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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="7608ae8817ca6a8e4e58f5a4f1fc62fc"><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 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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" 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>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" 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value="wpforms"></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-8315-field-hp" class="wpforms-field-label">Comment</label><input type="text" name="wpforms[hp]" id="wpforms-8315-field-hp" class="wpforms-field-medium"></div><div class="wpforms-recaptcha-container wpforms-is-recaptcha" ><div class="g-recaptcha" data-sitekey="6LcILukUAAAAAFLdNN-d-hfC42LchFA0z7J0ezCj"></div><input type="text" name="g-recaptcha-hidden" class="wpforms-recaptcha-hidden" style="position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;" required></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="8315"><input type="hidden" name="wpforms[author]" value="0"><button type="submit" name="wpforms[submit]" class="wpforms-submit om-trigger-conversion" id="wpforms-submit-8315" value="wpforms-submit" aria-live="assertive" >Submit</button></div></form></div> <!-- .wpforms-container -->