document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub27.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=2285354722&formid=3685&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:2285354722:27:3685\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>APPLICATION FOR MEMBERSHIP IN WOWOS CLUB</div></div> <div class=\"bn-form-desc\"><p>This is an e-contract that a Member of Wowos Club signs in order to be accepted to the Wowos Club PTY LTD (Reg. No.: 2016/544511/07). The member must read the Terms of Service (ToS) for Wowos Club (available on request). By submitting this contract the member acknowledges that s/he has read all the documentations accompanying the ToS available in various platforms including the WhatsApp Group associated with the Wowos Club PTY LTD. ');
document.write('');
document.write('I acknowledges that I have read the terms and conditions of the club and bind myself to them. Wowo’s Club shall be entitled to summarily cancel my registration at any time if I supply false or incorrect information.</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your first and last name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Surname <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-165246268283789\" placeholder=\"your first and last name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Company Name </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-168510982288621\" placeholder=\"If you have a business company\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Physical Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"enter your physical address here\" validator=\"\" required=\"required\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Postal Address </span> <span class=\"bn-input\"><textarea name=\"Field-151465519575171\" placeholder=\"enter your postal address here\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Mobile Number <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1514655124091107\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">What is your highest formal qualification?  </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"None\" checked=\"checked\"> <span class=\"bn-inner-label\">None</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"Matric\"> <span class=\"bn-inner-label\">Matric</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"Higher Certificate\"> <span class=\"bn-inner-label\">Higher Certificate</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"National Diploma\"> <span class=\"bn-inner-label\">National Diploma</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"Bachelor Degree\"> <span class=\"bn-inner-label\">Bachelor Degree</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"Honours Degree\"> <span class=\"bn-inner-label\">Honours Degree</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"Masters Degree\"> <span class=\"bn-inner-label\">Masters Degree</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314754219397\" value=\"PhD Degree\"> <span class=\"bn-inner-label\">PhD Degree</span></label></span></span></div></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">What is your age group?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"18 to 24\" checked=\"checked\"> <span class=\"bn-inner-label\">18 to 24</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"25 to 34\"> <span class=\"bn-inner-label\">25 to 34</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"35 to 44\"> <span class=\"bn-inner-label\">35 to 44</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"45 to 54\"> <span class=\"bn-inner-label\">45 to 54</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"55 to 64\"> <span class=\"bn-inner-label\">55 to 64</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-172314779838433\" value=\"65 or over\"> <span class=\"bn-inner-label\">65 or over</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Upload your picture for our photo gallery (optional) </span> <span class=\"bn-input\"><input type=\"file\" name=\"userfile\" value=\"\"> <input type=\"hidden\" name=\"MAX_FILE_SIZE\" value=\"2097152\"></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Which Cohort(s) do you want to belong to? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos General Club (WGC)\" required=\"required\" checked=\"checked\"> <span class=\"bn-inner-label\">Wowos General Club (WGC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Sedimonthole Stokvel Club (WSSC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Sedimonthole Stokvel Club (WSSC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Property Consortium Club (WPCC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Property Consortium Club (WPCC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Business Club (WBC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Business Club (WBC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Spiritual Club (WCC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Spiritual Club (WCC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Parent Club (WPC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Parent Club (WPC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Political Science Club (WPSC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Political Science Club (WPSC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Book Club (WBoC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Book Club (WBoC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Fitness and Lifestyle Club (WFLC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Fitness and Lifestyle Club (WFLC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Black Friday Club (WBFC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Black Friday Club (WBFC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Club Burial Society Club (WCBS)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Club Burial Society Club (WCBS)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Shareholders Club (WSHC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Shareholders Club (WSHC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Sport Club (WSpC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Sport Club (WSpC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Music Club (WMC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Music Club (WMC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Research and Development Club (WR&amp;DC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Research and Development Club (WR&amp;DC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Career Engaging Club (WCEC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Career Engaging Club (WCEC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Cybersecurity Club (WCyberC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Cybersecurity Club (WCyberC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Golf Club (WGolfC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Golf Club (WGolfC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Vacation Club (WVC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Vacation Club (WVC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Beauty and Style Club (WBSC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Beauty and Style Club (WBSC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Wine and Whiskey Club (WWWC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Wine and Whiskey Club (WWWC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"CADEL (Political Party of Wowos Club)\" required=\"required\"> <span class=\"bn-inner-label\">CADEL (Political Party of Wowos Club)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Bitcoin Club (WBitC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Bitcoin Club (WBitC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Software Development Club (WSDC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Software Development Club (WSDC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Mentor and Mentee Club (WMMC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Mentor and Mentee Club (WMMC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Marriage Club (WMC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Marriage Club (WMC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Student Club (WSC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Student Club (WSC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Ilima Club (WPlantC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Ilima Club (WPlantC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Cooking Club (WCookC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Cooking Club (WCookC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Etherum Club (WEC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Etherum Club (WEC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Grieving Club (WGrievingC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Grieving Club (WGrievingC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Birthday Contribution Club (WBCC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Birthday Contribution Club (WBCC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Groceries Club (WGrC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Groceries Club (WGrC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Covid-19 Club (WCovid-19)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Covid-19 Club (WCovid-19)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Business Analysis Club (WBAC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Business Analysis Club (WBAC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos Project Management Club (WPMC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos Project Management Club (WPMC)</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-154816947548487[]\" value=\"Wowos 20c Challenge Club (WC20cC)\" required=\"required\"> <span class=\"bn-inner-label\">Wowos 20c Challenge Club (WC20cC)</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Alternative Number </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1514655124091103\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">How did you hear about us? </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-151465528422565\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Should we add your mobile number to WhatsApp Cohorts as per your selection above?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151465604822359\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151465604822359\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Do you wish to receive our Wowos Club Newsletter that is sent via e-mail periodically? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-161791009789597\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-161791009789597\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Do you wish to be an annual paid-up member of Wowos Club?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1650477478840100\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1650477478840100\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Do you wish to be a Shareholder of Wowos Club?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-165047765812699\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-165047765812699\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Do you acknowledge all terms and conditions of this membership e-contract?  <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151465518061134\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151465518061134\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div>  <input 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document.write('}');
document.write('label.bn-radio span.bn-inner-label:before {');
document.write('  background: -moz-radial-gradient(center, ellipse cover,#ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('  background: -webkit-radial-gradient(center, ellipse cover, #ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('  background: radial-gradient(ellipse at center, #ffffff 0px,#ffffff 9px,rgba(0,0,0,0) 14px,rgba(0,0,0,0) 100%);');
document.write('}');
document.write('label.bn-checkbox span.bn-inner-label:before {');
document.write('  background: -moz-radial-gradient(left,rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background: -webkit-radial-gradient(left, rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background: linear-gradient(to right, rgba(255,255,255,0) 0px,rgba(255,255,255,0) 5px,#ffffff 5px,#ffffff 27px, rgba(0,0,0,0) 26px,rgba(0,0,0,0) 100%);');
document.write('  background-size: 28px 21px;');
document.write('  background-repeat: no-repeat;');
document.write('  background-position-y: 5px;');
document.write('}');
document.write('label.bn-checkbox span.bn-inner-label:before  {');
document.write('  content: \'check_box_outline_blank\';');
document.write('}');
document.write('label.bn-radio  span.bn-inner-label:before {');
document.write('  content: \'radio_button_unchecked\';');
document.write('}');
document.write('input[type=checkbox]:checked + span.bn-inner-label:before, input[type=radio]:checked + span.bn-inner-label:before {');
document.write('  opacity: 0;');
document.write('}');
document.write('input[type=checkbox] + span.bn-inner-label:after {');
document.write('  content: \'check_box\';');
document.write('  color:#2696f9;');
document.write('  color:#2696f9;');
document.write('}');
document.write('');
document.write('input[type=radio] + span.bn-inner-label:after {');
document.write('  content: \'radio_button_checked\';');
document.write('  color:#2696f9;');
document.write('  color:#2696f9;');
document.write('}');
document.write('input[type=radio]:not(:checked) + span.bn-inner-label:after,');
document.write('input[type=checkbox]:not(:checked) + span.bn-inner-label:after {');
document.write('  opacity: 0;');
document.write('  transform: scale(.3);');
document.write('}');
document.write('');
document.write('input[type=radio]:checked + span.bn-inner-label:after,');
document.write('input[type=checkbox]:checked + span.bn-inner-label:after {');
document.write('  opacity: 1;');
document.write('  transform: scale(1);');
document.write('}');
document.write('.bn-date-input {');
document.write('  position: relative;');
document.write('}');
document.write('.bn-date-input .bn-date-pick {');
document.write('  position: absolute;');
document.write('  width: 24px;');
document.write('  height: 24px;');
document.write('  font-size: 24px;');
document.write('  right: 5px;');
document.write('  top: 50%;');
document.write('  margin-top: -13px;');
document.write('');
document.write('}');
document.write('.bn-date-input .bn-date-pick {');
document.write('  color: #000;');
document.write('  color:#c4c4c4;');
document.write('  opacity: 0.75;');
document.write('}</style></form>');
document.write('<scr' + 'ipt src="//assets.bnidx.com/pixel/proMarket"></scr' + 'ipt>');