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[wpforms id="8315" title="false" description="false"]
<div class="wpforms-container wpforms-container-full" id="wpforms-8315"><form id="wpforms-form-8315" class="wpforms-validate wpforms-form" data-formid="8315" method="post" enctype="multipart/form-data" action="/birthday/" data-token="482496b35fa3006a1dd77881a69e025e"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-8315-field_1-container" class="wpforms-field wpforms-field-name" data-field-id="1"><label class="wpforms-field-label" for="wpforms-8315-field_1">Name <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-large"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-8315-field_1" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][1][first]" required><label for="wpforms-8315-field_1" class="wpforms-field-sublabel after ">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-8315-field_1-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][1][last]" required><label for="wpforms-8315-field_1-last" class="wpforms-field-sublabel after ">Last</label></div></div></div><div id="wpforms-8315-field_3-container" class="wpforms-field wpforms-field-email" data-field-id="3"><label class="wpforms-field-label" for="wpforms-8315-field_3">E-mail <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-8315-field_3" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][3]" required></div><div id="wpforms-8315-field_4-container" class="wpforms-field wpforms-field-password" data-field-id="4"><label class="wpforms-field-label" for="wpforms-8315-field_4">Password <span class="wpforms-required-label">*</span></label><input type="password" id="wpforms-8315-field_4" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][4]" required></div><div id="wpforms-8315-field_9-container" class="wpforms-field wpforms-field-date-time" data-field-id="9"><label class="wpforms-field-label" for="wpforms-8315-field_9">Birthday <span class="wpforms-required-label">*</span></label><select name="wpforms[fields][9][date][m]" id="wpforms-field_9-month" class="wpforms-field-date-time-date-month wpforms-field-required" required><option value="" class="placeholder" selected disabled>MM</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></select><span class="wpforms-field-date-time-date-sep">/</span><select name="wpforms[fields][9][date][d]" id="wpforms-field_9-day" class="wpforms-field-date-time-date-day wpforms-field-required" required><option value="" class="placeholder" selected disabled>DD</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><option value="21" >21</option><option value="22" >22</option><option value="23" >23</option><option value="24" >24</option><option value="25" >25</option><option value="26" >26</option><option value="27" >27</option><option value="28" >28</option><option value="29" >29</option><option value="30" >30</option><option value="31" >31</option></select><span class="wpforms-field-date-time-date-sep">/</span><select name="wpforms[fields][9][date][y]" id="wpforms-field_9-year" class="wpforms-field-date-time-date-year wpforms-field-required" required><option value="" class="placeholder" selected disabled>YYYY</option><option value="2022" >2022</option><option value="2021" >2021</option><option value="2020" >2020</option><option value="2019" >2019</option><option value="2018" >2018</option><option value="2017" >2017</option><option value="2016" >2016</option><option value="2015" >2015</option><option value="2014" >2014</option><option value="2013" >2013</option><option value="2012" >2012</option><option value="2011" >2011</option><option value="2010" >2010</option><option value="2009" >2009</option><option value="2008" >2008</option><option value="2007" >2007</option><option value="2006" >2006</option><option value="2005" >2005</option><option value="2004" >2004</option><option value="2003" >2003</option><option value="2002" >2002</option><option value="2001" >2001</option><option value="2000" >2000</option><option value="1999" >1999</option><option value="1998" >1998</option><option value="1997" >1997</option><option value="1996" >1996</option><option value="1995" >1995</option><option value="1994" >1994</option><option value="1993" >1993</option><option value="1992" >1992</option><option value="1991" >1991</option><option value="1990" >1990</option><option value="1989" >1989</option><option value="1988" >1988</option><option value="1987" >1987</option><option value="1986" >1986</option><option value="1985" >1985</option><option value="1984" >1984</option><option value="1983" >1983</option><option value="1982" >1982</option><option value="1981" >1981</option><option value="1980" >1980</option><option value="1979" >1979</option><option value="1978" >1978</option><option value="1977" >1977</option><option value="1976" >1976</option><option value="1975" >1975</option><option value="1974" >1974</option><option value="1973" >1973</option><option value="1972" >1972</option><option value="1971" >1971</option><option value="1970" >1970</option><option value="1969" >1969</option><option value="1968" >1968</option><option value="1967" >1967</option><option value="1966" >1966</option><option value="1965" >1965</option><option value="1964" >1964</option><option value="1963" >1963</option><option value="1962" >1962</option><option value="1961" >1961</option><option value="1960" >1960</option><option value="1959" >1959</option><option value="1958" >1958</option><option value="1957" >1957</option><option value="1956" >1956</option><option value="1955" >1955</option><option value="1954" >1954</option><option value="1953" >1953</option><option value="1952" >1952</option><option value="1951" >1951</option><option value="1950" >1950</option><option value="1949" >1949</option><option value="1948" >1948</option><option value="1947" >1947</option><option value="1946" >1946</option><option value="1945" >1945</option><option value="1944" >1944</option><option value="1943" >1943</option><option value="1942" >1942</option><option value="1941" >1941</option><option value="1940" >1940</option><option value="1939" >1939</option><option value="1938" >1938</option><option value="1937" >1937</option><option value="1936" >1936</option><option value="1935" >1935</option><option value="1934" >1934</option><option value="1933" >1933</option><option value="1932" >1932</option><option value="1931" >1931</option><option value="1930" >1930</option><option value="1929" >1929</option><option value="1928" >1928</option><option value="1927" >1927</option><option value="1926" >1926</option><option value="1925" >1925</option><option value="1924" >1924</option><option value="1923" >1923</option><option value="1922" >1922</option><option value="1921" >1921</option><option value="1920" 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type="hidden" name="wpforms[author]" value="71525"><button type="submit" name="wpforms[submit]" id="wpforms-submit-8315" class="wpforms-submit om-trigger-conversion" aria-live="assertive" value="wpforms-submit">Submit</button></div></form></div> <!-- .wpforms-container -->
