<div class='gf_browser_unknown gform_wrapper form-home_wrapper recap-btn_wrapper' id='gform_wrapper_6' ><form method='post' enctype='multipart/form-data' id='gform_6' class='form-home recap-btn' action='/conference-tables/endo-health-solutions/'> <div class='gform_body'><ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><li id='field_6_1' class='gfield gf_left_half one-half gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_6_1' >First Name<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_6_1' type='text' value='' class='medium' placeholder='First Name' aria-required="true" aria-invalid="false" /></div></li><li id='field_6_7' class='gfield gf_left_half one-half right gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_6_7' >Last Name<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_6_7' type='text' value='' class='medium' placeholder='Last Name' aria-required="true" aria-invalid="false" /></div></li><li id='field_6_2' class='gfield gf_left_half one-half gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_6_2' >Email<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_email'> <input name='input_2' id='input_6_2' type='text' value='' class='medium' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></li><li id='field_6_3' class='gfield gf_left_half one-half right gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_6_3' >Phone Number<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_6_3' type='text' value='' class='medium' placeholder='Phone Number' aria-required="true" aria-invalid="false" /></div></li><li id='field_6_9' class='gfield gf_left_half one-half field_sublabel_below field_description_below gfield_visibility_hidden' ><label class='gfield_label' >Best Time to Get in Touch</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_6_9'><li class='gchoice_6_9_1'> <input name='input_9.1' type='checkbox' value='Morning' id='choice_6_9_1' /> <label for='choice_6_9_1' id='label_6_9_1'>Morning</label> </li><li class='gchoice_6_9_2'> <input name='input_9.2' type='checkbox' value='Afternoon' id='choice_6_9_2' /> <label for='choice_6_9_2' id='label_6_9_2'>Afternoon</label> </li></ul></div></li><li id='field_6_11' class='gfield one-half right gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >&nbsp;</li><li id='field_6_5' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_5' id='input_6_5' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></li><li id='field_6_6' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_6' id='input_6_6' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></li><li id='field_6_12' class='gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_6_12' >Comments</label><div class='ginput_container'><input name='input_12' id='input_6_12' type='text' value='' /></div><div class='gfield_description' id='gfield_description_6_12'>This field is for validation purposes and should be left unchanged.</div></li> </ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_6' class='gform_button button' value='Submit' onclick='if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='6' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_6' value='WyJbXSIsIjAyNGIwMWI4MjhmMmMyMzRhNjRkNDBkNWVhMDM0Nzg1Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_6' id='gform_target_page_number_6' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_6' id='gform_source_page_number_6' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div><script type='text/javascript'> jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 6) {if(typeof Placeholders != 'undefined'){ Placeholders.enable(); }jQuery('#input_6_3').mask('(999) 999-9999').bind('keypress', function(e){if(e.which == 13){jQuery(this).blur();} } );} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} );</script><script type='text/javascript'> jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [6, 1]) } ); </script>