{"id":33,"date":"2025-09-12T13:59:44","date_gmt":"2025-09-12T13:59:44","guid":{"rendered":"https:\/\/disasterreadyiv.com\/?page_id=33"},"modified":"2025-09-19T13:28:05","modified_gmt":"2025-09-19T13:28:05","slug":"become-a-member","status":"publish","type":"page","link":"https:\/\/disasterreadyiv.com\/?page_id=33","title":{"rendered":"Become a Member"},"content":{"rendered":"<div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Membership Application<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='33' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"97b876235b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F33\" \/><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_organization_name' id='label_ff_3_organization_name' >Organization or Program Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"organization_name\" class=\"ff-el-form-control\" placeholder=\"Enter Organization Name\" data-name=\"organization_name\" id=\"ff_3_organization_name\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Desired Membership Level\">Desired Membership Level<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_f9cb0acc6714d82d6bf6b80c065e2786'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Active Participant\"  id='input_radio_1_f9cb0acc6714d82d6bf6b80c065e2786' aria-label='Active Participant' aria-invalid='false' aria-required=true> <span>Active Participant<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_cf7453bf250cf4d785ea84988b6bb2e3'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"As\/If Needed\"  id='input_radio_1_cf7453bf250cf4d785ea84988b6bb2e3' aria-label='As\/If Needed' aria-invalid='false' aria-required=true> <span>As\/If Needed<\/span><\/label><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"organization_address\" ><div class='ff-el-input--label'><label aria-label=\"Organization Address\">Organization Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_organization_address_address_line_1_' id='label_ff_3_organization_address_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"organization_address[address_line_1]\" id=\"ff_3_organization_address_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_organization_address_city_' id='label_ff_3_organization_address_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"organization_address[city]\" id=\"ff_3_organization_address_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_1\" ><h3 class='ff-el-section-title'>Primary Disaster Contact<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div data-type=\"name-element\" data-name=\"primary_contact_name\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_primary_contact_name_primary_first_name_' id='label_ff_3_primary_contact_name_primary_first_name_' >Primary Contact Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"primary_contact_name[primary_first_name]\" id=\"ff_3_primary_contact_name_primary_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_primary_contact_email' id='label_ff_3_primary_contact_email' aria-label=\"Primary Contact Email\">Primary Contact Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"primary_contact_email\" id=\"ff_3_primary_contact_email\" class=\"ff-el-form-control\" placeholder=\"Enter Primary Contact Email\" data-name=\"primary_contact_email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_primary_contact_phone' id='label_ff_3_primary_contact_phone' aria-label=\"Primary Contact Phone\">Primary Contact Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"primary_contact_phone\" data-mask=\"(000) 000-0000\" class=\"ff-el-form-control\" placeholder=\"Enter Primary Contact Phone\" data-name=\"primary_contact_phone\" id=\"ff_3_primary_contact_phone\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-3_2\" ><h3 class='ff-el-section-title'>Organization Details<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff-el-form-top ff_list_inline'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"County Area(s) Your Organization Services (check all that apply)\">County Area(s) Your Organization Services (check all that apply)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_d4084dcb094151e0b55ff1d701919077'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Bureau\"  id='checkbox_d4084dcb094151e0b55ff1d701919077' aria-label='Bureau' aria-invalid='false' aria-required=false> <span>Bureau<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_104c2f5900739029676c71d665209ff0'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Putnam\"  id='checkbox_104c2f5900739029676c71d665209ff0' aria-label='Putnam' aria-invalid='false' aria-required=false> <span>Putnam<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_9007399febab8f99c4295da2c0ce7e18'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Lasalle\"  id='checkbox_9007399febab8f99c4295da2c0ce7e18' aria-label='Lasalle' aria-invalid='false' aria-required=false> <span>Lasalle<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top ff_list_inline'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Where do you provide services at?\">Where do you provide services at?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_5532aa3d5300d2e2666721e0607be101'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"At the site of the disaster\"  id='checkbox_1_5532aa3d5300d2e2666721e0607be101' aria-label='At the site of the disaster' aria-invalid='false' aria-required=false> <span>At the site of the disaster<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_b0cc6b4393e93be441b832717a079e3a'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"At our organization&#039;s location\"  id='checkbox_1_b0cc6b4393e93be441b832717a079e3a' aria-label='At our organization&#039;s location' aria-invalid='false' aria-required=false> <span>At our organization's location<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_22da470f197c58abb2b4a200b62f4579'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" 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