{"id":226,"date":"2026-02-19T15:04:17","date_gmt":"2026-02-19T15:04:17","guid":{"rendered":"https:\/\/ancjoburg.org.za\/app\/?page_id=226"},"modified":"2026-07-25T13:28:46","modified_gmt":"2026-07-25T13:28:46","slug":"canvasser-details","status":"publish","type":"page","link":"https:\/\/ancjoburg.org.za\/app\/canvasser-details\/","title":{"rendered":"Canvasser Details"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"226\" class=\"elementor elementor-226\">\n\t\t\t\t<div data-ka-cursor-size=\"1\" class=\"elementor-element elementor-element-38f929f1 e-flex e-con-boxed e-con e-parent\" data-id=\"38f929f1\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;kng_cursor_interaction&quot;:&quot;default&quot;,&quot;kng_cursor_magnetic&quot;:&quot;none&quot;,&quot;kng_cursor_size_multiplier&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]}}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div data-ka-cursor-size=\"1\" class=\"elementor-element elementor-element-2de717a2 elementor-widget elementor-widget-text-editor\" data-id=\"2de717a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;kng_cursor_interaction&quot;:&quot;default&quot;,&quot;kng_cursor_magnetic&quot;:&quot;none&quot;,&quot;kng_cursor_size_multiplier&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]}}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div data-ka-cursor-size=\"1\" class=\"elementor-element elementor-element-81d087d e-flex e-con-boxed e-con e-parent\" data-id=\"81d087d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;kng_cursor_interaction&quot;:&quot;default&quot;,&quot;kng_cursor_magnetic&quot;:&quot;none&quot;,&quot;kng_cursor_size_multiplier&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]}}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div data-ka-cursor-size=\"1\" class=\"elementor-element elementor-element-92dc4d0 elementor-widget elementor-widget-shortcode\" data-id=\"92dc4d0\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;kng_cursor_interaction&quot;:&quot;default&quot;,&quot;kng_cursor_magnetic&quot;:&quot;none&quot;,&quot;kng_cursor_size_multiplier&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]}}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class='fluentform ff-default fluentform_wrapper_51 ffs_default_wrap'><form data-form_id=\"51\" id=\"fluentform_51\" class=\"frm-fluent-form fluent_form_51 ff-el-form-top ff_form_instance_51_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_51_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;\">Voter Registration Campaign_2 Testing form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='226' \/><input type=\"hidden\" id=\"_fluentform_51_fluentformnonce\" name=\"_fluentform_51_fluentformnonce\" value=\"06d4bb5501\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/app\/wp-json\/wp\/v2\/pages\/226\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_1\" ><h2 class=\"page-title\" style=\"text-align: center\"><a style=\"color: #ffd700;background-color: #000000;font-size: 23px;border-radius: 30px;text-decoration: none;font-weight: bold;font-style: normal;padding: 0.9rem 1rem;border-color: #000000\" href=\"https:\/\/www.elections.org.za\/pw\/voter\/Who-Is-My-Ward-Councillor\" target=\"_blank\" rel=\"noopener noreferrer\">Check your Voter Registration <\/a><\/h2>\n<p style=\"text-align: center\"><a style=\"color: #000000;background-color: #ffd700;font-size: 16px;border-radius: 5px;text-decoration: none;font-weight: bold;font-style: normal;padding: 0.8rem 1rem;border-color: #000000\" href=\"https:\/\/registertovote.elections.org.za\/voter\/registration\/za\" target=\"_blank\" rel=\"noopener noreferrer\">\u00a0New Registration \/ Change of Address<\/a>\u00a0<\/p><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_2\" ><h2><strong>Volunteer Details<\/strong><\/h2><\/div><div data-type=\"name-element\" data-name=\"names\" 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 asterisk-right\"><label for='ff_51_names_first_name_' id='label_ff_51_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_51_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" tabindex=\"1\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_names_last_name_' id='label_ff_51_names_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_51_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" tabindex=\"2\" aria-invalid=\"false\" aria-required=false><\/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_51_input_text_2' id='label_ff_51_input_text_2'>Cell phone number <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" tabindex=\"3\" id=\"ff_51_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_email' id='label_ff_51_email'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_51_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\" tabindex=\"4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_datetime' id='label_ff_51_datetime'>Date \/ Time<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date \/ Time Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_51_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\" tabindex=\"5\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_3\" ><h2><strong>Location Details<\/strong><\/h2><\/div><div class=\" ff-field_container ff-chained-select-field-wrapper\" data-type=\"chained-select\" data-name=\"chained_select\" data-source-type=\"file\" ><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_51_chained_select_Zone_' id='label_ff_51_chained_select_Zone_'>Zone<\/label><\/div><div class='ff-el-input--content'><select disabled name=\"chained_select[Zone]\" class=\"ff-el-form-control  el-chained-select\" data-name=\"chained_select\" data-source-type=\"file\" tabindex=\"6\" id=\"ff_51_chained_select_Zone_\" data-index=\"0\" data-meta_key=\"chained_select_chained_select\" data-key=\"Zone\" ><option value=''>Zone<\/option><option value='Zone 1'>Zone 1<\/option><option value='Zone 2'>Zone 2<\/option><option value='Zone 3'>Zone 3<\/option><option value='Zone 4'>Zone 4<\/option><option value='Zone 5'>Zone 5<\/option><option value='Zone 6'>Zone 6<\/option><option value='Zone 7'>Zone 7<\/option><option value='Zone 8'>Zone 8<\/option><option value='Zone 9'>Zone 9<\/option><option value='Zone 10'>Zone 10<\/option><option value='Zone 11'>Zone 11<\/option><option value='Zone 12'>Zone 12<\/option><option value='Zone 13'>Zone 13<\/option><option value='Zone 14'>Zone 14<\/option><option value='Zone 15'>Zone 15<\/option><option value='Zone 16'>Zone 16<\/option><\/select><\/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_51_chained_select_Ward_' id='label_ff_51_chained_select_Ward_'>Ward<\/label><\/div><div class='ff-el-input--content'><select disabled name=\"chained_select[Ward]\" class=\"ff-el-form-control  el-chained-select\" data-name=\"chained_select\" data-source-type=\"file\" tabindex=\"7\" id=\"ff_51_chained_select_Ward_\" data-index=\"1\" data-meta_key=\"chained_select_chained_select\" data-key=\"Ward\" ><option value=''>Ward<\/option><\/select><\/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_51_chained_select_Voting_District_' id='label_ff_51_chained_select_Voting_District_'>Voting District<\/label><\/div><div class='ff-el-input--content'><select disabled name=\"chained_select[Voting District]\" class=\"ff-el-form-control  el-chained-select\" data-name=\"chained_select\" data-source-type=\"file\" tabindex=\"8\" id=\"ff_51_chained_select_Voting_District_\" data-index=\"2\" data-meta_key=\"chained_select_chained_select\" data-key=\"Voting District\" ><option value=''>Voting District<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_4\" ><h2><strong>Voter Details (Individual)<\/strong><\/h2><\/div><div data-type=\"name-element\" data-name=\"names_1\" 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 asterisk-right\"><label for='ff_51_names_1_first_name_' id='label_ff_51_names_1_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_51_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" tabindex=\"9\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_names_1_last_name_' id='label_ff_51_names_1_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_51_names_1_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" tabindex=\"10\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_input_text_4' id='label_ff_51_input_text_4'>ID Number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" tabindex=\"11\" id=\"ff_51_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_input_text_7' id='label_ff_51_input_text_7'>Cell Phone Number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" data-name=\"input_text_7\" tabindex=\"12\" id=\"ff_51_input_text_7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_email_1' id='label_ff_51_email_1'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_51_email_1\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email_1\" tabindex=\"13\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_dropdown_3' id='label_ff_51_dropdown_3'>Age Group<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_3\" id=\"ff_51_dropdown_3\" class=\"ff-el-form-control\" data-name=\"dropdown_3\" data-calc_value=\"0\" tabindex=\"14\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_51_dropdown_3\"><option value=\"\">- Select -<\/option><option value=\"16-25\"  >16-25<\/option><option value=\"26-35\"  >26-35<\/option><option value=\"36-59\"  >36-59<\/option><option value=\"60+\"  >60+<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_dropdown_4' id='label_ff_51_dropdown_4'>Gender<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_4\" id=\"ff_51_dropdown_4\" class=\"ff-el-form-control\" data-name=\"dropdown_4\" data-calc_value=\"0\" tabindex=\"15\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_51_dropdown_4\"><option value=\"\">- Select -<\/option><option value=\"Male\"  >Male<\/option><option value=\"Female\"  >Female<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_5\" ><h2><strong>Voter Address Details<\/strong><\/h2><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_input_text_3' id='label_ff_51_input_text_3'>Address:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" placeholder=\"type your address...\" data-name=\"input_text_3\" tabindex=\"16\" id=\"ff_51_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_6\" ><h2><strong>Voter Registration Status<\/strong><\/h2><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_dropdown_5' id='label_ff_51_dropdown_5'>Are You Registered To Vote?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_5\" id=\"ff_51_dropdown_5\" class=\"ff-el-form-control\" data-name=\"dropdown_5\" data-calc_value=\"0\" tabindex=\"17\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_51_dropdown_5\"><option value=\"\">- Select -<\/option><option value=\"New Registration\"  >New Registration<\/option><option value=\"Change of Address\"  >Change of Address<\/option><option value=\"Checking\"  >Checking<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_7\" ><h2><strong>Vote ANC Campaign<\/strong><\/h2><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_dropdown' id='label_ff_51_dropdown'>1. Voting Preference <\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_51_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\" tabindex=\"18\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_51_dropdown\"><option value=\"\">--- Select ---<\/option><option value=\"Vote ANC\"  >Vote ANC<\/option><option value=\"Undecided \"  >Undecided<\/option><option value=\"Hostile\"  >Hostile<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_51_dropdown_11' id='label_ff_51_dropdown_11'>2. Follow-Up Required <\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_11\" id=\"ff_51_dropdown_11\" class=\"ff-el-form-control\" data-name=\"dropdown_11\" data-calc_value=\"0\" tabindex=\"19\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_51_dropdown_11\"><option value=\"\">- Select -<\/option><option value=\"Yes\"  >Yes<\/option><option value=\"No\"  >No<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_dropdown_12' id='label_ff_51_dropdown_12'>3. If Yes, assign to:<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_12\" id=\"ff_51_dropdown_12\" class=\"ff-el-form-control\" data-name=\"dropdown_12\" data-calc_value=\"0\" tabindex=\"20\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_12\"><option value=\"\">- Select -<\/option><option value=\"Ward Councilor\"  >Ward Councilor<\/option><option value=\"Branch Executive Committee (BEC)\"  >Branch Executive Committee (BEC)<\/option><option value=\"VD Coordinator\"  >VD Coordinator<\/option><option value=\"BET Coordinator\"  >BET Coordinator<\/option><option value=\"ZET Coordinator\"  >ZET Coordinator<\/option><option value=\"Regional Executive Committee\"  >Regional Executive Committee<\/option><option value=\"Service Delivery Team\"  >Service Delivery Team<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_dropdown_13' id='label_ff_51_dropdown_13'>4. Reason for Follow-up<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_13\" id=\"ff_51_dropdown_13\" class=\"ff-el-form-control\" data-name=\"dropdown_13\" data-calc_value=\"0\" tabindex=\"21\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_13\"><option value=\"\">- Select -<\/option><option value=\"Voter requested another visit\"  >Voter requested another visit<\/option><option value=\"Voter undecided\"  >Voter undecided<\/option><option value=\"Service delivery complaint\"  >Service delivery complaint<\/option><option value=\"Registration assistance required \"  >Registration assistance required<\/option><option value=\"Special Vote assistance \"  >Special Vote assistance<\/option><option value=\"Transport required on voting day\"  >Transport required on voting day<\/option><option value=\"Other\"  >Other<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_8\" ><h2>\u00a0<strong>Special Voter Eligibility<\/strong><\/h2><\/div><div class='ff-el-group'><div class='ff-el-input--content'><select name=\"dropdown_7\" id=\"ff_51_dropdown_7\" class=\"ff-el-form-control\" data-name=\"dropdown_7\" data-calc_value=\"0\" tabindex=\"22\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_7\"><option value=\"\">- Select -<\/option><option value=\"Elderly(60+)\"  >Elderly(60+)<\/option><option value=\"Person with Dissability\"  >Person with Dissability<\/option><option value=\"Temporarily Disabled\/Injured\"  >Temporarily Disabled\/Injured<\/option><option value=\"Pregnant\"  >Pregnant<\/option><option value=\"Essential Worker(Unavailable on Voting Day)\"  >Essential Worker(Unavailable on Voting Day)<\/option><option value=\"Other(Specify)\"  >Other(Specify)<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_dropdown_8' id='label_ff_51_dropdown_8'>Type of Special Vote Required<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_8\" id=\"ff_51_dropdown_8\" class=\"ff-el-form-control\" data-name=\"dropdown_8\" data-calc_value=\"0\" tabindex=\"23\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_8\"><option value=\"\">- Select -<\/option><option value=\"Home Visit\"  >Home Visit<\/option><option value=\"Voting Station\"  >Voting Station<\/option><option value=\"Not Sure\"  >Not Sure<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_9\" ><h2><strong>Transport Support?<\/strong><\/h2>\n<p><span style=\"color: #000000\">Will you require transport on voting day? (Yes or No)<\/span><\/p><\/div><div class='ff-el-group'><div class='ff-el-input--content'><select name=\"dropdown_9\" id=\"ff_51_dropdown_9\" class=\"ff-el-form-control\" data-name=\"dropdown_9\" data-calc_value=\"0\" tabindex=\"24\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_9\"><option value=\"\">- Select -<\/option><option value=\"Yes\"  >Yes<\/option><option value=\"No\"  >No<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_51_dropdown_10' id='label_ff_51_dropdown_10'>If Yes:<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_10\" id=\"ff_51_dropdown_10\" class=\"ff-el-form-control\" data-name=\"dropdown_10\" data-calc_value=\"0\" tabindex=\"25\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_51_dropdown_10\"><option value=\"\">Preferred Voting Time<\/option><option value=\"Early Morning (07h00-10h00)\"  >Early Morning (07h00-10h00)<\/option><option value=\"Midday(10h00-14h00)\"  >Midday(10h00-14h00)<\/option><option value=\"Late Afternoon (14h00-19h00)\"  >Late Afternoon (14h00-19h00)<\/option><\/select><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-51_10\" ><h2><span style=\"color: #000000\"><strong>Community Issues<\/strong><\/span><\/h2><\/div><div class='ff-el-group ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  >Checkbox Field<\/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_379b21276af4dcf0d0e6ca22564d7787'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"26\" value=\"Water\"  id='checkbox_379b21276af4dcf0d0e6ca22564d7787' aria-label='Water' aria-invalid='false' aria-required=false> <span>Water<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2546e6a4f6f2dde05da8e3fa3c1047ed'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Electricity\"  id='checkbox_2546e6a4f6f2dde05da8e3fa3c1047ed' aria-label='Electricity' aria-invalid='false' aria-required=false> <span>Electricity<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_763da0a50f730e9d54072dece34e517e'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Billing\"  id='checkbox_763da0a50f730e9d54072dece34e517e' aria-label='Billing' aria-invalid='false' aria-required=false> <span>Billing<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' 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