{"id":5845,"date":"2012-04-17T19:24:14","date_gmt":"2012-04-17T19:24:14","guid":{"rendered":"http:\/\/teampossabilities.org\/?page_id=31"},"modified":"2021-03-10T00:59:40","modified_gmt":"2021-03-10T08:59:40","slug":"become-a-member","status":"publish","type":"page","link":"https:\/\/teampossabilities.org\/become-a-member\/","title":{"rendered":"Become a Member"},"content":{"rendered":"<h2 style=\"text-align: center;\">Membership to PossAbilities is FREE!<\/h2>\n<p><strong>What is a PossAbilities Member?<\/strong><strong><br \/>\n<\/strong>An eligible member is any individual with a permanent physical or intellectual disability and\/or veteran as clinically diagnosed according to the Social Security Administration Blue Book Part A or Part B. A list of official impairments may be found at: <a href=\"http:\/\/www.ssa.gov\/disability\/professionals\/bluebook\/\" target=\"_blank\" rel=\"noopener\">http:\/\/www.ssa.gov\/disability\/professionals\/bluebook\/<\/a>.<\/p>\n<p><strong>What is a PossAbilities Support Member?<\/strong><strong><br \/>\n<\/strong>Support members are able-bodied community members that would like to be part of the PossAbilities family. Whether you\u2019re interested in volunteering, making a donation, or would just like to keep up with the current events of the program\u2026we need support members! It is our support members that strengthen our program and enable us to provide opportunities for our members.<\/p>\n<p align=\"center\"><strong>Membership is free of charge! Just fill out the form below to join!<br \/>\nBe sure to designate whether you are a member or a support member.<\/strong><\/p>\n<p align=\"center\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_14' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">PossAbilities Membership Application<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_14'  action='\/wp-json\/wp\/v2\/pages\/5845' data-formid='14' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LeZVqUiAAAAAPgdRJoiUtbOH0z415xJIu4Mys-C' data-tabindex='0'><input id=\"input_47b0d6b5e46e7e2cbae66fa7fce8f868\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_47b0d6b5e46e7e2cbae66fa7fce8f868\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_14' class='gform_fields left_label form_sublabel_below description_below'><li id=\"field_14_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_10\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Membership Type - Select all that apply<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_14_10'><li class='gchoice gchoice_14_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Member'  id='choice_14_10_1'   aria-describedby=\"gfield_description_14_10\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_1' id='label_14_10_1' class='gform-field-label gform-field-label--type-inline'>Member<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_14_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Support Member'  id='choice_14_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_2' id='label_14_10_2' class='gform-field-label gform-field-label--type-inline'>Support Member<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_14_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Veteran'  id='choice_14_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_3' id='label_14_10_3' class='gform-field-label gform-field-label--type-inline'>Veteran<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_14_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Volunteer'  id='choice_14_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_4' id='label_14_10_4' class='gform-field-label gform-field-label--type-inline'>Volunteer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_14_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Peer Visitor'  id='choice_14_10_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_5' id='label_14_10_5' class='gform-field-label gform-field-label--type-inline'>Peer Visitor<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_14_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Community Partner*'  id='choice_14_10_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_10_6' id='label_14_10_6' class='gform-field-label gform-field-label--type-inline'>Community Partner*<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_14_10'>* Community Partners are considered supporters of the program and are not eligible for benefits. Benefits are only available to members with a disability or veterans. By checking this box your organization will be added to our mailing list only.<\/div><\/li><li id=\"field_14_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name of Applicant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_14_3'>\n                            <span id='input_14_3_3_container' class='name_first gform-grid-col' >\n                                                    <input type='text' name='input_3.3' id='input_14_3_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_14_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                               <\/span>\n                            <span id='input_14_3_6_container' class='name_last gform-grid-col' >\n                                                    <input type='text' name='input_3.6' id='input_14_3_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_14_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><div class='gfield_description' id='gfield_description_14_3'>If you are completing this application on behalf of someone else, please list name of disabled person here. Thank you.<\/div><\/li><li id=\"field_14_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_6\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Birthdate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_14_6' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_14_6_1_container'>\n                                            <input type='number' maxlength='2' name='input_6[]' id='input_14_6_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_14_6_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_14_6_2_container'>\n                                            <input type='number' maxlength='2' name='input_6[]' id='input_14_6_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_14_6_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_14_6_3_container'>\n                                            <input type='number' maxlength='4' name='input_6[]' id='input_14_6_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_14_6_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/div><\/li><li id=\"field_14_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_5\" ><label class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_14_5'>\n\t\t\t<li class='gchoice gchoice_14_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='Male'  id='choice_14_5_0'    \/>\n\t\t\t\t<label for='choice_14_5_0' id='label_14_5_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_14_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='Female'  id='choice_14_5_1'    \/>\n\t\t\t\t<label for='choice_14_5_1' id='label_14_5_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_14_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_4\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_14_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_14_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_14_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_14_4_1' id='input_14_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_14_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_14_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_14_4_3' id='input_14_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_14_4_4_container' >\n                                        <input type='text' name='input_4.4' id='input_14_4_4' value=''      aria-required='true'    \/>\n                                        <label for='input_14_4_4' id='input_14_4_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_14_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_14_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_14_4_5' id='input_14_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_14_4_6_container' >\n                                        <select name='input_4.6' id='input_14_4_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_14_4_6' id='input_14_4_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_14_7\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_7\" ><label class='gfield_label gform-field-label' for='input_14_7'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_14_7' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_14_8\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_8\" ><label class='gfield_label gform-field-label' for='input_14_8'>Mobile Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_14_8' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_14_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_9\" ><label class='gfield_label gform-field-label' for='input_14_9'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_14_9' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_14_19\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_19\" ><p class=\"notice\">Please use a different email address as we are having trouble sending our newsletter to @llu.edu addresses at this time. Thank you.<\/p><\/li><li id=\"field_14_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_11\" ><label class='gfield_label gform-field-label' for='input_14_11'>Clinically Diagnosed Disability<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_14_11' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='None' >None<\/option><option value='Acrophobia' >Acrophobia<\/option><option value='ADD\/ADHD' >ADD\/ADHD<\/option><option value='Agoraphobia' >Agoraphobia<\/option><option value='Alzheimer&#039;s Disease' >Alzheimer&#039;s Disease<\/option><option value='Amputation' >Amputation<\/option><option value='Anxiety Disorder' >Anxiety Disorder<\/option><option value='Arthritis' >Arthritis<\/option><option value='Asperger Syndrome' >Asperger Syndrome<\/option><option value='Asthma' >Asthma<\/option><option value='Autism' >Autism<\/option><option value='Bipolar Disorder' >Bipolar Disorder<\/option><option value='Blindness' >Blindness<\/option><option value='Cancer' >Cancer<\/option><option value='Cardiovascular System Disorders' >Cardiovascular System Disorders<\/option><option value='Cerebral Palsy' >Cerebral Palsy<\/option><option value='Chronic Fatigue Syndrome' >Chronic Fatigue Syndrome<\/option><option value='Depresion' >Depresion<\/option><option value='Diabetes' >Diabetes<\/option><option value='Digestive System Disorders' >Digestive System Disorders<\/option><option value='Down Syndrome' >Down Syndrome<\/option><option value='Dyscalculia' >Dyscalculia<\/option><option value='Dyslexia' >Dyslexia<\/option><option value='Endocrine System Disorders' >Endocrine System Disorders<\/option><option value='Genitourinary Impairment' >Genitourinary Impairment<\/option><option value='Hearing Impairment' >Hearing Impairment<\/option><option value='Hearing Loss' >Hearing Loss<\/option><option value='Hematological Disorder' >Hematological Disorder<\/option><option value='HIV AIDS' >HIV AIDS<\/option><option value='Immune System Disorders' >Immune System Disorders<\/option><option value='Memory Loss' >Memory Loss<\/option><option value='Meniere&#039;s Disease' >Meniere&#039;s Disease<\/option><option value='Mental Disorders' >Mental Disorders<\/option><option value='Muscular Distrophy' >Muscular Distrophy<\/option><option value='Multiple Sclerosis' >Multiple Sclerosis<\/option><option value='Obsessive Compulsive Disorder (OCD)' >Obsessive Compulsive Disorder (OCD)<\/option><option value='Paralysis' >Paralysis<\/option><option value='Parkinson&#039;s Disease' >Parkinson&#039;s Disease<\/option><option value='Renal Failure' >Renal Failure<\/option><option value='Respiratory Disorders' >Respiratory Disorders<\/option><option value='Rheumatoid Arthritis' >Rheumatoid Arthritis<\/option><option value='Schizophrenia' >Schizophrenia<\/option><option value='Seizure Disorder' >Seizure Disorder<\/option><option value='Sickle Cell Anemia' >Sickle Cell Anemia<\/option><option value='Spina Bifida' >Spina Bifida<\/option><option value='Spinal Cord Injury - Quadriplegic' >Spinal Cord Injury - Quadriplegic<\/option><option value='Spinal Cord Injury - Paraplegic' >Spinal Cord Injury - Paraplegic<\/option><option value='Spinal Cord Injury - Other' >Spinal Cord Injury - Other<\/option><option value='Soft Tissue Injury (Burns)' >Soft Tissue Injury (Burns)<\/option><option value='Stroke' >Stroke<\/option><option value='Substance Abuse Addiction' >Substance Abuse Addiction<\/option><option value='Tinnitus' >Tinnitus<\/option><option value='Traumatic Brain Injury' >Traumatic Brain Injury<\/option><option value='Tuberculosis' >Tuberculosis<\/option><option value='Visual Impairment' >Visual Impairment<\/option><\/select><\/div><\/li><li id=\"field_14_17\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_17\" ><label class='gfield_label gform-field-label' for='input_14_17'>How did you hear about us?<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_14_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_18\" ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_14_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_13\" ><label class='gfield_label gform-field-label' for='input_14_13'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_14_13' type='text' value='' class='medium'  aria-describedby=\"gfield_description_14_13\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_14_13'>I certify that the information I have given is true and accurate. In addition, my electronic signature verifies membership acceptance to join PossAbilities and gives you permission to take photographs of me or my dependent named above to serve the best interests of Loma Linda University Medical Center or any of its divisions or schools. \r\n\r\nPlease sign by entering your full name in the box above.<\/div><\/li><li id=\"field_14_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_14_14\" ><label class='gfield_label gform-field-label' for='input_14_14'>Signature (Only For Members &amp; Peer Visitors) If you are not disabled, please enter &#039;Not Disabled&#039;<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_14_14' type='text' value='' class='medium'  aria-describedby=\"gfield_description_14_14\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_14_14'>I certify that I am eligible for membership in PossAbilities due to my permanent clinical disability which is among those listed in Part A or Part B of the official 'List of Impairments' found at http:\/\/www.ssa.gov\/disability\/professionals\/bluebook\/ \r\n\r\n\r\nPlease sign by entering your full name in the box above.<\/div><\/li><\/ul><\/div>\n        <div class='gform_footer left_label'> <input type='submit' id='gform_submit_button_14' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_14\"]){return false;}  if( !jQuery(\"#gform_14\")[0].checkValidity || jQuery(\"#gform_14\")[0].checkValidity()){window[\"gf_submitting_14\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_14\"]){return false;} if( !jQuery(\"#gform_14\")[0].checkValidity || jQuery(\"#gform_14\")[0].checkValidity()){window[\"gf_submitting_14\"]=true;}  jQuery(\"#gform_14\").trigger(\"submit\",[true]); 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What is a PossAbilities Member? An eligible member is any individual with a permanent physical or intellectual disability and\/or veteran as clinically diagnosed according to the Social Security Administration Blue Book Part A or Part B. A list of official impairments may be found at: http:\/\/www.ssa.gov\/disability\/professionals\/bluebook\/. What is a PossAbilities [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/pages\/5845"}],"collection":[{"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/comments?post=5845"}],"version-history":[{"count":8,"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/pages\/5845\/revisions"}],"predecessor-version":[{"id":9523,"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/pages\/5845\/revisions\/9523"}],"wp:attachment":[{"href":"https:\/\/teampossabilities.org\/wp-json\/wp\/v2\/media?parent=5845"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}