{"id":58,"date":"2020-12-21T16:20:31","date_gmt":"2020-12-21T21:20:31","guid":{"rendered":"https:\/\/www.naepc.org\/forms\/?page_id=58"},"modified":"2026-02-02T14:15:12","modified_gmt":"2026-02-02T19:15:12","slug":"council-renewal","status":"publish","type":"page","link":"https:\/\/www.naepc.org\/forms\/council-renewal\/","title":{"rendered":"Council Dues Renewal and Service Payments"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-14oh2-3fd7d45e173889a5d80d2723d29c836d\">\n.flex_column.av-14oh2-3fd7d45e173889a5d80d2723d29c836d{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-14oh2-3fd7d45e173889a5d80d2723d29c836d av_one_full  avia-builder-el-0  el_before_av_hr  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-kiz2bu34-c173f9c52a69a5665e8d1bd83b64e09e '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h1>Council Dues Renewal and Service Payments<\/h1>\n<h3><strong>Due by April 1, 2026<\/strong><\/h3>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kj39sl2p-f033f297eb8d27d9efe0216e7c6647ba\">\n#top .hr.hr-invisible.av-kj39sl2p-f033f297eb8d27d9efe0216e7c6647ba{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-kj39sl2p-f033f297eb8d27d9efe0216e7c6647ba hr-invisible  avia-builder-el-2  el_after_av_textblock  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-kiz2bu34-1-b2aeca22d9bc338f61d000716e66ac41 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_24'  action='\/forms\/wp-json\/wp\/v2\/pages\/58' data-formid='24' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_24' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_24_58\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_58'>Name<\/label><div class='ginput_container'><input name='input_58' id='input_24_58' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_24_58'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_24_3\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Council Information<\/h3><\/div><div id=\"field_24_1\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_1'>Council Name<\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_24_1' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_2\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_2'>Current Primary Contact Name<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_24_2' type='text' value='' class='large'  aria-describedby=\"gfield_description_24_2\"  placeholder='Include designations, such as AEP, CLU, CFP, EPLS, or JD.'  aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_24_2'>(Council Contact\/ Association Executive)<\/div><\/div><div id=\"field_24_5\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_5'>Company<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_24_5' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_24_6\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_24_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_24_6_1_container' >\n                                        <label for='input_24_6_1' id='input_24_6_1_label' class='gform-field-label gform-field-label--type-sub '>Address<\/label>\n                                        <input type='text' name='input_6.1' id='input_24_6_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_24_6_2_container' >\n                                        <label for='input_24_6_2' id='input_24_6_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_6.2' id='input_24_6_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_24_6_3_container' >\n                                    <label for='input_24_6_3' id='input_24_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_6.3' id='input_24_6_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_24_6_4_container' >\n                                        <label for='input_24_6_4' id='input_24_6_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_6.4' id='input_24_6_4'     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                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_24_6_5_container' >\n                                    <label for='input_24_6_5' id='input_24_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_6.5' id='input_24_6_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_24_6_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_24_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_7'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_24_7' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_8\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_8'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_24_8' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_24_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><strong>To find your current level of website service, Leimberg Information Services (LISI) subscription status and Every Council Campaign (ECC) enrollment status, <a href=\"http:\/\/www.naepc.org\/forms\/wp-content\/uploads\/CouncilsAndServices26.pdf\" target=\"_blank\"><u>click here<\/u><\/a>.<\/strong><\/p><\/div><div id=\"field_24_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Every Council Campaign<\/h3><\/div><div id=\"field_24_55\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>The Every Council Campaign allows NAEPC to communicate the many benefits of council affiliation directly with your council's members and is included with your council\u2019s membership.  Member data will not be made available to anyone outside of NAEPC, nor will NAEPC ever sell member data. <a href=\"\/affiliated-councils\/every-council-campaign\" target=\"_blank\">Learn more<\/a>.<\/p><\/div><fieldset id=\"field_24_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please select the information your council wants to receive:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_57'>\n\t\t\t<div class='gchoice gchoice_24_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Our Council has decided to participate in the &lt;strong&gt;COMPLETE&lt;\/strong&gt; Every Council Campaign, including emails regarding NAEPC news\/benefits, upcoming Webinar announcements, and NAEPC Journal updates.'  id='choice_24_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_57_0' id='label_24_57_0' class='gform-field-label gform-field-label--type-inline'>Our Council has decided to participate in the <strong>COMPLETE<\/strong> Every Council Campaign, including emails regarding NAEPC news\/benefits, upcoming Webinar announcements, and NAEPC Journal updates.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Our council would like to specify the types of emails they receive (select and indicate below).'  id='choice_24_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_57_1' id='label_24_57_1' class='gform-field-label gform-field-label--type-inline'>Our council would like to specify the types of emails they receive (select and indicate below).<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_57_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Our Council Members do not wish to receive any communication directly from NAEPC regarding our member benefits.'  id='choice_24_57_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_57_2' id='label_24_57_2' class='gform-field-label gform-field-label--type-inline'>Our Council Members do not wish to receive any communication directly from NAEPC regarding our member benefits.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_56\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Indicate the information your council wants to receive (BASIC is required):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><span class='gfield_choice_limit_message gfield_description' id='gfield_choice_limit_message_24_56'>Select up to <strong>2<\/strong> choices.<\/span><div class='gfield_checkbox ' id='input_24_56'><div class='gchoice gchoice_24_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='BASIC Every Council Campaign NAEPC News' checked='checked' id='choice_24_56_1'   aria-describedby=\"gfield_choice_limit_message_24_56\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_24_56_1' id='label_24_56_1' class='gform-field-label gform-field-label--type-inline'>BASIC Every Council Campaign NAEPC News<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_24_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='NAEPC Journal Publication Notifications'  id='choice_24_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_24_56_2' id='label_24_56_2' class='gform-field-label gform-field-label--type-inline'>NAEPC Journal Publication Notifications<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_24_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='Robert G. Alexander Webinar Series Updates'  id='choice_24_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_24_56_3' id='label_24_56_3' class='gform-field-label gform-field-label--type-inline'>Robert G. Alexander Webinar Series Updates<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Council Dues<\/h3><\/div><div id=\"field_24_40\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Council dues are now based on an annual base fee of $103 plus a per member fee of $1.65. For the purposes of the calculation, you must use the total membership number from your most recently-closed calendar or fiscal year. Interim payments will not be required for additional members joining during the current calendar or fiscal year.<\/div><div id=\"field_24_52\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_24_52 gfield_product_24_52 field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_24_52_1'>Base Fee<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_52.1' value='Base Fee' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_24_52' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_24_52' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_52.2' id='ginput_base_price_24_52' value='$103.00' aria-label='Base Fee Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_52.3' value='1' class='ginput_quantity_24_52 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_24_51\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_24_51 gfield_product_24_51 gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_24_51_1'><span class=\"gform-field-label gfield_label_product\">Numbers of Members as of Most Recently Closed Fiscal\/Calendar Year<\/span> <span class=\"screen-reader-text\">Quantity<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_51.1' value='Numbers of Members as of Most Recently Closed Fiscal\/Calendar Year' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_24_51' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_24_51'>$1.65<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_51.2' id='ginput_base_price_24_51' class='gform_hidden' value='$1.65'\/>\n\t\t\t\t\t <label for='ginput_quantity_24_51_1' class='ginput_quantity_label gform-field-label' aria-hidden='true'>Quantity<\/label> <input type='number' name='input_51.3' value='' id='input_24_51_1' class='ginput_quantity' size='10' min='0'   aria-label=\"Quantity Numbers of Members as of Most Recently Closed Fiscal\/Calendar Year\" aria-describedby=\"ginput_product_price_24_51\" \/>\n\t\t\t\t<\/div><\/div><div id=\"field_24_53\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Website (Optional)<\/h3><\/div><fieldset id=\"field_24_17\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_24_17 gfield_product_24_17 field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Website Subscription Level<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_17'>\n\t\t\t<div class='gchoice gchoice_24_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Our Council does not have a website.|0'  id='choice_24_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_0' id='label_24_17_0' class='gform-field-label gform-field-label--type-inline'>Our Council does not have a website.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='$400 for Level I|400'  id='choice_24_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_1' id='label_24_17_1' class='gform-field-label gform-field-label--type-inline'>$400 for Level I<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='$800 for Level II|800'  id='choice_24_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_2' id='label_24_17_2' class='gform-field-label gform-field-label--type-inline'>$800 for Level II<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='$1,200 for Level III|1200'  id='choice_24_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_3' id='label_24_17_3' class='gform-field-label gform-field-label--type-inline'>$1,200 for Level III<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='$1,600 for Level IV|1600'  id='choice_24_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_4' id='label_24_17_4' class='gform-field-label gform-field-label--type-inline'>$1,600 for Level IV<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Website Upgrade\/Enrollment<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_24_43'><div class='gchoice gchoice_24_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='We want to upgrade or enroll in this service. Please contact me.'  id='choice_24_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_24_43_1' id='label_24_43_1' class='gform-field-label gform-field-label--type-inline'>We want to upgrade or enroll in this service. Please contact me.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_19\" class=\"gfield gfield--type-website gfield--input-type-website field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_19'>Website Address if NOT Hosted by NAEPC<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_19' id='input_24_19' type='url' value='' class='medium'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_24_42\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Learn more about NAEPC\u2019s <a href=\"https:\/\/www.naepc.org\/affiliated-councils\/website-packages\" target=\"_blank\">website solutions and features<\/a>.<\/div><div id=\"field_24_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Leimberg (LISI) Subscription<\/h3><\/div><div id=\"field_24_37\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Learn more about this <a href=\"\/affiliated-councils\/leimberg-service\" target=\"_blank\">valuable council benefit<\/a>. Leimberg Service (LISI) is based on the council\u2019s current TOTAL membership, at $24\/member.<\/p>\n<p>Renewing Councils: Please provide an updated membership list in an Excel file with first name, last name, and email address to <a href=\"mailto:LISIUpdate@naepc.org\">LISIUpdate@naepc.org<\/a>.<\/p><\/div><fieldset id=\"field_24_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Leimberg Options<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_24_29'><div class='gchoice gchoice_24_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Please renew our service.'  id='choice_24_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_24_29_1' id='label_24_29_1' class='gform-field-label gform-field-label--type-inline'>Please renew our service.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_24_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='My council would like to enroll in the LISI service. We understand that we will be charged $24\/member for our total current membership as reported on this form.'  id='choice_24_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_24_29_2' id='label_24_29_2' class='gform-field-label gform-field-label--type-inline'>My council would like to enroll in the LISI service. We understand that we will be charged $24\/member for our total current membership as reported on this form.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_54\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_24_54 gfield_product_24_54 gfield_calculation field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_24_54_1'>Leimberg (LISI) Subscription<\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_54.1' value='Leimberg (LISI) Subscription' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_24_54' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_24_54'>$0.00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_54.2' id='ginput_base_price_24_54' class='gform_hidden ginput_calculated_price' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_54.3' value='1' class='ginput_quantity_24_54 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_24_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Total of Council Dues (and Website Subscription)<\/h3><\/div><div id=\"field_24_20\" class=\"gfield gfield--type-total gfield--input-type-total gfield--width-full field_highlighted gfield_price gfield_price_24_ gfield_total gfield_total_24_ field_sublabel_above gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_24_20'>Total of Council Dues (and Website Subscription)<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_20' id='input_24_20' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_24' \/>\n\t\t\t\t\t\t<\/div><\/div><div id=\"field_24_34\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Payment Information<\/h3><\/div><fieldset id=\"field_24_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_22'>\n\t\t\t<div class='gchoice gchoice_24_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='MasterCard'  id='choice_24_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_22_0' id='label_24_22_0' class='gform-field-label gform-field-label--type-inline'>MasterCard<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='VISA'  id='choice_24_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_22_1' id='label_24_22_1' class='gform-field-label gform-field-label--type-inline'>VISA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='American Express'  id='choice_24_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_22_2' id='label_24_22_2' class='gform-field-label gform-field-label--type-inline'>American Express<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Discover'  id='choice_24_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_22_3' id='label_24_22_3' class='gform-field-label gform-field-label--type-inline'>Discover<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_23\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_third gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_23'>Credit Card Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_24_23' type='text' value='' class='medium' maxlength='20'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_middle_third gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_24'>Exp. Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_24_24' type='text' value='' class='medium' maxlength='5'   placeholder='mm\/yy' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_right_third gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_47'>Billing Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_24_47' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_25\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_25'>Signature<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_24_25' type='text' value='' class='large'    placeholder='Type your full name here.'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_45\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>I am authorized to act on behalf of the council and the information provided in this form is accurate to the best of my knowledge.<\/p>\n<p>Upon completion of this renewal, please submit a <a href=\"https:\/\/www.naepc.org\/forms\/council-board-update\/\" target=\"_blank\">Council Board of Directors Update Form<\/a> so we can communicate directly with your entire board about NAEPC and council-related matters.<\/p><\/div><div id=\"field_24_46\" class=\"gfield gfield--type-captcha gfield--input-type-captcha field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_46'>CAPTCHA<\/label><div id='input_24_46' class='ginput_container ginput_recaptcha' data-sitekey='6LfVJJIeAAAAAIVRVyW7fxig1VuldfDJt8HlIQq8'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_24' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' 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