHURST NB' >BATHURST NB<\/option><option value='BELLEVILLE ON' >BELLEVILLE ON<\/option><option value='BROCKVILLE ON' >BROCKVILLE ON<\/option><option value='CAP-AUX-MEULES QC' >CAP-AUX-MEULES QC<\/option><option value='CARAQUET NB' >CARAQUET NB<\/option><option value='CHARLOTTETOWN PE' >CHARLOTTETOWN PE<\/option><option value='CHATHAM ON' >CHATHAM ON<\/option><option value='CHICOUTIMI QC' >CHICOUTIMI QC<\/option><option value='CORNWALL ON' >CORNWALL ON<\/option><option value='DAWSON YT' >DAWSON YT<\/option><option value='DIGBY NS' >DIGBY NS<\/option><option value='EDMONTON AB' >EDMONTON AB<\/option><option value='GASP\u00c9 QC' >GASP\u00c9 QC<\/option><option value='GODERICH ON' >GODERICH ON<\/option><option value='GRAND MANAN NB' >GRAND MANAN NB<\/option><option value='HALIFAX NS' >HALIFAX NS<\/option><option value='HAMILTON ON' >HAMILTON ON<\/option><option value='HAY RIVER NT' >HAY RIVER NT<\/option><option value='IQALUIT NU' >IQALUIT NU<\/option><option value='KENORA ON' >KENORA ON<\/option><option value='KINGSTON ON' >KINGSTON ON<\/option><option value='LIVERPOOL NS' >LIVERPOOL NS<\/option><option value='LUNENBURG NS' >LUNENBURG NS<\/option><option value='MIDLAND ON' >MIDLAND ON<\/option><option value='MONCTON NB' >MONCTON NB<\/option><option value='MONTREAL QC' >MONTREAL QC<\/option><option value='NANAIMO BC' >NANAIMO BC<\/option><option value='NANTICOKE ON' >NANTICOKE ON<\/option><option value='OTTAWA ON' >OTTAWA ON<\/option><option value='OWEN SOUND ON' >OWEN SOUND ON<\/option><option value='PETERBOROUGH ON' >PETERBOROUGH ON<\/option><option value='PORT ALBERNI BC' >PORT ALBERNI BC<\/option><option value='PORT COLBORNE ON' >PORT COLBORNE ON<\/option><option value='PORT DOVER ON' >PORT DOVER ON<\/option><option value='PORT HAWKESBURY NS' >PORT HAWKESBURY NS<\/option><option value='PRESCOTT ON' >PRESCOTT ON<\/option><option value='PRINCE ALBERT SK' >PRINCE ALBERT SK<\/option><option value='PRINCE RUPERT BC' >PRINCE RUPERT BC<\/option><option value='QU\u00c9BEC QC' >QU\u00c9BEC QC<\/option><option value='SAINT JOHN NB' >SAINT JOHN NB<\/option><option value='SARNIA ON' >SARNIA ON<\/option><option value='SAULT STE. MARIE ON' >SAULT STE. MARIE ON<\/option><option value='SHELBURNE NS' >SHELBURNE NS<\/option><option value='SOREL QC' >SOREL QC<\/option><option value='ST. ANDREWS NB' >ST. ANDREWS NB<\/option><option value='ST. CATHARINES ON' >ST. CATHARINES ON<\/option><option value='ST. JOHN&#039;S NL' >ST. JOHN&#039;S NL<\/option><option value='SYDNEY NS' >SYDNEY NS<\/option><option value='THUNDER BAY ON' >THUNDER BAY ON<\/option><option value='TORONTO ON' >TORONTO ON<\/option><option value='TROIS RIVIERES QC' >TROIS RIVIERES QC<\/option><option value='VANCOUVER BC' >VANCOUVER BC<\/option><option value='VICTORIA BC' >VICTORIA BC<\/option><option value='WALLACEBURG ON' >WALLACEBURG ON<\/option><option value='WEYMOUTH NS' >WEYMOUTH NS<\/option><option value='WHITEHORSE YT' >WHITEHORSE YT<\/option><option value='WINDSOR ON' >WINDSOR ON<\/option><option value='WINNIPEG MB' >WINNIPEG MB<\/option><option value='YARMOUTH NS' >YARMOUTH NS<\/option><option value='YELLOWKNIFE NT' >YELLOWKNIFE NT<\/option><\/select><\/div><\/li><li id=\"field_76_16\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_15\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><font size=\"3\">NOTE:  In the case of an Indian Band, this application must be made by person(s) authorized by Band Council Resolution OR by affixing the seal of the Indian Band on this application.<\/font><\/li><li id=\"field_76_125\" class=\"gfield gfield--type-form gform-theme__no-reset--children field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_125'>Owners<\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-1\">\n\t\t\t\t\tFull Legal Name\t\t\t\t<\/th>\n\t\t\t\t\t\t<th class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Full Legal Name\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button type=\"button\" class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit Entry {0} where Full Legal Name is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button type=\"button\" class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete Entry {0} where Full Legal Name is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"2\">\n\t\t\t\tThere are no <span>Entries.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"76\"\n\t\t        data-nestedformid=\"71\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd Entry\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of entries reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_125\"\n                id=\"input_76_125\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><\/li><li id=\"field_76_33\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">INDIVIDUAL<\/h2><\/li><li id=\"field_76_34\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_34'>Signed at<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_76_34' type='text' value='' class='medium'    placeholder='Place'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_35\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_35'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_35' id='input_76_35' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='YYYY-MM-DD' aria-describedby=\"input_76_35_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_76_35_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_76_35' class='gform_hidden' value='https:\/\/vesselregistrar.ca\/nvrc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_76_36\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_36'>Signature of Owner<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_76_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_80\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_37\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">1 - CORPORATION<\/h2><\/li><li id=\"field_76_38\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_38'>I<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_76_38' type='text' value='' class='medium'    placeholder='Name and title'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_39\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_39'>state that I have authority to bind<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_76_39' type='text' value='' class='medium'    placeholder='Name of corporation'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_40\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_40'>I also state that<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_76_40' type='text' value='' class='medium'    placeholder='Name of corporation'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_41\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >is the name of a corporation which legally exists at the date of this Application:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_76_41'>\n\t\t\t<li class='gchoice gchoice_76_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='as per the laws of Canada; OR'  id='choice_76_41_0'    \/>\n\t\t\t\t<label for='choice_76_41_0' id='label_76_41_0' class='gform-field-label gform-field-label--type-inline'>as per the laws of Canada; OR<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_76_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='as per the laws of (province\/state)'  id='choice_76_41_1'    \/>\n\t\t\t\t<label for='choice_76_41_1' id='label_76_41_1' class='gform-field-label gform-field-label--type-inline'>as per the laws of (province\/state)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_42\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_42'>Name of province\/state<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_76_42' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_53\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>This Application must be signed by any Officer or Director of the corporation who has the authority to bind the corporation. Pursuant to Sections 51(2) and 75.01\n(2) of the <strong><i>Canada Shipping Act, 2001<\/i><\/strong>) applicants may be required to provide additional information as requested by the Chief Registrar.<\/p>\n<p>I understand that it is an offence for a person to knowingly make a false or misleading statement in writing and that the penalty can be a fine or imprisonment or\nboth if found guilty in a court of law (Section 37 of the <strong><i>Canada Shipping Act, 2001<\/i><\/strong>).<\/li><li id=\"field_76_44\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_44'>Signature of Officer or Director<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_76_44' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_45\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_45'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_76_45' type='text' value='' class='datepicker gform-datepicker ymd_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='YYYY-MM-DD' aria-describedby=\"input_76_45_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_76_45_date_format' class='screen-reader-text'>YYYY dash MM dash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_76_45' class='gform_hidden' value='https:\/\/vesselregistrar.ca\/nvrc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_76_46\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">2 - CORPORATION<\/h2><\/li><li id=\"field_76_47\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_47'>I<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_76_47' type='text' value='' class='medium'    placeholder='Name and title'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_48\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_48'>state that I have authority to bind<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_76_48' type='text' value='' class='medium'    placeholder='Name of corporation'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_49\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_49'>I also state that<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_76_49' type='text' value='' class='medium'    placeholder='Name of corporation'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_50\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >is the name of a corporation which legally exists at the date of this Application:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_76_50'>\n\t\t\t<li class='gchoice gchoice_76_50_0'>\n\t\t\t\t<input name='input_50' type='radio' value='as per the laws of Canada; OR'  id='choice_76_50_0'    \/>\n\t\t\t\t<label for='choice_76_50_0' id='label_76_50_0' class='gform-field-label gform-field-label--type-inline'>as per the laws of Canada; OR<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_76_50_1'>\n\t\t\t\t<input name='input_50' type='radio' value='as per the laws of (province\/state)'  id='choice_76_50_1'    \/>\n\t\t\t\t<label for='choice_76_50_1' id='label_76_50_1' class='gform-field-label gform-field-label--type-inline'>as per the laws of (province\/state)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_51\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_51'>Name of province\/state<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_76_51' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_52\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>This Application must be signed by any Officer or Director of the corporation who has the authority to bind the corporation. Pursuant to Sections 51(2) and 75.01\n(2) of the <strong><i>Canada Shipping Act, 2001<\/i><\/strong>) applicants may be required to provide additional information as requested by the Chief Registrar.<\/p>\n<p>I understand that it is an offence for a person to knowingly make a false or misleading statement in writing and that the penalty can be a fine or imprisonment or\nboth if found guilty in a court of law (Section 37 of the <strong><i>Canada Shipping Act, 2001<\/i><\/strong>).<\/li><li id=\"field_76_54\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_54'>Signature of Officer or Director<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_76_54' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_55\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_55'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_55' id='input_76_55' type='text' value='' class='datepicker gform-datepicker ymd_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='YYYY-MM-DD' aria-describedby=\"input_76_55_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_76_55_date_format' class='screen-reader-text'>YYYY dash MM dash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_76_55' class='gform_hidden' value='https:\/\/vesselregistrar.ca\/nvrc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_76_61\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">INDIAN BAND<\/h2><\/li><li id=\"field_76_62\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_62'>Name of Indian Band<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_76_62' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_63\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_63'>Signature<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_76_63' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_64\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_64'>Name of person signing above<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_76_64' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_65\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_65'>Date Application signed<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_65' id='input_76_65' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='YYYY-MM-DD' aria-describedby=\"input_76_65_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_76_65_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_76_65' class='gform_hidden' value='https:\/\/vesselregistrar.ca\/nvrc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_76_92\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_101\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4><b>Contact Information<\/b><\/h4><\/li><li id=\"field_76_93\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_93'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_76_93' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_100\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_100'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_76_100' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_99\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_99'>Telephone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_76_99' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_96\" class=\"gfield gfield--type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_96'>Facsimile<\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_76_96' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_109\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_76_109_container'>\n                                <span id='input_76_109_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_109' id='input_76_109' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_76_109' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_76_109_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_109_2' id='input_76_109_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_76_109_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_76_82\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_119\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_119 gfield_product_76_119 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_119_1'>TEST - Change of Vessel Name<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_119.1' value='TEST - Change of Vessel Name' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_119' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_119.2' id='ginput_base_price_76_119' class='gform_hidden' value='$ 1.00 CAD' aria-label='TEST - Change of Vessel Name Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_119.3' value='1' class='ginput_quantity_76_119 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_107\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_107 gfield_product_76_107 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_107_1'>Change of Vessel Name<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_107.1' value='Change of Vessel Name' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_107' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_107.2' id='ginput_base_price_76_107' class='gform_hidden' value='$ 375.00 CAD' aria-label='Change of Vessel Name Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_107.3' value='1' class='ginput_quantity_76_107 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_108\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_108 gfield_product_76_108 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_108_1'>Transfer of Port of Registry<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_108.1' value='Transfer of Port of Registry' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_108' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_108.2' id='ginput_base_price_76_108' class='gform_hidden' value='$ 325.00 CAD' aria-label='Transfer of Port of Registry Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_108.3' value='1' class='ginput_quantity_76_108 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_120\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_120 gfield_product_76_120 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_120_1'>Transfer of Port of Registry<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_120.1' value='Transfer of Port of Registry' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_120' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_120.2' id='ginput_base_price_76_120' class='gform_hidden' value='$ 325.00 CAD' aria-label='Transfer of Port of Registry Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_120.3' value='1' class='ginput_quantity_76_120 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_121\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please select any additional services you wish to have processed<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_76_121'><li class='gchoice gchoice_76_121_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.1' type='checkbox'  value='Priority Request\/Rush Processing'  id='choice_76_121_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_121_1' id='label_76_121_1' class='gform-field-label gform-field-label--type-inline'>Priority Request\/Rush Processing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_76_121_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.2' type='checkbox'  value='Certified Transcript'  id='choice_76_121_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_121_2' id='label_76_121_2' class='gform-field-label gform-field-label--type-inline'>Certified Transcript<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_76_121_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_121.3' type='checkbox'  value='Uncertified Transcript'  id='choice_76_121_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_121_3' id='label_76_121_3' class='gform-field-label gform-field-label--type-inline'>Uncertified Transcript<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_122\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_122 gfield_product_76_122 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_122_1'>Priority Request\/Rush Processing<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_122.1' value='Priority Request\/Rush Processing' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_122' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_122.2' id='ginput_base_price_76_122' class='gform_hidden' value='$ 70.00 CAD' aria-label='Priority Request\/Rush Processing Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_122.3' value='1' class='ginput_quantity_76_122 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_124\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_124 gfield_product_76_124 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_124_1'>Certified Transcript<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_124.1' value='Certified Transcript' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_124' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_124.2' id='ginput_base_price_76_124' class='gform_hidden' value='$ 165.00 CAD' aria-label='Certified Transcript Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_124.3' value='1' class='ginput_quantity_76_124 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_123\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_76_123 gfield_product_76_123 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_76_123_1'>Uncertified Transcript<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_123.1' value='Uncertified Transcript' class='gform_hidden' \/>\n\t\t\t\t\t\n\t\t\t\t\t\t<label for='ginput_base_price_76_123' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_123.2' id='ginput_base_price_76_123' class='gform_hidden' value='$ 85.00 CAD' aria-label='Uncertified Transcript Price'  \/>\n\t\t\t\t\t\n\t\t\t\t\t<input type='hidden' name='input_123.3' value='1' class='ginput_quantity_76_123 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id=\"field_76_86\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_85\" class=\"gfield gfield--type-total gfield_price gfield_price_76_ gfield_total gfield_total_76_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_76_85'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_76'>$ 0.00 CAD<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_85' id='input_76_85' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_76_87\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Authorization<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_76_31'><li class='gchoice gchoice_76_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected Transport Canada documents. I understand that my application will be processed in the order in which it is received by National Vessel Registry Center Corp, a third-party fee for service company. I understand that application and processing fees are non-refundable as per National Vessel Registry Center Corp&#039;s no refund policy. I understand that submitting another application for vessel documentation will supersede the current\/pending application for that vessel.'  id='choice_76_31_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_31_1' id='label_76_31_1' class='gform-field-label gform-field-label--type-inline'>I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected Transport Canada documents. I understand that my application will be processed in the order in which it is received by National Vessel Registry Center Corp, a third-party fee for service company. I understand that application and processing fees are non-refundable as per National Vessel Registry Center Corp's no refund policy. I understand that submitting another application for vessel documentation will supersede the current\/pending application for that vessel.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_127\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_127'>CAPACITY OF PERSON SIGNING (E.G., OWNER, CO-OWNER, PRESIDENT, CEO, OFFICER, DIRECTOR, ETC.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_127' id='input_76_127' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_88\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_126\" class=\"gfield gfield--type-stripe_creditcard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--type-stripe_creditcard-card\"  ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_76_126_1'>Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard ginput_stripe_creditcard gform-grid-row' id='input_76_126'><div class='ginput_full gform-grid-col' id='input_76_126_1_container' data-payment-element='false'><div id='input_76_126_1' class='gform-theme-field-control StripeElement--card'><\/div><label for='input_76_126_1' id='input_76_126_1_label' class='gform-field-label gform-field-label--type-sub'>Card Details<\/label><\/div><!-- .ginput_full --><div class='ginput_full gform-grid-col' id='input_76_126_5_container'>\r\n\t\t\t\t\t<input type='text' name='input_126.5' id='input_76_126_5' value=''>\r\n\t\t\t\t\t<label for='input_76_126_5' id='input_76_126_5_label' class='gform-field-label gform-field-label--type-sub'>Cardholder Name<\/label>\r\n\t\t\t\t<\/div><\/div><!-- .ginput_container -->\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\t:root {\r\n  \t\t\t\t\t--link-login-string: \"Link login\"\r\n\t\t\t\t}\r\n\t\t\t<\/style><\/li><li id=\"field_76_89\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Having Trouble? Check this box to move forward without your Credit Card<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_76_89'><li class='gchoice gchoice_76_89_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.1' type='checkbox'  value='*My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment.'  id='choice_76_89_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_89_1' id='label_76_89_1' class='gform-field-label gform-field-label--type-inline'>*My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_22\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Billing Address<\/h2><\/li><li id=\"field_76_26\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_76_26' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_76_26_1_container' >\n                                        <label for='input_76_26_1' id='input_76_26_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_26.1' id='input_76_26_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_76_26_2_container' >\n                                        <label for='input_76_26_2' id='input_76_26_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_26.2' id='input_76_26_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_76_26_3_container' >\n                                    <label for='input_76_26_3' id='input_76_26_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_26.3' id='input_76_26_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_26.4' id='input_76_26_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_76_26_5_container' >\n                                    <label for='input_76_26_5' id='input_76_26_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code (required for Canadian [A1A 1A1] and US [#####] only)<\/label>\n                                    <input type='text' name='input_26.5' id='input_76_26_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_76_26_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_76_113\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_113'>State\/Province\/Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_113' id='input_76_113' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland &amp; Labrador' >Newfoundland &amp; Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_76_114\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_114'>Other<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_76_114' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_115\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_115'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_115' id='input_76_115' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/li><li id=\"field_76_84\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_76_27\" class=\"gfield gfield--type-checkbox gfield--type-choice shipping-address-input field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_76_27'><li class='gchoice gchoice_76_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='Is your shipping address different from the one above?'  id='choice_76_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_76_27_1' id='label_76_27_1' class='gform-field-label gform-field-label--type-inline'>Is your shipping address different from the one above?<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_76_25\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Shipping Address<\/h2><\/li><li id=\"field_76_29\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_76_29' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_76_29_1_container' >\n                                        <label for='input_76_29_1' id='input_76_29_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_29.1' id='input_76_29_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_76_29_2_container' >\n                                        <label for='input_76_29_2' id='input_76_29_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_29.2' id='input_76_29_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_76_29_3_container' >\n                                    <label for='input_76_29_3' id='input_76_29_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_29.3' id='input_76_29_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_29.4' id='input_76_29_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_76_29_5_container' >\n                                    <label for='input_76_29_5' id='input_76_29_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code (required for Canadian [A1A 1A1] and US [#####] only)<\/label>\n                                    <input type='text' name='input_29.5' id='input_76_29_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_29.6' id='input_76_29_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_76_116\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_116'>State\/Province\/Region<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_116' id='input_76_116' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland &amp; Labrador' >Newfoundland &amp; Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_76_117\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_117'>Other<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_76_117' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_76_118\" class=\"gfield gfield--type-select gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_118'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_76_118' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option 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