{"id":21603,"date":"2022-07-25T16:04:38","date_gmt":"2022-07-25T08:04:38","guid":{"rendered":"https:\/\/www.myskinbar.com\/?page_id=21603"},"modified":"2022-07-25T16:06:15","modified_gmt":"2022-07-25T08:06:15","slug":"form-lx","status":"publish","type":"page","link":"https:\/\/www.myskinbar.com\/form-lx\/","title":{"rendered":"Sign Up Form &#8211; LX"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row full_width=&#8221;stretch_row_content&#8221; full_height=&#8221;yes&#8221; equal_height=&#8221;yes&#8221; el_class=&#8221;about-menu&#8221; el_id=&#8221;registerpage&#8221;][vc_column css=&#8221;.vc_custom_1517295885106{background-color: #ffffff !important;}&#8221;][vc_column_text el_class=&#8221;nomarginbtm&#8221;]<\/p>\n<h2>Create an account<\/h2>\n<div id=\"register-page-notice\">By creating an account, you will be able to move through the checkout process faster, store multiple shipping addresses, view and track your orders and more.<\/div>\n<p>[\/vc_column_text]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_3' >\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/wp-json\/wp\/v2\/pages\/21603' >\n                        <div class='gform_body gform-body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_3_1\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_1\"><label class='gfield_label' for='input_3_1' >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_1' id='input_3_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_2\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_2\"><label class='gfield_label' for='input_3_2' >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_2' id='input_3_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_25\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_3_25\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_3_25' >cardID<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_3_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_3_10\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_10\"><legend class='gfield_label'  >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_10'>\n\t\t\t<div class='gchoice gchoice_3_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Male'  id='choice_3_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_0' id='label_3_10_0'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Female'  id='choice_3_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Unlisted'  id='choice_3_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2'>Unlisted<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Prefer Not to Answer' checked='checked' id='choice_3_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_3' id='label_3_10_3'>Prefer Not to Answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_20\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_20\"><legend class='gfield_label gfield_label_before_complex'  >Skin Concerns<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_20'><div class='gchoice gchoice_3_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Acne Sensitive'  id='choice_3_20_1'   aria-describedby=\"gfield_description_3_20\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_1' id='label_3_20_1'>Acne Sensitive<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Sensitive and Sunburn'  id='choice_3_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_2' id='label_3_20_2'>Sensitive and Sunburn<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='Aging Concerns'  id='choice_3_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_3' id='label_3_20_3'>Aging Concerns<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='Pigmentation'  id='choice_3_20_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_4' id='label_3_20_4'>Pigmentation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='No concerns'  id='choice_3_20_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_20_5' id='label_3_20_5'>No concerns<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_20'>You may tick more than 1.<\/div><\/fieldset><div id=\"field_3_23\"  class=\"gfield gfield--width-full register-birthday gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_23\"><label class='gfield_label' for='input_3_23' >Birthday<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_3_23' type='text' value='' class='large'    placeholder='e.g. Jun 1990' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_3_16\"  class=\"gfield gfield_contains_required field_sublabel_above field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_16\"><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_3_16' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_3_16_1_container' >\n                                        <label for='input_3_16_1' id='input_3_16_1_label' >Street Address<\/label>\n                                        <input type='text' name='input_16.1' id='input_3_16_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_3_16_2_container' >\n                                        <label for='input_3_16_2' id='input_3_16_2_label' >Address Line 2<\/label>\n                                        <input type='text' name='input_16.2' id='input_3_16_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_3_16_3_container' >\n                                    <label for='input_3_16_3' id='input_3_16_3_label' >City<\/label>\n                                    <input type='text' name='input_16.3' id='input_3_16_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_3_16_4_container' >\n                                        <label for='input_3_16_4' id='input_3_16_4_label' >State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_16.4' id='input_3_16_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_3_16_5_container' >\n                                    <label for='input_3_16_5' id='input_3_16_5_label' >ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_16.5' id='input_3_16_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_3_16_6_container' >\n                                        <label for='input_3_16_6' id='input_3_16_6_label' >Country<\/label>\n                                        <select name='input_16.6' id='input_3_16_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CG' >Congo, Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czech Republic<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini (Swaziland)<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macau<\/option><option value='MK' >Macedonia<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='KP' >North Korea<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RO' >Romania<\/option><option value='RU' >Russia<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia<\/option><option value='KR' >South Korea<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen Islands<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >Turkey<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AX' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_17\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_17\"><label class='gfield_label' for='input_3_17' >Mobile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_3_17' type='text' value='' class='medium'  placeholder='Please omit any dashes' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_5\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_5\"><label class='gfield_label' for='input_3_5' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_3_5' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_3_6\"  class=\"gfield pwd gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_3_6\"><legend class='gfield_label gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_password' id='input_3_6_container'>\n\t\t\t\t\t\t<span id='input_3_6_1_container' class='ginput_left'>\n\t\t\t\t\t\t\t<label for='input_3_6' >Password *<\/label>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_6' id='input_3_6'   value=''   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_3_6_2_container' class='ginput_right'>\n\t\t\t\t\t\t\t<label for='input_3_6_2' >Confirm Password *<\/label>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_6_2' id='input_3_6_2'   value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><\/fieldset><div id=\"field_3_15\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_15\"><label class='gfield_label' for='input_3_15' >Enter the CAPCHA code<\/label><div class='gfield_captcha_container'><img class='gfield_captcha' src='https:\/\/www.myskinbar.com\/wp-content\/uploads\/gravity_forms\/0-38f712508d099283b92db652d30e4dd5\/1199485312.png' alt='' width='150' height='42' \/><div class='gfield_captcha_input_container simple_captcha_medium'><input type='text' autocomplete='off' name='input_15' id='input_3_15' \/><input type='hidden' name='input_captcha_prefix_15' value='1199485312' \/><\/div><\/div><div class='gfield_description' id='gfield_description_3_15'>Please enter the 5 characters you see<\/div><\/div><div id=\"field_3_29\"  class=\"gfield gfield--width-full gfield_description gfield_html gfield_html_formatted field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_29\"><p>The Personal Data you provide will be used to create and manage your account on mySKINBAR.com. <\/p>\n<p>You are automatically opted-in or subscribed\nto receive both service notifications (like OTPs and account reminders) and promotional messages via email. This is necessary to allow us to send you notifications and reminders for you to use your coupon before it expires.<\/p>\n\n<p>You may opt-out or unsubscribe from receiving promotional messages anytime after you redeem your coupon or after the coupon expires.<\/p><\/div><fieldset id=\"field_3_28\"  class=\"gfield gfield--width-full hidden field_sublabel_below field_description_below hidden_label gfield_visibility_hidden\"  data-js-reload=\"field_3_28\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gfield_label_before_complex'  >Checkbox<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_28'><div class='gchoice gchoice_3_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Yes, I also want to  receive  promotional  messages and subscribe to newsletter'  id='choice_3_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_28_1' id='label_3_28_1'>Yes, I also want to  receive  promotional  messages and subscribe to newsletter<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_30\"  class=\"gfield gfield--width-full form-mailchimp hidden gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_30\"><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_30'><li class='gchoice_3_30'>\n                        <input name='input_30' type='checkbox' value='1' checked='checked' id='choice_3_30'   \/>\n                        <label for='choice_3_30' id='label_3_30'>Yes, I also want to receive promotional messages and subscribe to newsletter<\/label>\n                    <\/li><\/ul><\/div><\/div><div id=\"field_3_27\"  class=\"gfield gfield--width-full gfield_description gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_27\"><p>By completing this form, you agree to these <a href='https:\/\/www.myskinbar.com\/terms-and-conditions\/coupon-term\/50cashcoupon\/'><b>terms<\/b><\/a>. <\/p><\/div><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_3\"]){return false;}  window[\"gf_submitting_3\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} window[\"gf_submitting_3\"]=true;  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=3&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJbXSIsIjlmNWU3ZTAxOGM2ZWZiMzZiYWFiY2MwMTg4N2ZjZTVlIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_3' id='gform_ajax_frame_3' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n                <script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/www.myskinbar.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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