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opened 2025-10-14 16:24:56 -06:00 by navan · 0 comments

navan commented

2025-10-14 16:24:56 -06:00

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Originally created by @jchesner on 12/16/2020

Hi. I have a form created. Upon submission, I am receiving the code, rather than the thankyou_message. Any help would be greatly appreciated!!
`

<link rel="stylesheet" href="https://unpkg.com/purecss@1.0.0/build/pure-min.css">

<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0-alpha.6/css/bootstrap.min.css" integrity="sha384-rwoIResjU2yc3z8GV/NPeZWAv56rSmLldC3R/AZzGRnGxQQKnKkoFVhFQhNUwEyJ" crossorigin="anonymous">

<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js" integrity="sha384-Tc5IQib027qvyjSMfHjOMaLkfuWVxZxUPnCJA7l2mCWNIpG9mGCD8wGNIcPD7Txa" crossorigin="anonymous"></script>

<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
    
<link href='http://fonts.googleapis.com/css?family=Roboto' rel='stylesheet'Â Â type='text/css'>

<script src="https://use.fontawesome.com/37f0b94556.js"></script>

</head>

<div class="row">
    <div class="col-xs-12 col-md-12 col-lg-12">
        <img src="https://achievece.com/wp-content/uploads/2020/02/AchieveCE-Kabrio.png" width="200" style="padding-top: 20px; margin-left: 40px; padding-bottom: 5px;">
        <br /><br />
        <hr style="border: 1px solid #036cb0; width: 100%; padding: 0px; margin: 0px;"><br />
    </div>
</div>

<form id="gform" method="POST" action="https://script.google.com/macros/s/AKfycby5LkcasuDHgCBCbAC5fR7nX-DL8NNetBGasoUklFlOBs54MI4/exec">

<div class="row" style="margin-left: 20px; margin-right: 20px;">
    <div class="col-xs-12 col-md-12 col-lg-12">
        <font style="font-size: 20px; font-weight: 600; color: #036cb0;">PROPOSAL FORM - PHARMACY</font><br />
        AchieveCE is always looking for CPE activity proposals that meet various state-required continuing education needs and allows pharmacy professionals to grow in their profession. Whether it is a webinar or a monograph, we are looking for CPE activities about a variety of topics and depths that can help both pharmacy and pharmacy technicians be the best at what they do.<br /><br />
        AchieveCE accepts and evaluates proposals throughout the year. Proposals reviewed are evaluated based on the following criteria:<br /><br />
        <div class="row">
            <div class="col-xs-12 col-md-6 col-lg-6">
                <ul>
                    <li>Quality of proposal</li>
                    <li>Clearly defined topic focus and objectives</li>
                    <li>Practical application of materials proposed</li>
                </ul>
            </div>
            <div class="col-xs-12 col-md-6 col-lg-6">
                <ul>
                    <li>Relevance to modern practice</li>
                    <li>Previous experience in presenting and writing CPE activities</li>
                    <li>Compliance to ACPE standards for CPE</li>
                </ul>
            </div>
        </div>
        All proposals for CPE activities must be original and unpublished.<br /><br />AchieveCE has also selected a number of topics that address the identified needs of pharmacy professionals in the country. Activity proposals should be designed to meet these topics.<br /><br />If the topic you wish to write about or present is not included in our list of selected topics, you may still submit a proposal, provided that an evidence of the need for the topic is included in your submission AND that you have subject matter expertise in the topic you wish to write about. A subject matter expertise is one who practices in the area related to the topic and one who meets the following criteria:<br /><br />
        <div class="row">
            <div class="col-xs-12 col-md-6 col-lg-6">
                <ul>
                    <li>Certification in the subject matter by the Board of Pharmacy Specialties or similar</li>
                    <li>Leadership position at the local, state, or national level</li>
                </ul>
            </div>
            <div class="col-xs-12 col-md-6 col-lg-6">
                <ul>
                    <li>Publication in a peer-reviewed journal or study presentation to a state-wide or national audience</li>
                    <li>High regard of professional peers</li>
                </ul>
            </div>
        </div>
        Please complete the online activity proposal form after you have reviewed the information above.  You may contact <a href="mailto:gracielle.tubera@achievece.com" style="text-decoration: none;">Gracielle Tubera</a> with any concerns and questions about your proposal submission.
        <hr style="border: 1px solid #f4f4f4;"><br />
    </div>
</div>    
    
<div class="row" style="margin-left: 40px; margin-right: 40px;">
    <fieldset class="pure-form" style="background-color: #f4f4f4; width: 100%;">
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="firstName"><strong>First Name</strong> <font style="color: #fc4952;">*</font></label><br />
                <input type="text" placeholder="" id="firstName" name="firstName" style="border: 1px solid #00cdc8; width: 100%;" required />
            </div>
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="lastName"><strong>Last Name</strong> <font style="color: #fc4952;">*</font></label><br />
                <input placeholder="" id="lastName" name="lastName" style="border: 1px solid #00cdc8; width: 100%;" required  />
            </div>
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="email"><strong>Email Address</strong> <font style="color: #fc4952;">*</font></label><br />
                <input placeholder="" type="email" name="email" style="border: 1px solid #00cdc8; width: 100%;" required >
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="activityTitle"><strong>Activity Title</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Please be creative when choosing a title.</font></label><br />
                <input type="text" placeholder="" id="activityTitle" name="activityTitle" style="border: 1px solid #00cdc8; width: 100%;" required  />
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="activityType"><strong>Activity Type</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label><br />
                <input placeholder="" type="radio" name="activityType" value="live" required>&nbsp;&nbsp;Live Webinar&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input placeholder="" type="radio" name="activityType" value="hsMonograph" >&nbsp;&nbsp;Home Study Monograph
            </div>
            <div class="col-xs-12 col-md-3 col-lg-3">
                <label for="completionDate"><strong>Anticipated Completion Date</strong> <font style="color: #fc4952;">*</font></label><br />
                <input placeholder="" id="completionDate" name="completionDate" type="date" style="border: 1px solid #00cdc8;" required />
            </div>
            <div class="col-xs-12 col-md-3 col-lg-3">
                <label for="topicDesignation"><strong>ACPE Topic Designation</strong> <font style="color: #fc4952;">*</font></label><br />
                <select required id="topicDesignation" name="topicDesignation" style="border: 1px solid #00cdc8; width: 69%;">
                    <option value="" disable selected class="defaulted" required> </option>
                    <option value="Drug Therapy">Drug Therapy</option>
                    <option value="AIDS Therapy">AIDS Therapy</option>
                    <option value="Law">Law</option>
                    <option value="General Pharmacy">General Pharmacy</option>
                    <option value="Patient Safety">Patient Safety</option>
                    <option value="Immunizations">Immunizations</option>
                    <option value="Compounding">Compounding</option>
                    <option value="Immunizations">Immunizations</option>
                    <option value="Pain Management">Pain Management</option>
                </select>
            </div>
            <div class="col-xs-12 col-md-2 col-lg-2">
                <label for="activityLength"><strong>Activity Length</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label><br />
                <select required id="activityLength" name="activityLength" onclick="checkObjCount(this);" style="border: 1px solid #00cdc8;">
                    <option value="" disable selected class="defaulted" required> </option>
                    <option value="1">1 hour</option>
                    <option value="1.5">1.5 hours</option>
                    <option value="2">2 hours</option>
                    <option value="Other">Other</option>
                </select> 
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-6 col-lg-6">
                <label for="experience"><strong>Please describe prior presentation experience on this topic.</strong> <font style="color: #fc4952;">*</font></label><br />
                <textarea class="form-control" rows="2" id="experience" name="experience" style="border: 1px solid #00cdc8; width: 100%;" required></textarea>
            </div>
            <div class="col-xs-12 col-md-3 col-lg-3">
                <label for="present4ce"><strong>Have you presented for another CE provider?</strong> <font style="color: #fc4952;">*</font></label><br />
                <input placeholder="" type="radio" name="present4ce" id="present4ceYes" value="Yes" onclick="showCEproviders(this);" >&nbsp;&nbsp;Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input placeholder="" type="radio" name="present4ce" id="present4ceNo" value="No" onclick="showCEproviders(this);" >&nbsp;&nbsp;No
            </div>
            <div class="col-xs-12 col-md-3 col-lg-3">
                <label for="ceProviders"><strong>Please list CE providers you have presented for.</strong></label><br />
                <input type="text" placeholder="" id="ceProviders" name="ceProviders" style="border: 1px solid #00cdc8; width: 100%;" disabled  />
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="activityBasis"><strong>Activity Basis</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label><br />
                <div class="row">
                    <div class="col-xs-12 col-md-6 col-lg-6">
                        <input placeholder="" type="radio" name="activityBasis" value="Knowledge-Based" required>&nbsp;&nbsp;Knowledge-Based<br />
                        <font style="font-size: 10px; color: #687683;">These activities are primarily constructed to transmit knowledge. The facts must be based on evidence as accepted in the literature by the health care professions.</font>
                    </div>
                    <div class="col-xs-12 col-md-6 col-lg-6">
                        <input placeholder="" type="radio" name="activityBasis" value="Application-Based" >&nbsp;&nbsp;Application-Based<br />
                        <font style="font-size: 10px; color: #687683;">These activities are primarily constructed to apply the information learned in the time frame allotted. The information must be based on evidence as accepted in the literature by the health care professions.</font>
                    </div>
                </div>
            </div>
            <div class="col-xs-12 col-md-1 col-lg-1"></div>
            <div class="col-xs-12 col-md-7 col-lg-7">
                <label for="activityLevel"><strong>Activity Complexity Level</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label><br />
                <div class="row">
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="activityLevel" value="General Overview" required >&nbsp;&nbsp;Level 1: Recall<br />
                        <font style="font-size: 10px; color: #687683;">This activity requires only a surface understanding of data presented and often consists of verbatim recall from data or simple understanding of a single word or phrase.  Participants are required to recall information such as a fact, definition, or term.</font>
                    </div>
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="activityLevel" value="Specialized Topic" >&nbsp;&nbsp;Level 2: Basic Application of Skills & Concepts<br />
                        <font style="font-size: 10px; color: #687683;">This activity includes the engagement of some mental processing beyond recalling a response. Participants are required to make observations of data through classification, tables, graphs, and charts</font>
                    </div>
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="activityLevel" value="In-Depth Focus" >&nbsp;&nbsp;Level 3: Strategic Thinking & Reasoning<br />
                        <font style="font-size: 10px; color: #687683;">This activity requires proving understanding of data with reasoning and planning.  Participants are required to draw conclusions from observations, citing evidence, and understanding various concepts used to solve problems.</font>
                    </div>
                </div>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-6 col-lg-6">
                <label for="targetprof"><strong>Target Audience</strong> <font style="color: #fc4952;">*</font></label>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Select all that apply.</font><br />
                <div class="row">
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input type="checkbox" id="targetprofPharm" name="targetprof" value="Pharmacists" onclick="showHidePharmObj(this);"  />&nbsp;&nbsp;Pharmacists
                    </div>
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input type="checkbox" id="targetprofTech" name="targetprof" value="Pharmacy Technicians" onclick="showHideTechObj(this);" />&nbsp;&nbsp;Pharmacy Technicians
                    </div>
                    <!--<div class="col-xs-12 col-md-4 col-lg-4">
                        <input type="checkbox" id="targetprofNurse" name="targetprof" value="Nurses" onclick="showHideNurseObj(this);" />&nbsp;&nbsp;Nurses
                    </div>-->
                </div>
            </div>
            <div class="col-xs-12 col-md-2 col-lg-2"></div>
            <div class="col-xs-12 col-md-4 col-lg-4">
                <label for="offLabelUse"><strong>Will off-label use be discussed?</strong> <font style="color: #fc4952;">*</font></label><br />
                <div class="row">
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="offLabelUse" value="Yes" required >&nbsp;&nbsp;Yes
                    </div>
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="offLabelUse" value="No" >&nbsp;&nbsp;No
                    </div>
                    <div class="col-xs-12 col-md-4 col-lg-4">
                        <input placeholder="" type="radio" name="offLabelUse" value="Does Not Apply" >&nbsp;&nbsp;Does Not Apply
                    </div>
                </div>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="practiceSetting"><strong>Target Practice Setting</strong> <font style="color: #fc4952;">*</font></label>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Select all that apply.</font><br />
                <div class="row">
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Concentrated Focus" />&nbsp;&nbsp;Concentrated Focus
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Health System"  />&nbsp;&nbsp;Health System
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Retail" />&nbsp;&nbsp;Retail
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Pharmaceutical Industry" />&nbsp;&nbsp;Pharmaceutical Industry
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Other/Non-Patient Interaction" />&nbsp;&nbsp;Other/Non-Patient Interaction
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                    </div>
                </div>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="practiceClassification"><strong>Target Practice Classification</strong></label>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Select all that apply.</font><br />
                <div class="row">
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Administration" />&nbsp;&nbsp;Administration<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Home Health Care" />&nbsp;&nbsp;Home Health Care<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Nuclear" />&nbsp;&nbsp;Nuclear<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Specialty" />&nbsp;&nbsp;Specialty
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Ambulatory Care" />&nbsp;&nbsp;Ambulatory Care<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Home Infusion" />&nbsp;&nbsp;Home Infusion<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Oncology" />&nbsp;&nbsp;Oncology<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Veterinary" />&nbsp;&nbsp;Veterinary
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Biotechnology" />&nbsp;&nbsp;Biotechnology<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Inpatient" />&nbsp;&nbsp;Inpatient<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Other" />&nbsp;&nbsp;Other<br /><br />
                        
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Clinical" />&nbsp;&nbsp;Clinical<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Long-Term Care" />&nbsp;&nbsp;Long-Term Care<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Outpatient" />&nbsp;&nbsp;Outpatient<br /><br />
                        
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Compounding" />&nbsp;&nbsp;Compounding<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Mail Service" />&nbsp;&nbsp;Mail Service<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Poison Control" />&nbsp;&nbsp;Poison Control<br /><br />
                        
                    </div>
                    <div class="col-xs-12 col-md-2 col-lg-2">
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Consultant" />&nbsp;&nbsp;Consultant<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Managed Care" />&nbsp;&nbsp;Managed Care<br /><br />
                        <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Research" />&nbsp;&nbsp;Research
                        
                    </div>
                </div>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="PharmObj"><strong>Pharmacist Learning Objectives</strong></label><br />
                <input type="text" placeholder="Learning Objective 1 *" id="pharmObj1" name="pharmObj1" style="border: 1px solid #00cdc8; width: 100%;" disabled />
                <input type="text" placeholder="Learning Objective 2 *" id="pharmObj2" name="pharmObj2" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 3 *" id="pharmObj3" name="pharmObj3" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 4 *" id="pharmObj4" name="pharmObj4" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden />
                <input type="text" placeholder="Learning Objective 5" id="pharmObj5" name="pharmObj5" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden />
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="PharmObj"><strong>Pharmacy Technician Learning Objectives</strong>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Please identify learning objectives that are different from pharmacist objectives and are truly pertinent to the pharmacy technician.</font></label><br />
                <input type="text" placeholder="Learning Objective 1 *" id="techObj1" name="techObj1" style="border: 1px solid #00cdc8; width: 100%;" disabled />
                <input type="text" placeholder="Learning Objective 2 *" id="techObj2" name="techObj2" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 3 *" id="techObj3" name="techObj3" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 4 *" id="techObj4" name="techObj4" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden />
                <input type="text" placeholder="Learning Objective 5" id="techObj5" name="techObj5" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden />
            </div>
        </div>
        <!--<div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="PharmObj"><strong>Nurse Learning Objectives</strong>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Please identify learning objectives that are different from pharmacist objectives and are truly pertinent to the nurse.</font></label><br />
                <input type="text" placeholder="Learning Objective 1 *" id="nurseObj1" name="nurseObj1" style="border: 1px solid #beca28; width: 100%;" disabled />
                <input type="text" placeholder="Learning Objective 2 *" id="nurseObj2" name="nurseObj2" style="border: 1px solid #beca28; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 3 *" id="nurseObj3" name="nurseObj3" style="border: 1px solid #beca28; width: 100%; margin-top: 10px;" disabled />
                <input type="text" placeholder="Learning Objective 4 *" id="nurseObj4" name="nurseObj4" style="border: 1px solid #beca28; width: 100%; margin-top: 10px;" disabled hidden />
                <input type="text" placeholder="Learning Objective 5" id="nurseObj5" name="nurseObj5" style="border: 1px solid #beca28; width: 100%; margin-top: 10px;" disabled hidden />
            </div>
        </div>-->
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="gap"><strong>Knowledge Gap/Educational Need</strong> <font style="color: #fc4952;">*</font></label><br />
                <textarea class="form-control" rows="5" id="gap" name="gap" style="border: 1px solid #00cdc8; width: 100%;" required></textarea>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="gapAddress"><strong>How Need Will Be Addressed/Description of Activity</strong> <font style="color: #fc4952;">*</font></label><br />
                <textarea class="form-control" rows="10" id="gapAddress" name="gapAddress" style="border: 1px solid #00cdc8; width: 100%;" required></textarea>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <label for="citations"><strong>Cite Materials You Plan To Use To Address The Need</strong> <font style="color: #fc4952;">*</font>&nbsp;&nbsp;<font style="font-size: 10px; color: #687683;">Not all materials need to be cited here.  Please cite the major reference used as a basis for the activity, i.e., new guidelines, study revealing new information, new standards of care, etc.</font></label><br />
                <textarea class="form-control" rows="4" id="citations" name="citations" style="border: 1px solid #00cdc8; width: 100%;" required></textarea>
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;">
            <div class="col-xs-12 col-md-9 col-lg-9">
                <label for="keywords"><strong>Please provide several keywords related to this activity.</strong> <font style="color: #fc4952;">*</font></label><br />
                <input type="text" placeholder="" id="keywords" name="keywords" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" required />
            </div>
            <div class="col-xs-12 col-md-1 col-lg-1">
            </div>
            <div class="col-xs-12 col-md-2 col-lg-2">
                <label for="member"><strong>Are you an AchieveCE member?</strong> <font style="color: #fc4952;">*</font></label><br />
                <input placeholder="" type="radio" name="member" value="Yes" required >&nbsp;&nbsp;Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                <input placeholder="" type="radio" name="member" value="No" >&nbsp;&nbsp;No
            </div>
        </div>
        <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px; margin-bottom: 30px; text-align: center;">
            <div class="col-xs-12 col-md-12 col-lg-12">
                <input type="submit" value="SUBMIT ACTIVITY PROPOSAL" style="background-color: #036cb0; color: #ffffff; font-weight: 600; border: 0; border-radius: 5px; padding-bottom: 5px; padding-top: 3px; padding-left: 10px; padding-right: 10px; font-size: 14px;">
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</div>    

</form>

<div style="display:none;" id="thankyou_message">
    <div class="row" style="margin-left: 20px; margin-right: 20px;">
        <div class="col-xs-12 col-md-12 col-lg-12">
            <font style="font-size: 20px; font-weight: 600;">ACTIVITY PROPOSAL SUBMISSION SUCCESSFUL</font><br />
                    Thank you for submitting an activity proposal to AchieveCE.  Your proposal will be reviewed by our Educational Review Board and you will be notified if your proposal has been approved.<br /><br />
        </div>
    </div>
</div>

<br /><br /><br /><br />        

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</html>`

*Originally created by @jchesner on 12/16/2020* Hi. I have a form created. Upon submission, I am receiving the code, rather than the thankyou_message. Any help would be greatly appreciated!! ` <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd"> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <title>Activity Proposal Submission Form</title> <link rel="stylesheet" href="https://unpkg.com/purecss@1.0.0/build/pure-min.css"> <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0-alpha.6/css/bootstrap.min.css" integrity="sha384-rwoIResjU2yc3z8GV/NPeZWAv56rSmLldC3R/AZzGRnGxQQKnKkoFVhFQhNUwEyJ" crossorigin="anonymous"> <script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js" integrity="sha384-Tc5IQib027qvyjSMfHjOMaLkfuWVxZxUPnCJA7l2mCWNIpG9mGCD8wGNIcPD7Txa" crossorigin="anonymous"></script> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <link href='http://fonts.googleapis.com/css?family=Roboto' rel='stylesheet'Â Â type='text/css'> <script src="https://use.fontawesome.com/37f0b94556.js"></script> </head> <style> html * { font-family: 'Roboto', sans-serif; color: #424242; font-size: 12px; } input[type='radio']:after { width: 15px; height: 15px; border-radius: 15px; top: -2px; left: -1px; position: relative; background-color: #ffffff; content: ''; display: inline-block; visibility: visible; border: 1px solid #00cdc8; } input[type='radio']:checked:after { width: 15px; height: 15px; border-radius: 15px; top: -2px; left: -1px; position: relative; background-color: #00cdc8; content: ''; display: inline-block; visibility: visible; border: 1px solid #ffffff; } input[type='checkbox']:after { width: 15px; height: 15px; top: -2px; left: -1px; position: relative; background-color: #ffffff; content: ''; display: inline-block; visibility: visible; border: 1px solid #00cdc8; } input[type='checkbox']:checked:after { width: 15px; height: 15px; top: -2px; left: -1px; position: relative; background-color: #00cdc8; content: ''; display: inline-block; visibility: visible; border: 1px solid #ffffff; } </style> <body onload="start()" style="padding-top: 25px;"> <div class="row"> <div class="col-xs-12 col-md-12 col-lg-12"> <img src="https://achievece.com/wp-content/uploads/2020/02/AchieveCE-Kabrio.png" width="200" style="padding-top: 20px; margin-left: 40px; padding-bottom: 5px;"> <br /><br /> <hr style="border: 1px solid #036cb0; width: 100%; padding: 0px; margin: 0px;"><br /> </div> </div> <form id="gform" method="POST" action="https://script.google.com/macros/s/AKfycby5LkcasuDHgCBCbAC5fR7nX-DL8NNetBGasoUklFlOBs54MI4/exec"> <div class="row" style="margin-left: 20px; margin-right: 20px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <font style="font-size: 20px; font-weight: 600; color: #036cb0;">PROPOSAL FORM - PHARMACY</font><br /> AchieveCE is always looking for CPE activity proposals that meet various state-required continuing education needs and allows pharmacy professionals to grow in their profession. Whether it is a webinar or a monograph, we are looking for CPE activities about a variety of topics and depths that can help both pharmacy and pharmacy technicians be the best at what they do.<br /><br /> AchieveCE accepts and evaluates proposals throughout the year. Proposals reviewed are evaluated based on the following criteria:<br /><br /> <div class="row"> <div class="col-xs-12 col-md-6 col-lg-6"> <ul> <li>Quality of proposal</li> <li>Clearly defined topic focus and objectives</li> <li>Practical application of materials proposed</li> </ul> </div> <div class="col-xs-12 col-md-6 col-lg-6"> <ul> <li>Relevance to modern practice</li> <li>Previous experience in presenting and writing CPE activities</li> <li>Compliance to ACPE standards for CPE</li> </ul> </div> </div> All proposals for CPE activities must be original and unpublished.<br /><br />AchieveCE has also selected a number of topics that address the identified needs of pharmacy professionals in the country. Activity proposals should be designed to meet these topics.<br /><br />If the topic you wish to write about or present is not included in our list of selected topics, you may still submit a proposal, provided that an evidence of the need for the topic is included in your submission AND that you have subject matter expertise in the topic you wish to write about. A subject matter expertise is one who practices in the area related to the topic and one who meets the following criteria:<br /><br /> <div class="row"> <div class="col-xs-12 col-md-6 col-lg-6"> <ul> <li>Certification in the subject matter by the Board of Pharmacy Specialties or similar</li> <li>Leadership position at the local, state, or national level</li> </ul> </div> <div class="col-xs-12 col-md-6 col-lg-6"> <ul> <li>Publication in a peer-reviewed journal or study presentation to a state-wide or national audience</li> <li>High regard of professional peers</li> </ul> </div> </div> Please complete the online activity proposal form after you have reviewed the information above. You may contact <a href="mailto:gracielle.tubera@achievece.com" style="text-decoration: none;">Gracielle Tubera</a> with any concerns and questions about your proposal submission. <hr style="border: 1px solid #f4f4f4;"><br /> </div> </div> <div class="row" style="margin-left: 40px; margin-right: 40px;"> <fieldset class="pure-form" style="background-color: #f4f4f4; width: 100%;"> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="firstName"><strong>First Name</strong> <font style="color: #fc4952;">*</font></label><br /> <input type="text" placeholder="" id="firstName" name="firstName" style="border: 1px solid #00cdc8; width: 100%;" required /> </div> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="lastName"><strong>Last Name</strong> <font style="color: #fc4952;">*</font></label><br /> <input placeholder="" id="lastName" name="lastName" style="border: 1px solid #00cdc8; width: 100%;" required /> </div> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="email"><strong>Email Address</strong> <font style="color: #fc4952;">*</font></label><br /> <input placeholder="" type="email" name="email" style="border: 1px solid #00cdc8; width: 100%;" required > </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="activityTitle"><strong>Activity Title</strong> <font style="color: #fc4952;">*</font>  <font style="font-size: 10px; color: #687683;">Please be creative when choosing a title.</font></label><br /> <input type="text" placeholder="" id="activityTitle" name="activityTitle" style="border: 1px solid #00cdc8; width: 100%;" required /> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="activityType"><strong>Activity Type</strong> <font style="color: #fc4952;">*</font>     </label><br /> <input placeholder="" type="radio" name="activityType" value="live" required>  Live Webinar      <input placeholder="" type="radio" name="activityType" value="hsMonograph" >  Home Study Monograph </div> <div class="col-xs-12 col-md-3 col-lg-3"> <label for="completionDate"><strong>Anticipated Completion Date</strong> <font style="color: #fc4952;">*</font></label><br /> <input placeholder="" id="completionDate" name="completionDate" type="date" style="border: 1px solid #00cdc8;" required /> </div> <div class="col-xs-12 col-md-3 col-lg-3"> <label for="topicDesignation"><strong>ACPE Topic Designation</strong> <font style="color: #fc4952;">*</font></label><br /> <select required id="topicDesignation" name="topicDesignation" style="border: 1px solid #00cdc8; width: 69%;"> <option value="" disable selected class="defaulted" required> </option> <option value="Drug Therapy">Drug Therapy</option> <option value="AIDS Therapy">AIDS Therapy</option> <option value="Law">Law</option> <option value="General Pharmacy">General Pharmacy</option> <option value="Patient Safety">Patient Safety</option> <option value="Immunizations">Immunizations</option> <option value="Compounding">Compounding</option> <option value="Immunizations">Immunizations</option> <option value="Pain Management">Pain Management</option> </select> </div> <div class="col-xs-12 col-md-2 col-lg-2"> <label for="activityLength"><strong>Activity Length</strong> <font style="color: #fc4952;">*</font>     </label><br /> <select required id="activityLength" name="activityLength" onclick="checkObjCount(this);" style="border: 1px solid #00cdc8;"> <option value="" disable selected class="defaulted" required> </option> <option value="1">1 hour</option> <option value="1.5">1.5 hours</option> <option value="2">2 hours</option> <option value="Other">Other</option> </select> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-6 col-lg-6"> <label for="experience"><strong>Please describe prior presentation experience on this topic.</strong> <font style="color: #fc4952;">*</font></label><br /> <textarea class="form-control" rows="2" id="experience" name="experience" style="border: 1px solid #00cdc8; width: 100%;" required></textarea> </div> <div class="col-xs-12 col-md-3 col-lg-3"> <label for="present4ce"><strong>Have you presented for another CE provider?</strong> <font style="color: #fc4952;">*</font></label><br /> <input placeholder="" type="radio" name="present4ce" id="present4ceYes" value="Yes" onclick="showCEproviders(this);" >  Yes      <input placeholder="" type="radio" name="present4ce" id="present4ceNo" value="No" onclick="showCEproviders(this);" >  No </div> <div class="col-xs-12 col-md-3 col-lg-3"> <label for="ceProviders"><strong>Please list CE providers you have presented for.</strong></label><br /> <input type="text" placeholder="" id="ceProviders" name="ceProviders" style="border: 1px solid #00cdc8; width: 100%;" disabled /> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="activityBasis"><strong>Activity Basis</strong> <font style="color: #fc4952;">*</font>     </label><br /> <div class="row"> <div class="col-xs-12 col-md-6 col-lg-6"> <input placeholder="" type="radio" name="activityBasis" value="Knowledge-Based" required>  Knowledge-Based<br /> <font style="font-size: 10px; color: #687683;">These activities are primarily constructed to transmit knowledge. The facts must be based on evidence as accepted in the literature by the health care professions.</font> </div> <div class="col-xs-12 col-md-6 col-lg-6"> <input placeholder="" type="radio" name="activityBasis" value="Application-Based" >  Application-Based<br /> <font style="font-size: 10px; color: #687683;">These activities are primarily constructed to apply the information learned in the time frame allotted. The information must be based on evidence as accepted in the literature by the health care professions.</font> </div> </div> </div> <div class="col-xs-12 col-md-1 col-lg-1"></div> <div class="col-xs-12 col-md-7 col-lg-7"> <label for="activityLevel"><strong>Activity Complexity Level</strong> <font style="color: #fc4952;">*</font>     </label><br /> <div class="row"> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="activityLevel" value="General Overview" required >  Level 1: Recall<br /> <font style="font-size: 10px; color: #687683;">This activity requires only a surface understanding of data presented and often consists of verbatim recall from data or simple understanding of a single word or phrase. Participants are required to recall information such as a fact, definition, or term.</font> </div> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="activityLevel" value="Specialized Topic" >  Level 2: Basic Application of Skills & Concepts<br /> <font style="font-size: 10px; color: #687683;">This activity includes the engagement of some mental processing beyond recalling a response. Participants are required to make observations of data through classification, tables, graphs, and charts</font> </div> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="activityLevel" value="In-Depth Focus" >  Level 3: Strategic Thinking & Reasoning<br /> <font style="font-size: 10px; color: #687683;">This activity requires proving understanding of data with reasoning and planning. Participants are required to draw conclusions from observations, citing evidence, and understanding various concepts used to solve problems.</font> </div> </div> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-6 col-lg-6"> <label for="targetprof"><strong>Target Audience</strong> <font style="color: #fc4952;">*</font></label>  <font style="font-size: 10px; color: #687683;">Select all that apply.</font><br /> <div class="row"> <div class="col-xs-12 col-md-4 col-lg-4"> <input type="checkbox" id="targetprofPharm" name="targetprof" value="Pharmacists" onclick="showHidePharmObj(this);" />  Pharmacists </div> <div class="col-xs-12 col-md-4 col-lg-4"> <input type="checkbox" id="targetprofTech" name="targetprof" value="Pharmacy Technicians" onclick="showHideTechObj(this);" />  Pharmacy Technicians </div>  </div> </div> <div class="col-xs-12 col-md-2 col-lg-2"></div> <div class="col-xs-12 col-md-4 col-lg-4"> <label for="offLabelUse"><strong>Will off-label use be discussed?</strong> <font style="color: #fc4952;">*</font></label><br /> <div class="row"> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="offLabelUse" value="Yes" required >  Yes </div> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="offLabelUse" value="No" >  No </div> <div class="col-xs-12 col-md-4 col-lg-4"> <input placeholder="" type="radio" name="offLabelUse" value="Does Not Apply" >  Does Not Apply </div> </div> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="practiceSetting"><strong>Target Practice Setting</strong> <font style="color: #fc4952;">*</font></label>  <font style="font-size: 10px; color: #687683;">Select all that apply.</font><br /> <div class="row"> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Concentrated Focus" />  Concentrated Focus </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Health System" />  Health System </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Retail" />  Retail </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Pharmaceutical Industry" />  Pharmaceutical Industry </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceSetting" name="practiceSetting" value="Other/Non-Patient Interaction" />  Other/Non-Patient Interaction </div> <div class="col-xs-12 col-md-2 col-lg-2"> </div> </div> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="practiceClassification"><strong>Target Practice Classification</strong></label>  <font style="font-size: 10px; color: #687683;">Select all that apply.</font><br /> <div class="row"> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Administration" />  Administration<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Home Health Care" />  Home Health Care<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Nuclear" />  Nuclear<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Specialty" />  Specialty </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Ambulatory Care" />  Ambulatory Care<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Home Infusion" />  Home Infusion<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Oncology" />  Oncology<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Veterinary" />  Veterinary </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Biotechnology" />  Biotechnology<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Inpatient" />  Inpatient<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Other" />  Other<br /><br /> </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Clinical" />  Clinical<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Long-Term Care" />  Long-Term Care<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Outpatient" />  Outpatient<br /><br /> </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Compounding" />  Compounding<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Mail Service" />  Mail Service<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Poison Control" />  Poison Control<br /><br /> </div> <div class="col-xs-12 col-md-2 col-lg-2"> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Consultant" />  Consultant<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Managed Care" />  Managed Care<br /><br /> <input type="checkbox" id="practiceClassification" name="practiceClassification" value="Research" />  Research </div> </div> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="PharmObj"><strong>Pharmacist Learning Objectives</strong></label><br /> <input type="text" placeholder="Learning Objective 1 *" id="pharmObj1" name="pharmObj1" style="border: 1px solid #00cdc8; width: 100%;" disabled /> <input type="text" placeholder="Learning Objective 2 *" id="pharmObj2" name="pharmObj2" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled /> <input type="text" placeholder="Learning Objective 3 *" id="pharmObj3" name="pharmObj3" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled /> <input type="text" placeholder="Learning Objective 4 *" id="pharmObj4" name="pharmObj4" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden /> <input type="text" placeholder="Learning Objective 5" id="pharmObj5" name="pharmObj5" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden /> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="PharmObj"><strong>Pharmacy Technician Learning Objectives</strong>  <font style="font-size: 10px; color: #687683;">Please identify learning objectives that are different from pharmacist objectives and are truly pertinent to the pharmacy technician.</font></label><br /> <input type="text" placeholder="Learning Objective 1 *" id="techObj1" name="techObj1" style="border: 1px solid #00cdc8; width: 100%;" disabled /> <input type="text" placeholder="Learning Objective 2 *" id="techObj2" name="techObj2" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled /> <input type="text" placeholder="Learning Objective 3 *" id="techObj3" name="techObj3" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled /> <input type="text" placeholder="Learning Objective 4 *" id="techObj4" name="techObj4" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden /> <input type="text" placeholder="Learning Objective 5" id="techObj5" name="techObj5" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" disabled hidden /> </div> </div>  <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="gap"><strong>Knowledge Gap/Educational Need</strong> <font style="color: #fc4952;">*</font></label><br /> <textarea class="form-control" rows="5" id="gap" name="gap" style="border: 1px solid #00cdc8; width: 100%;" required></textarea> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="gapAddress"><strong>How Need Will Be Addressed/Description of Activity</strong> <font style="color: #fc4952;">*</font></label><br /> <textarea class="form-control" rows="10" id="gapAddress" name="gapAddress" style="border: 1px solid #00cdc8; width: 100%;" required></textarea> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <label for="citations"><strong>Cite Materials You Plan To Use To Address The Need</strong> <font style="color: #fc4952;">*</font>  <font style="font-size: 10px; color: #687683;">Not all materials need to be cited here. Please cite the major reference used as a basis for the activity, i.e., new guidelines, study revealing new information, new standards of care, etc.</font></label><br /> <textarea class="form-control" rows="4" id="citations" name="citations" style="border: 1px solid #00cdc8; width: 100%;" required></textarea> </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px;"> <div class="col-xs-12 col-md-9 col-lg-9"> <label for="keywords"><strong>Please provide several keywords related to this activity.</strong> <font style="color: #fc4952;">*</font></label><br /> <input type="text" placeholder="" id="keywords" name="keywords" style="border: 1px solid #00cdc8; width: 100%; margin-top: 10px;" required /> </div> <div class="col-xs-12 col-md-1 col-lg-1"> </div> <div class="col-xs-12 col-md-2 col-lg-2"> <label for="member"><strong>Are you an AchieveCE member?</strong> <font style="color: #fc4952;">*</font></label><br /> <input placeholder="" type="radio" name="member" value="Yes" required >  Yes      <input placeholder="" type="radio" name="member" value="No" >  No </div> </div> <div class="row" style="margin-left: 20px; margin-right: 20px; margin-top: 30px; margin-bottom: 30px; text-align: center;"> <div class="col-xs-12 col-md-12 col-lg-12"> <input type="submit" value="SUBMIT ACTIVITY PROPOSAL" style="background-color: #036cb0; color: #ffffff; font-weight: 600; border: 0; border-radius: 5px; padding-bottom: 5px; padding-top: 3px; padding-left: 10px; padding-right: 10px; font-size: 14px;"> </div> </div> </fieldset> </div> </form> <div style="display:none;" id="thankyou_message"> <div class="row" style="margin-left: 20px; margin-right: 20px;"> <div class="col-xs-12 col-md-12 col-lg-12"> <font style="font-size: 20px; font-weight: 600;">ACTIVITY PROPOSAL SUBMISSION SUCCESSFUL</font><br /> Thank you for submitting an activity proposal to AchieveCE. Your proposal will be reviewed by our Educational Review Board and you will be notified if your proposal has been approved.<br /><br /> </div> </div> </div> <br /><br /><br /><br /> <script data-cfasync="false" type="text/javascript" src="https://cdn.rawgit.com/dwyl/html-form-send-email-via-google-script-without-server/master/form-submission-handler.js"></script>  <script type="text/javascript"> function start() { ifPatientSafety(); } </script> <script type="text/javascript"> function showCEproviders() { if (document.getElementById('present4ceYes').checked == true) { document.getElementById('ceProviders').removeAttribute('disabled'); document.getElementById('ceProviders').required = true; } else { document.getElementById('ceProviders').setAttribute('disabled', 'disabled'); document.getElementById('ceProviders').required = false; } } </script> <script type="text/javascript"> function checkObjCount() { showHidePharmObj(); showHideTechObj(); showHideNurseObj(); } </script> <script type="text/javascript"> function showHidePharmObj() { var actLenPharm = document.getElementById('activityLength').value; if (document.getElementById('targetprofPharm').checked == true) { document.getElementById('pharmObj1').removeAttribute('disabled'); document.getElementById('pharmObj1').required = true; document.getElementById('pharmObj2').removeAttribute('disabled'); document.getElementById('pharmObj2').required = true; document.getElementById('pharmObj3').removeAttribute('disabled'); document.getElementById('pharmObj3').required = true; if (actLenPharm != '1' && actLenPharm != '') { document.getElementById('pharmObj4').removeAttribute('hidden'); document.getElementById('pharmObj4').removeAttribute('disabled'); document.getElementById('pharmObj4').required = true; document.getElementById('pharmObj5').removeAttribute('hidden'); document.getElementById('pharmObj5').removeAttribute('disabled'); document.getElementById('pharmObj5').required = false; } else { document.getElementById('pharmObj4').setAttribute('hidden', 'hidden'); document.getElementById('pharmObj4').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj4').required = false; document.getElementById('pharmObj5').setAttribute('hidden', 'hidden'); document.getElementById('pharmObj5').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj5').required = false; } } else { document.getElementById('pharmObj1').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj1').required = false; document.getElementById('pharmObj2').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj2').required = false; document.getElementById('pharmObj3').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj3').required = false; document.getElementById('pharmObj4').setAttribute('hidden', 'hidden'); document.getElementById('pharmObj4').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj4').required = false; document.getElementById('pharmObj5').setAttribute('hidden', 'hidden'); document.getElementById('pharmObj5').setAttribute('disabled', 'disabled'); document.getElementById('pharmObj5').required = false; } } </script> <script type="text/javascript"> function ifPatientSafety() { var dropdown = document.getElementById("topicDesignation"); dropdown.onchange = function(event){ if(dropdown.value=="Patient Safety"){ alert("PATIENT SAFETY\n\nThe prevention of healthcare errors, and the elimination or mitigation of patient injury caused by healthcare errors. 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