{"id":3107,"date":"2025-05-07T23:51:54","date_gmt":"2025-05-07T23:51:54","guid":{"rendered":"https:\/\/wisewomeninitiative.org\/staging\/1401\/?page_id=3107"},"modified":"2025-05-28T03:22:32","modified_gmt":"2025-05-28T03:22:32","slug":"membership-registration","status":"publish","type":"page","link":"https:\/\/wisewomeninitiative.org\/staging\/1401\/membership-registration\/","title":{"rendered":"Membership Registration"},"content":{"rendered":"\r\n<div class=\"sg-row sg-container sg-element container\" data-eq=\"1748402301107\">\r\n\t\t\r\n\t<div class=\"row-inner container-inner element-inner\">\r\n\t\t<div class=\"row-wrap container-wrap element-wrap\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\r\n\t\t\t<div class=\"row-content container-content element-content\">\r\n\t\t\t\t\r\n<div class=\"sg-column sg-container sg-element\" data-eq=\"1748402301108\">\r\n\t\t\r\n\t<div class=\"column-container container\">\r\n\t\t<div class=\"column-inner container-inner element-inner\">\r\n\t\t\t<div class=\"column-wrap container-wrap element-wrap\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t<div class=\"column-content container-content element-content\">\r\n\t\t\t\t\t\r\n<div class=\"sg-highlight-text sg-element\" data-settings=\"{&quot;strings&quot;:[&quot;Bigger&quot;,&quot;Bolder&quot;,&quot;Animated&quot;]}\" data-eq=\"1748402388143\">\r\n\t\t\r\n\t<div class=\"highlight-inner element-inner\">\r\n\t\t<div class=\"highlight-wrap element-wrap\">\r\n\t\t\t<div class=\"highlight-content element-content\">\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t<h2 class=\"title \">Membership Registration<\/h2>\t\t\t\t\r\n\t\t\t\t\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\r\n<div class=\"sg-row sg-container sg-element container\" data-eq=\"1748402301110\">\r\n\t\t\r\n\t<div class=\"row-inner container-inner element-inner\">\r\n\t\t<div class=\"row-wrap container-wrap element-wrap\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\r\n\t\t\t<div class=\"row-content container-content element-content\">\r\n\t\t\t\t\r\n<div class=\"sg-column sg-container sg-element\" data-eq=\"1748402301111\">\r\n\t\t\r\n\t<div class=\"column-container container\">\r\n\t\t<div class=\"column-inner container-inner element-inner\">\r\n\t\t\t<div class=\"column-wrap container-wrap element-wrap\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t<div class=\"column-content container-content element-content\">\r\n\t\t\t\t\t\r\n<div class=\"sg-text-block sg-element\" data-eq=\"1748402301112\">\r\n\t\t\r\n\t<div class=\"text-inner element-inner\">\r\n\t\t<div class=\"text-wrap element-wrap\">\r\n\t\t\t<div class=\"text-content element-content\">\r\n\t\t\t\t<p>Becoming a member of WISEWOMEN means joining a vibrant community committed to advancing women&#8217;s health through evidence-based action and collaboration.<\/p>\n<p>As a member, you gain exclusive access to a growing pool of knowledge, tools, and resources \u2014 keeping you at the forefront of developments in the field. You&#8217;ll also receive a dedicated profile page to showcase your:<\/p>\n<ul>\n<li>Leadership in the women\u2019s health space<\/li>\n<li>Ongoing projects and initiatives<\/li>\n<li>Team members and collaborators<\/li>\n<li>Funding and research outputs<\/li>\n<\/ul>\n<p>Join WISEWOMEN today and become part of a transformative movement working toward a healthier future for women everywhere.<\/p>\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\n\n<style id=\"wpforms-css-vars-3066\">\n\t\t\t\t#wpforms-3066 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3066\"><form id=\"wpforms-form-3066\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3066\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/staging\/1401\/wp-json\/wp\/v2\/pages\/3107\" data-token=\"a68a37d3131ec41522e5437d1b00ea2c\" data-token-time=\"1780205304\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3066-field_15-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-modern\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_15\">Title <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-3066-field_15\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"1\" name=\"wpforms[fields][15]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>e.g. Dr, Prof, Ms, Mr, Mx<\/option><option value=\"Mr\"  class=\"choice-1 depth-1\"  >Mr<\/option><option value=\"Mrs\"  class=\"choice-2 depth-1\"  >Mrs<\/option><option value=\"Ms\"  class=\"choice-3 depth-1\"  >Ms<\/option><option value=\"Dr\"  class=\"choice-4 depth-1\"  >Dr<\/option><option value=\"Prof\"  class=\"choice-5 depth-1\"  >Prof<\/option><option value=\"Mx\"  class=\"choice-6 depth-1\"  >Mx<\/option><option value=\"Sir\"  class=\"choice-7 depth-1\"  >Sir<\/option><option value=\"Lady\"  class=\"choice-8 depth-1\"  >Lady<\/option><option value=\"Hon\"  class=\"choice-12 depth-1\"  >Hon<\/option><option value=\"Chief\"  class=\"choice-18 depth-1\"  >Chief<\/option><option value=\"Sen\"  class=\"choice-19 depth-1\"  >Sen<\/option><option value=\"Ambassador\"  class=\"choice-20 depth-1\"  >Ambassador<\/option><\/select><\/div><div id=\"wpforms-3066-field_24-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-one-half wpforms-field-select-style-modern\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_24\">Preferred Pronouns<\/label><select id=\"wpforms-3066-field_24\" class=\"wpforms-payment-price wpforms-field-medium choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"\" name=\"wpforms[fields][24]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>e.g. she\/her, he\/him, they\/them, prefer not to say<\/option><option value=\"1\" data-amount=\"10.00\" data-custom-properties=\"10.00\" >She\/her<\/option><option value=\"2\" data-amount=\"25.00\" data-custom-properties=\"25.00\" >He\/him<\/option><option value=\"3\" data-amount=\"50.00\" data-custom-properties=\"50.00\" >They\/them<\/option><option value=\"4\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Prefer not to say<\/option><\/select><\/div><div id=\"wpforms-3066-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Full Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3066-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-3066-field_1-error\" required><label for=\"wpforms-3066-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3066-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-3066-field_1-last-error\" required><label for=\"wpforms-3066-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3066-field_13-container\" class=\"wpforms-field wpforms-field-email wpforms-one-third wpforms-first\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_13\">Organization \/ Academic \/ Research Affiliation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3066-field_13\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][13]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3066-field_13-error\" required><\/div><div id=\"wpforms-3066-field_19-container\" class=\"wpforms-field wpforms-field-email wpforms-one-third\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_19\">Education \/ Training Background <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3066-field_19\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][19]\" placeholder=\"e.g. BSc in Public Health, PhD in Psychology, MBBS\" spellcheck=\"false\" aria-errormessage=\"wpforms-3066-field_19-error\" required><\/div><div id=\"wpforms-3066-field_32-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-one-third wpforms-field-select-style-modern\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_32\">Current Position<\/label><select id=\"wpforms-3066-field_32\" class=\"wpforms-payment-price wpforms-field-medium choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"1\" name=\"wpforms[fields][32]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'><\/option><option value=\"1\" data-amount=\"10.00\" data-custom-properties=\"10.00\" >Student<\/option><option value=\"2\" data-amount=\"25.00\" data-custom-properties=\"25.00\" >Postdoctoral Fellow<\/option><option value=\"3\" data-amount=\"50.00\" data-custom-properties=\"50.00\" >Clinician<\/option><option value=\"4\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Policy Advisor<\/option><option value=\"5\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Academic Staff<\/option><option value=\"6\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Public Health Professional<\/option><option value=\"7\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Community Advocate<\/option><option value=\"9\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Other<\/option><\/select><\/div>\t\t<div id=\"wpforms-3066-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-3066-field_3\" >Mobile Experience \/<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-3066-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-3066-field_2-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_2\">Email Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3066-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3066-field_2-error\" required><\/div><div id=\"wpforms-3066-field_4-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_4\">Address<\/label><textarea id=\"wpforms-3066-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-3066-field_4-error\" ><\/textarea><\/div><div id=\"wpforms-3066-field_16-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-first\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_16\">City <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3066-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-3066-field_16-error\" required><\/div><div id=\"wpforms-3066-field_12-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-one-fourth wpforms-field-select-style-modern\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_12\">State <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-3066-field_12\" class=\"wpforms-payment-price wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'><\/option><option value=\"1\" data-amount=\"10.00\" data-custom-properties=\"10.00\" >New South Wales<\/option><option value=\"2\" data-amount=\"25.00\" data-custom-properties=\"25.00\" >Victoria<\/option><option value=\"4\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Queensland<\/option><option value=\"3\" data-amount=\"50.00\" data-custom-properties=\"50.00\" >Western Australia<\/option><option value=\"5\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >South Australia<\/option><option value=\"6\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Tasmania<\/option><option value=\"7\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >Not Listed<\/option><\/select><\/div><div id=\"wpforms-3066-field_18-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_18\">Postal Code <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3066-field_18\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][18]\" step=\"any\" aria-errormessage=\"wpforms-3066-field_18-error\" required><\/div><div id=\"wpforms-3066-field_26-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_26\">Country <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3066-field_26\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][26]\" step=\"any\" aria-errormessage=\"wpforms-3066-field_26-error\" required><\/div><div id=\"wpforms-3066-field_7-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth wpforms-first\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_7\">Mobile \/ Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3066-field_7\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][7]\" placeholder=\"Enter Mobile \/ Home phone\" step=\"any\" aria-errormessage=\"wpforms-3066-field_7-error\" required><\/div><div id=\"wpforms-3066-field_27-container\" class=\"wpforms-field wpforms-field-number wpforms-one-fourth\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_27\">Language(s) Spoken <\/label><input type=\"number\" id=\"wpforms-3066-field_27\" class=\"wpforms-field-large\" name=\"wpforms[fields][27]\" placeholder=\"Enter Mobile \/ Home phone\" step=\"any\" aria-errormessage=\"wpforms-3066-field_27-error\" ><\/div><div id=\"wpforms-3066-field_30-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-one-fourth wpforms-field-select-style-modern\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-3066-field_30\"># Experience in Women\u2019s Health<\/label><select id=\"wpforms-3066-field_30\" class=\"wpforms-payment-price wpforms-field-large choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][30]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Years of Experience <\/option><option value=\"1\" data-amount=\"10.00\" data-custom-properties=\"10.00\" >0\u20132 years<\/option><option value=\"2\" data-amount=\"25.00\" data-custom-properties=\"25.00\" >3\u20135 years<\/option><option value=\"3\" data-amount=\"50.00\" data-custom-properties=\"50.00\" >6\u201310 years<\/option><option value=\"4\" data-amount=\"0.00\" data-custom-properties=\"0.00\" >10+ years<\/option><\/select><\/div><div id=\"wpforms-3066-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Primary Topic of Interest <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3066-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_1\" name=\"wpforms[fields][8]\" value=\"Preconception, Pregnancy, Postpartum and Intrapartum Health of Women and Babies\" aria-errormessage=\"wpforms-3066-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_1\">Preconception, Pregnancy, Postpartum and Intrapartum Health of Women and Babies<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_2\" name=\"wpforms[fields][8]\" value=\"Sexual Health\" aria-errormessage=\"wpforms-3066-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_2\">Sexual Health<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_3\" name=\"wpforms[fields][8]\" value=\"Reproductive Health\" aria-errormessage=\"wpforms-3066-field_8_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_3\">Reproductive Health<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_4\" name=\"wpforms[fields][8]\" value=\"Healthy Lifestyle, Nutrition, Physical Activity and the Prevention of Obesity\" aria-errormessage=\"wpforms-3066-field_8_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_4\">Healthy Lifestyle, Nutrition, Physical Activity and the Prevention of Obesity<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_5\" name=\"wpforms[fields][8]\" value=\"Mental Health\" aria-errormessage=\"wpforms-3066-field_8_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_5\">Mental Health<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_6\" name=\"wpforms[fields][8]\" value=\"Healthy Aging\" aria-errormessage=\"wpforms-3066-field_8_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_6\">Healthy Aging<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_7\" name=\"wpforms[fields][8]\" value=\"Chronic Disease and Preventative Health including Cancer and Heart\" aria-errormessage=\"wpforms-3066-field_8_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_7\">Chronic Disease and Preventative Health including Cancer and Heart<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_8\" name=\"wpforms[fields][8]\" value=\"\u200bViolence and Abuse\" aria-errormessage=\"wpforms-3066-field_8_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_8\">\u200bViolence and Abuse<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-3066-field_8_9\" name=\"wpforms[fields][8]\" value=\"Indigenous Health\" aria-errormessage=\"wpforms-3066-field_8_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_8_9\">Indigenous Health<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3066-field_22-container\" class=\"wpforms-field wpforms-field-payment-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Secondary Topic of Interest<\/legend><ul id=\"wpforms-3066-field_22\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_1\" class=\"wpforms-payment-price\" data-amount=\"10.00\" name=\"wpforms[fields][22][]\" value=\"1\" aria-errormessage=\"wpforms-3066-field_22_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_1\">Preconception, Pregnancy, Postpartum and Intrapartum Health of Women and Babies<\/label><\/li><li class=\"choice-2\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_2\" class=\"wpforms-payment-price\" data-amount=\"25.00\" name=\"wpforms[fields][22][]\" value=\"2\" aria-errormessage=\"wpforms-3066-field_22_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_2\">Sexual Health<\/label><\/li><li class=\"choice-3\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_3\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][22][]\" value=\"3\" aria-errormessage=\"wpforms-3066-field_22_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_3\">Reproductive Health<\/label><\/li><li class=\"choice-4\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_4\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][22][]\" value=\"4\" aria-errormessage=\"wpforms-3066-field_22_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_4\">Healthy Lifestyle, Nutrition, Physical Activity and the Prevention of Obesity<\/label><\/li><li class=\"choice-6\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_6\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][22][]\" value=\"6\" aria-errormessage=\"wpforms-3066-field_22_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_6\">Mental Health<\/label><\/li><li class=\"choice-7\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_7\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][22][]\" value=\"7\" aria-errormessage=\"wpforms-3066-field_22_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_7\">Healthy Aging<\/label><\/li><li class=\"choice-8\"><input type=\"checkbox\" id=\"wpforms-3066-field_22_8\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][22][]\" value=\"8\" aria-errormessage=\"wpforms-3066-field_22_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3066-field_22_8\">Chronic Disease and Preventative 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