{"id":2936,"date":"2022-12-07T14:21:43","date_gmt":"2022-12-07T19:21:43","guid":{"rendered":"https:\/\/als-ny.org\/?page_id=2936"},"modified":"2022-12-07T14:21:43","modified_gmt":"2022-12-07T19:21:43","slug":"new-als-registration","status":"publish","type":"page","link":"https:\/\/als-ny.blackbaudwp.com\/es\/navigating-als\/newly-diagnosed\/new-als-registration\/","title":{"rendered":"Nuevo registro de ALS"},"content":{"rendered":"\n\n\t\t\n                            <h2>New ALS Registration<\/h2>\n                        <form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/?page_id=2936&#038;fl_builder#gf_3' novalidate>\n                        <fieldset id=\"field_3_1\"   data-js-reload=\"field_3_1\"><legend class='gfield_label gfield_label_before_complex'>Name<\/legend>\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value='' tabindex='101'  aria-required='false'     \/>\n                                                    <label for='input_3_1_3'>First<\/label>\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value='' tabindex='103'  aria-required='false'     \/>\n                                                    <label for='input_3_1_6'>Last<\/label>\n                        <\/fieldset><fieldset id=\"field_3_3\"   data-js-reload=\"field_3_3\"><legend class='gfield_label gfield_label_before_complex'>Address<\/legend>    \n                                    <input type='text' name='input_3.3' id='input_3_3_3' value='' tabindex='106'   aria-required='false'    \/>\n                                    <label for='input_3_3_3' id='input_3_3_3_label'>City<\/label>\n                                        <select name='input_3.4' id='input_3_3_4' tabindex='107'    aria-required='false'><option value='' selected='selected'><\/option><option value='Alabama'>Alabama<\/option><option value='Alaska'>Alaska<\/option><option value='American Samoa'>American Samoa<\/option><option value='Arizona'>Arizona<\/option><option value='Arkansas'>Arkansas<\/option><option value='California'>California<\/option><option value='Colorado'>Colorado<\/option><option value='Connecticut'>Connecticut<\/option><option value='Delaware'>Delaware<\/option><option value='District of Columbia'>District of Columbia<\/option><option value='Florida'>Florida<\/option><option value='Georgia'>Georgia<\/option><option value='Guam'>Guam<\/option><option value='Hawaii'>Hawaii<\/option><option value='Idaho'>Idaho<\/option><option value='Illinois'>Illinois<\/option><option value='Indiana'>Indiana<\/option><option value='Iowa'>Iowa<\/option><option value='Kansas'>Kansas<\/option><option value='Kentucky'>Kentucky<\/option><option value='Louisiana'>Louisiana<\/option><option value='Maine'>Maine<\/option><option value='Maryland'>Maryland<\/option><option value='Massachusetts'>Massachusetts<\/option><option value='Michigan'>Michigan<\/option><option value='Minnesota'>Minnesota<\/option><option value='Mississippi'>Mississippi<\/option><option value='Missouri'>Missouri<\/option><option value='Montana'>Montana<\/option><option value='Nebraska'>Nebraska<\/option><option value='Nevada'>Nevada<\/option><option value='New Hampshire'>New Hampshire<\/option><option value='New Jersey'>New Jersey<\/option><option value='New Mexico'>New Mexico<\/option><option value='New York'>New York<\/option><option value='North Carolina'>North Carolina<\/option><option value='North Dakota'>North Dakota<\/option><option value='Northern Mariana Islands'>Northern Mariana Islands<\/option><option value='Ohio'>Ohio<\/option><option value='Oklahoma'>Oklahoma<\/option><option value='Oregon'>Oregon<\/option><option value='Pennsylvania'>Pennsylvania<\/option><option value='Puerto Rico'>Puerto Rico<\/option><option value='Rhode Island'>Rhode Island<\/option><option value='South Carolina'>South Carolina<\/option><option value='South Dakota'>South Dakota<\/option><option value='Tennessee'>Tennessee<\/option><option value='Texas'>Texas<\/option><option value='Utah'>Utah<\/option><option value='U.S. Virgin Islands'>U.S. Virgin Islands<\/option><option value='Vermont'>Vermont<\/option><option value='Virginia'>Virginia<\/option><option value='Washington'>Washington<\/option><option value='West Virginia'>West Virginia<\/option><option value='Wisconsin'>Wisconsin<\/option><option value='Wyoming'>Wyoming<\/option><option value='Armed Forces Americas'>Armed Forces Americas<\/option><option value='Armed Forces Europe'>Armed Forces Europe<\/option><option value='Armed Forces Pacific'>Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_3_3_4' id='input_3_3_4_label'>State<\/label>\n                                    <input type='text' name='input_3.5' id='input_3_3_5' value='' tabindex='109'   aria-required='false'    \/>\n                                    <label for='input_3_3_5' id='input_3_3_5_label'>ZIP Code<\/label>\n                                <input type='hidden' class='gform_hidden' name='input_3.6' id='input_3_3_6' value='United States' \/>\n                <\/fieldset><label class='gfield_label' for='input_3_6'>Date of Diagnosis<\/label>\n                            <input name='input_6' id='input_3_6' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='110'  placeholder='mm\/dd\/yyyy' aria-describedby=\"input_3_6_date_format\" aria-invalid=\"false\" \/>\n                            MM slash DD slash YYYY\n                        <input type='hidden' id='gforms_calendar_icon_input_3_6' class='gform_hidden' value='https:\/\/als-ny.blackbaudwp.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><label class='gfield_label' for='input_3_5'>Email<\/label>\n                            <input name='input_5' id='input_3_5' type='email' value='' class='large' tabindex='111'    aria-invalid=\"false\"  \/>\n                        <label class='gfield_label' for='input_3_4'>Phone<\/label><input name='input_4' id='input_3_4' type='tel' value='' class='large' tabindex='112'   aria-invalid=\"false\"   \/>\n         <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Submit' tabindex='113' onclick='if(window[\"gf_submitting_3\"]){return false;}  if( !jQuery(\"#gform_3\")[0].checkValidity || jQuery(\"#gform_3\")[0].checkValidity()){window[\"gf_submitting_3\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} if( !jQuery(\"#gform_3\")[0].checkValidity || jQuery(\"#gform_3\")[0].checkValidity()){window[\"gf_submitting_3\"]=true;}  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=3&amp;title=1&amp;description=1&amp;tabindex=100' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJbXSIsIjliNDk1MWFkZDAxNjNkYzJhNDE4OWZlYWZkYzBlMjBlIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n                        <\/form>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_3' id='gform_ajax_frame_3' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\n","protected":false},"excerpt":{"rendered":"<p>Nuevo registro de ALS Nombre Nombre Nombre Apellido Direcci\u00f3n Ciudad AlabamaAlaskaSamoa AmericanaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrito de ColumbiaFloridaGeorgiaGuamHawaiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNueva JerseyNuevo M\u00e9xicoNueva YorkCarolina del NorteMar\u00eda del Norte Islas naOhioOklahomaOreg\u00f3nPensilvaniaPuerto RicoRhode IslandCarolina del SurDakota del SurTennesseeTexasUtahU.S. Islas V\u00edrgenesVermontVirginiaWashingtonVirginia OccidentalWisconsinWyomingFuerzas Armadas de las Am\u00e9ricasFuerzas Armadas\u2026<\/p>","protected":false},"author":49,"featured_media":0,"parent":1699,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2936","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/pages\/2936","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/users\/49"}],"replies":[{"embeddable":true,"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/comments?post=2936"}],"version-history":[{"count":2,"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/pages\/2936\/revisions"}],"predecessor-version":[{"id":2938,"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/pages\/2936\/revisions\/2938"}],"up":[{"embeddable":true,"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/pages\/1699"}],"wp:attachment":[{"href":"https:\/\/als-ny.blackbaudwp.com\/es\/wp-json\/wp\/v2\/media?parent=2936"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}