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<div class="wpforms-container wpforms-container-full" id="wpforms-11393"><form id="wpforms-form-11393" class="wpforms-validate wpforms-form" data-formid="11393" method="post" enctype="multipart/form-data" action="/tag/reputation/" data-token="f2c7576c949b8b9398d28e4b5f07f118"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-11393-field_0-container" class="wpforms-field wpforms-field-name name" data-field-id="0"><label class="wpforms-field-label" for="wpforms-11393-field_0">Name <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-medium"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-11393-field_0" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][0][first]" required><label for="wpforms-11393-field_0" class="wpforms-field-sublabel after ">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-11393-field_0-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][0][last]" required><label for="wpforms-11393-field_0-last" class="wpforms-field-sublabel after ">Last</label></div></div></div><div id="wpforms-11393-field_1-container" class="wpforms-field wpforms-field-email" data-field-id="1"><label class="wpforms-field-label" for="wpforms-11393-field_1">Email <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-11393-field_1" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][1]" required></div><div id="wpforms-11393-field_7-container" class="wpforms-field wpforms-field-text" data-field-id="7"><label class="wpforms-field-label" for="wpforms-11393-field_7">Title & Organization <span class="wpforms-required-label">*</span></label><input type="text" id="wpforms-11393-field_7" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][7]" required></div><div id="wpforms-11393-field_2-container" class="wpforms-field wpforms-field-textarea" data-field-id="2"><label class="wpforms-field-label" for="wpforms-11393-field_2">What's the situation? <span class="wpforms-required-label">*</span></label><textarea id="wpforms-11393-field_2" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][2]" required></textarea></div><div id="wpforms-11393-field_4-container" class="wpforms-field wpforms-field-checkbox wpforms-list-2-columns" data-field-id="4"><label class="wpforms-field-label" for="wpforms-11393-field_4">I need:</label><ul id="wpforms-11393-field_4"><li class="choice-9 depth-1"><input type="checkbox" id="wpforms-11393-field_4_9" name="wpforms[fields][4][]" value="COVID-19 Response" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_9">COVID-19 Response</label></li><li class="choice-5 depth-1"><input type="checkbox" id="wpforms-11393-field_4_5" name="wpforms[fields][4][]" value="Get Me In/Out of the News" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_5">Get Me In/Out of the News</label></li><li class="choice-6 depth-1"><input type="checkbox" id="wpforms-11393-field_4_6" name="wpforms[fields][4][]" value="Public & Media Relations" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_6">Public & Media Relations</label></li><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-11393-field_4_1" name="wpforms[fields][4][]" value="Crisis & Issues" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_1">Crisis & Issues</label></li><li class="choice-7 depth-1"><input type="checkbox" id="wpforms-11393-field_4_7" name="wpforms[fields][4][]" value="Influencing Congress & Regulators" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_7">Influencing Congress & Regulators</label></li><li class="choice-2 depth-1"><input type="checkbox" id="wpforms-11393-field_4_2" name="wpforms[fields][4][]" value="Marketing" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_2">Marketing</label></li><li class="choice-3 depth-1"><input type="checkbox" id="wpforms-11393-field_4_3" name="wpforms[fields][4][]" value="Social & Digital Media" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_3">Social & Digital Media</label></li><li class="choice-4 depth-1"><input type="checkbox" id="wpforms-11393-field_4_4" name="wpforms[fields][4][]" value="Media Training" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_4">Media Training</label></li><li class="choice-8 depth-1"><input type="checkbox" id="wpforms-11393-field_4_8" name="wpforms[fields][4][]" value="Websites, Videos & Creative" ><label class="wpforms-field-label-inline" for="wpforms-11393-field_4_8">Websites, Videos & Creative</label></li></ul></div><div id="wpforms-11393-field_5-container" class="wpforms-field wpforms-field-radio" data-field-id="5"><label class="wpforms-field-label" for="wpforms-11393-field_5">I would like for you to... <span class="wpforms-required-label">*</span></label><ul id="wpforms-11393-field_5" class="wpforms-field-required"><li class="choice-1 depth-1"><input type="radio" id="wpforms-11393-field_5_1" name="wpforms[fields][5]" value="Send Me Information" required ><label class="wpforms-field-label-inline" for="wpforms-11393-field_5_1">Send Me Information</label></li><li class="choice-2 depth-1"><input type="radio" id="wpforms-11393-field_5_2" name="wpforms[fields][5]" value="Call me" required ><label class="wpforms-field-label-inline" for="wpforms-11393-field_5_2">Call me</label></li></ul></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-11393-field-hp" class="wpforms-field-label">Message</label><input type="text" name="wpforms[hp]" id="wpforms-11393-field-hp" class="wpforms-field-medium"></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="11393"><input type="hidden" name="wpforms[author]" value="1"><button type="submit" name="wpforms[submit]" class="wpforms-submit om-trigger-conversion" id="wpforms-submit-11393" value="wpforms-submit" aria-live="assertive" data-alt-text="Sending..." data-submit-text="Submit">Submit</button></div></form></div> <!-- .wpforms-container -->
