{"id":2458,"date":"2023-06-05T16:54:40","date_gmt":"2023-06-05T20:54:40","guid":{"rendered":"https:\/\/jassuremacause.ca\/i-want-to-subscribe\/"},"modified":"2024-04-23T11:51:13","modified_gmt":"2024-04-23T15:51:13","slug":"i-want-to-subscribe","status":"publish","type":"page","link":"https:\/\/jassuremacause.ca\/en\/i-want-to-subscribe\/","title":{"rendered":"I want to subscribe"},"content":{"rendered":"<style>.kb-row-layout-id2458_ba3805-5e > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2458_ba3805-5e > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2458_ba3805-5e > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1800px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:6%;padding-bottom:6%;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2458_ba3805-5e{background-image:url('https:\/\/jassuremacause.ca\/wp-content\/uploads\/2023\/06\/donateur-flou4-jmc-e1686326356257.png');background-size:cover;background-position:50% 50%;background-attachment:scroll;background-repeat:no-repeat;}.kb-row-layout-id2458_ba3805-5e > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2458_ba3805-5e > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2458_ba3805-5e > .kt-row-column-wrap{padding-top:12%;padding-bottom:12%;grid-template-columns:minmax(0, 1fr);}}.kb-row-layout-id2458_ba3805-5e .forminator-input-with-suffix {\r    width: 100%;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-label {\r    padding-bottom: 5px;\r}\r.kb-row-layout-id2458_ba3805-5e div#consent-1 {\r    margin-top: 2%;\r}\r.kb-row-layout-id2458_ba3805-5e input, .kb-row-layout-id2458_ba3805-5e .select2-selection {\r    height: 45px;\r    font-weight:500!important;\r    font-size: 18px!important;\r    font-family: Roboto!important;\r    color: #D57263!important;\r    border-radius:50px!important;\r    background-color:transparent!important;\r}\r.kb-row-layout-id2458_ba3805-5e .select2-selection__rendered, .kb-row-layout-id2458_ba3805-5e .forminator-radio-label {\r    font-weight:500!important;\r    font-size: 18px!important;\r    font-family: Roboto!important;\r    color: #D57263!important;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-select-dropdown-container--open .forminator-custom-form-1790.forminator-dropdown--default .select2-results .select2-results__options .select2-results__option.select2-results__option--selected {\r    background-color: #D57263;\r    color: #FFFFFF;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-label, .kb-row-layout-id2458_ba3805-5e .forminator-consent__label p {\r    font-weight: 400!important;\r    line-height: 1.3!important;\r    display: block!important;\r    font-size: 18px!important;\r    color: var(--global-palette2)!important;\r}\r\r.kb-row-layout-id2458_ba3805-5e .forminator-currency, .kb-row-layout-id2458_ba3805-5e .autreOrganisme input {\r    border-radius: 0px!important;\r    border-top-width: 0px!important;\r    border-left-width: 0px!important;\r    border-right-width: 0px!important;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-grouped-fields .forminator-row {\r    margin-bottom: 10px!important;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-grouped-fields .forminator-field {\r    display: flex;\r    flex-wrap: wrap;\r}\r\r.kb-row-layout-id2458_ba3805-5e .forminator-input-with-suffix img {\r    left: 669px!important;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-grouped-fields .forminator-label {\r  white-space: nowrap;\r  align-self: flex-end;\r  width: 12%;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-error-message {\r    width: 100%;\r    color: #D57263;\r}\r.kb-row-layout-id2458_ba3805-5e span.forminator-suffix {\r    visibility: hidden;\r}\r.kb-row-layout-id2458_ba3805-5e span.forminator-suffix:after {\r    content: \"$\";\r    visibility: visible;\r    color:#707070;\r    font-weight:500!important;\r    font-size: 18px!important;\r    font-family: Roboto!important;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-button-submit {\r    background-color: #D57263!important;\r    border-radius: 50px!important;\r    padding: 12px 25px!important;\r    color: #FFFFFF;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-row-last .forminator-field {\r    display: flex;\r    justify-content: center;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-field-radio {\r    margin-top: 15px;\r    padding-right: 5px;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-required {\r  color: #D57263;\r}\r@media (max-width:768px) {\r  .kb-row-layout-id2458_ba3805-5e .forminator-input-with-suffix {\r    width: 75%;\r}\r.kb-row-layout-id2458_ba3805-5e .forminator-grouped-fields .forminator-label {\r  white-space: nowrap;\r  align-self: flex-end;\r  width: 25%;\r}\r}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2458_ba3805-5e alignnone kt-row-has-bg resp wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2458_64e0d9-15 > .kt-inside-inner-col,.kadence-column2458_64e0d9-15 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2458_64e0d9-15 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2458_64e0d9-15 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2458_64e0d9-15 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2458_64e0d9-15 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2458_64e0d9-15{position:relative;}@media all and (max-width: 1024px){.kadence-column2458_64e0d9-15 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2458_64e0d9-15 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2458_64e0d9-15 inner-column-1\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15, .wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15[data-kb-block=\"kb-adv-heading2458_286734-15\"]{padding-bottom:0px;margin-bottom:10px;text-align:center;font-weight:700;font-style:normal;font-family:Roboto;text-transform:uppercase;}.wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15[data-kb-block=\"kb-adv-heading2458_286734-15\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15[data-kb-block=\"kb-adv-heading2458_286734-15\"] img.kb-inline-image{width:150px;vertical-align:baseline;}@media all and (max-width: 1024px){.wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15, .wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15[data-kb-block=\"kb-adv-heading2458_286734-15\"]{padding-right:80px;padding-left:80px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15, .wp-block-kadence-advancedheading.kt-adv-heading2458_286734-15[data-kb-block=\"kb-adv-heading2458_286734-15\"]{padding-right:0px;padding-left:0px;font-size:45px;line-height:1.1em;}}<\/style>\n<h1 class=\"kt-adv-heading2458_286734-15 wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2458_286734-15\">I want to subscribe<\/h1>\n\n\n<style>.wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97, .wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97[data-kb-block=\"kb-adv-heading2458_8a0215-97\"]{text-align:center;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97[data-kb-block=\"kb-adv-heading2458_8a0215-97\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97[data-kb-block=\"kb-adv-heading2458_8a0215-97\"] img.kb-inline-image{width:150px;vertical-align:baseline;}@media all and (max-width: 767px){.wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97, .wp-block-kadence-advancedheading.kt-adv-heading2458_8a0215-97[data-kb-block=\"kb-adv-heading2458_8a0215-97\"]{text-align:center!important;}}<\/style>\n<p class=\"kt-adv-heading2458_8a0215-97 wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2458_8a0215-97\">Fill in all the fields on the form to subscribe.<\/p>\n\n\n<style>.kb-row-layout-wrap.wp-block-kadence-rowlayout.kb-row-layout-id2458_649a16-c1{margin-top:4%;}.kb-row-layout-id2458_649a16-c1 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2458_649a16-c1 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2458_649a16-c1 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);padding-top:3%;padding-right:3%;padding-bottom:3%;padding-left:3%;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2458_649a16-c1{border-top-left-radius:8px;border-top-right-radius:8px;border-bottom-right-radius:8px;border-bottom-left-radius:8px;overflow:clip;isolation:isolate;}.kb-row-layout-id2458_649a16-c1 > .kt-row-layout-overlay{border-top-left-radius:8px;border-top-right-radius:8px;border-bottom-right-radius:8px;border-bottom-left-radius:8px;}.kb-row-layout-id2458_649a16-c1{background-color:rgba(255,255,255,0.4);}.kb-row-layout-id2458_649a16-c1 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2458_649a16-c1 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2458_649a16-c1 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2458_649a16-c1 alignnone kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col,.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2458_dc9e1f-50{position:relative;}@media all and (max-width: 1024px){.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2458_dc9e1f-50 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2458_dc9e1f-50 inner-column-1\"><div class=\"kt-inside-inner-col\">\n<script>\n\/\/ Attendez que le document soit charg\u00e9\ndocument.addEventListener(\"DOMContentLoaded\", function() {\n    \/\/ S\u00e9lectionnez tous les boutons sur la page\n    var boutons = document.querySelectorAll('button');\n    \n    \/\/ Parcourez tous les boutons\n    boutons.forEach(function(bouton) {\n        \/\/ Ajoutez un ID \u00e0 chaque bouton\n        bouton.id = \"form_submitB2C\";\n        console.log(\"ID ajout\u00e9 au bouton avec succ\u00e8s !\");\n    });\n\n    \/\/ V\u00e9rifiez si des boutons ont \u00e9t\u00e9 trouv\u00e9s\n    if (boutons.length === 0) {\n        console.error(\"Aucun bouton trouv\u00e9 !\");\n    }\n});\n\n<\/script>\n\n\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-2480 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-2480\" data-uid=\"69f16db96d5f8\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2480\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2480 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"2480\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f16db96d5f8\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-6  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-form-2480__field--select-3_69f16db96d5f8\" id=\"forminator-form-2480__field--select-3_69f16db96d5f8-label\" class=\"forminator-label\">Select one of the following options <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2480__field--select-3_69f16db96d5f8\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"- -\" data-search=\"false\" data-search-placeholder=\"- -\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2480__field--select-3_69f16db96d5f8-label\"><option value=\"\"  >- -<\/option><option value=\"Je-d\u00e9sire-souscrire-\u00e0-un-capital-d\u2019assurance-vie\"  data-calculation=\"0\">I want to take out a life insurance policy<\/option><option value=\"one\"  data-calculation=\"0\">I have a monthly budget<\/option><option value=\"two\"  data-calculation=\"0\">I have an annual budget<\/option><option value=\"J&#039;ai-un-budget-forfaitaire\"  data-calculation=\"0\">I have a lump sum budget<\/option><\/select><\/div><\/div><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-6 \"><div class=\"forminator-all-group-copies\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"currency-4\" class=\"forminator-field-currency forminator-col forminator-col-12  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-4_69f16db96d5f8\" id=\"forminator-field-currency-4_69f16db96d5f8-label\" class=\"forminator-label\">Amount of life insurance capital: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-4\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-4_69f16db96d5f8\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039; &#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" \/><span class=\"forminator-suffix\">CAD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-1\" class=\"forminator-field-currency forminator-col forminator-col-12  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-1_69f16db96d5f8\" id=\"forminator-field-currency-1_69f16db96d5f8-label\" class=\"forminator-label\">Monthly amount: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-1\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-1_69f16db96d5f8\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039; &#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" \/><span class=\"forminator-suffix\">CAD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-2\" class=\"forminator-field-currency forminator-col forminator-col-12  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-2_69f16db96d5f8\" id=\"forminator-field-currency-2_69f16db96d5f8-label\" class=\"forminator-label\">Annual amount: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-2\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-2_69f16db96d5f8\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039; &#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" \/><span class=\"forminator-suffix\">CAD<\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"currency-3\" class=\"forminator-field-currency forminator-col forminator-col-12  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-field-currency-3_69f16db96d5f8\" id=\"forminator-field-currency-3_69f16db96d5f8-label\" class=\"forminator-label\">Lump-sum amount: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-suffix\"><input name=\"currency-3\" value=\"\" placeholder=\"\" id=\"forminator-field-currency-3_69f16db96d5f8\" class=\"forminator-input forminator-currency\" data-required=\"1\" aria-required=\"1\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039; &#039;, &#039;radixPoint&#039;: &#039;,&#039;, &#039;digits&#039;: &#039;2&#039;\" data-hidden-behavior=\"zero\" \/><span class=\"forminator-suffix\">CAD<\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-6  halfwidth\"><div class=\"forminator-field\"><label for=\"forminator-form-2480__field--select-4_69f16db96d5f8\" id=\"forminator-form-2480__field--select-4_69f16db96d5f8-label\" class=\"forminator-label\">I want the following organization to benefit: <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2480__field--select-4_69f16db96d5f8\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Choose an organization\" data-search=\"false\" data-search-placeholder=\"Choose an organization\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2480__field--select-4_69f16db96d5f8-label\"><option value=\"\"  >Choose an organization<\/option><option value=\"La-Fondation-du-CLSC-CHSLD-de-l&#039;\u00c9rable\"  data-calculation=\"0\">Fondation du CLSC-CHSLD de l'\u00c9rable<\/option><option value=\"La-Fondation-les-amis-d&#039;Elliot\"  data-calculation=\"0\">Fondation les amis d'Elliot<\/option><option value=\"Maison-la-Cinqui\u00e8me-Saison\"  data-calculation=\"0\">Fondation Maison la Cinqui\u00e8me Saison<\/option><option value=\"Fondation-Maison-Marie-\u00c9lisabeth\"  data-calculation=\"0\">Fondation Maison Marie-\u00c9lisabeth<\/option><option value=\"one\"  data-calculation=\"0\">Fondation Vivere<\/option><option value=\"two\"  data-calculation=\"0\">La Fondation des Pompiers du Qu\u00e9bec pour les Grands Br\u00fbl\u00e9s<\/option><option value=\"La-Travers\u00e9e-12-18-ans\"  data-calculation=\"0\">La Travers\u00e9e 12-18 ans<\/option><option value=\"Maison-les-Couleurs-du-Vent\"  data-calculation=\"0\">Maison les Couleurs du Vent<\/option><option value=\"Parkinson-Qu\u00e9bec\"  data-calculation=\"0\">Parkinson Qu\u00e9bec<\/option><option value=\"Villa-Versant-du-Lac\"  data-calculation=\"0\">Villa Versant du Lac<\/option><option value=\"Other,-please-specify\"  data-calculation=\"0\">Other, please specify<\/option><\/select><\/div><\/div><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-6 \"><div class=\"forminator-all-group-copies\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f16db96d5f8\" id=\"forminator-field-text-1_69f16db96d5f8-label\" class=\"forminator-label\">Specify name of organization : <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f16db96d5f8\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69f16db96d5f8\" id=\"forminator-field-name-1_69f16db96d5f8-label\" class=\"forminator-label\">First name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69f16db96d5f8\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69f16db96d5f8\" id=\"forminator-field-name-2_69f16db96d5f8-label\" class=\"forminator-label\">Last name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_69f16db96d5f8\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-2480__field--select-1_69f16db96d5f8\" id=\"forminator-form-2480__field--select-1_69f16db96d5f8-label\" class=\"forminator-label\">Gender: <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2480__field--select-1_69f16db96d5f8\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"one\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select an option\" data-search=\"false\" data-search-placeholder=\"Please select an option\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2480__field--select-1_69f16db96d5f8-label\"><option value=\"\"  >Please select an option<\/option><option value=\"one\" selected=\"selected\" data-calculation=\"0\">Male<\/option><option value=\"two\"  data-calculation=\"0\">Female<\/option><\/select><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69f16db96d5f8\" id=\"forminator-field-date-1-picker_69f16db96d5f8-label\" class=\"forminator-label\">Date of birth: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_69f16db96d5f8\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"yy-mm-dd\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f16db96d5f8\" id=\"forminator-field-phone-1_69f16db96d5f8-label\" class=\"forminator-label\">Telephone: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69f16db96d5f8\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f16db96d5f8\" id=\"forminator-field-email-1_69f16db96d5f8-label\" class=\"forminator-label\">Email: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69f16db96d5f8\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69f16db96d5f8-label\"><span id=\"forminator-radiogroup-radio-2-69f16db96d5f8-label\" class=\"forminator-label\">Preferred language of communication: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f16db96d5f8\" class=\"forminator-radio forminator-radio-inline\" title=\"English\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-69f16db96d5f8\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">English<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f16db96d5f8\" class=\"forminator-radio forminator-radio-inline\" title=\"French\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-69f16db96d5f8\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">French<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69f16db96d5f8-label\"><span id=\"forminator-radiogroup-radio-1-69f16db96d5f8-label\" class=\"forminator-label\">In the last twelve months, have you used any substances or products containing tobacco, nicotine or marijuana mixed with nicotine or used electronic cigarettes? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f16db96d5f8\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69f16db96d5f8\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f16db96d5f8\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69f16db96d5f8\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69f16db96d5f8__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69f16db96d5f8-label\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69f16db96d5f8\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69f16db96d5f8-label\" aria-describedby=\"forminator-field-consent-1_69f16db96d5f8__description\" data-required=\"false\" aria-required=\"false\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69f16db96d5f8__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I want to provide evidence of insurability.<\/p><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Schedule an Appointment<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"a26acde770\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/2458\" \/><input type=\"hidden\" name=\"form_id\" value=\"2480\"><input type=\"hidden\" name=\"page_id\" value=\"2458\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/jassuremacause.ca\/en\/i-want-to-subscribe\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>I want to subscribe Fill in all the fields on the form to subscribe.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_eb_attr":"","inline_featured_image":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"class_list":["post-2458","page","type-page","status-publish","hentry"],"acf":[],"taxonomy_info":[],"featured_image_src_large":false,"author_info":{"display_name":"mbourgeault","author_link":"https:\/\/jassuremacause.ca\/en\/author\/mbourgeault\/"},"comment_info":"","_links":{"self":[{"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/pages\/2458","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/comments?post=2458"}],"version-history":[{"count":0,"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/pages\/2458\/revisions"}],"wp:attachment":[{"href":"https:\/\/jassuremacause.ca\/en\/wp-json\/wp\/v2\/media?parent=2458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}