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gchoice_12_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_5_0' id='label_12_5_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_5_1' id='label_12_5_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_5_2' id='label_12_5_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_5_3' id='label_12_5_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_5_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_5_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_5_4' id='label_12_5_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_55' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_4' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u0642\u0648\u062f \u0627\u0644\u0633\u064a\u0627\u0631\u0629 \u0628\u0639\u062f \u0627\u062d\u062a\u0633\u0627\u0621 \u0627\u0644\u0643\u062d\u0648\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_7'>\n\t\t\t<div class='gchoice gchoice_12_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_0' id='label_12_7_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_1' id='label_12_7_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_2' id='label_12_7_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_3' id='label_12_7_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_7_4' id='label_12_7_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_56' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_56' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_5' class='gform_page' data-js='page-field-id-56' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u062e\u0641\u064a \u0643\u0645\u064a\u0629 \u0627\u0644\u0643\u062d\u0648\u0644 \u0627\u0644\u062a\u064a \u062a\u062d\u062a\u0633\u064a\u0647\u0627 \u0639\u0646 \u0623\u0635\u062f\u0642\u0627\u0626\u0643 \u0648\u0623\u062d\u0628\u0627\u0626\u0643\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_10'>\n\t\t\t<div class='gchoice gchoice_12_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_0' id='label_12_10_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_1' id='label_12_10_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_2' id='label_12_10_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_3' id='label_12_10_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_10_4' id='label_12_10_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_57' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_57' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_6' class='gform_page' data-js='page-field-id-57' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u0642\u0631\u0631 \u062d\u062f\u0648\u062f \u0644\u0634\u0631\u0628 \u0627\u0644\u0643\u062d\u0648\u0644 \u0648\u0644\u0643\u0646\u0643 \u062a\u062c\u062f \u0635\u0639\u0648\u0628\u0629 \u0641\u064a \u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u064a\u0647\u0627\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_12'>\n\t\t\t<div class='gchoice gchoice_12_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_0' id='label_12_12_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_1' id='label_12_12_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_2' id='label_12_12_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_3' id='label_12_12_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_12_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_12_4' id='label_12_12_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_58' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_7' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u0623\u062e\u0628\u0631\u0643 \u0623\u062d\u062f \u0645\u0646 \u0642\u0628\u0644 \u0623\u0646 \u0627\u062d\u062a\u0633\u0627\u0621 \u0627\u0644\u0643\u062d\u0648\u0644 \u0633\u0648\u0641 \u064a\u0633\u0628\u0628 \u0644\u0643 \u0645\u0634\u0627\u0643\u0644 \u0635\u062d\u064a\u0629\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_14'>\n\t\t\t<div class='gchoice gchoice_12_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_0' id='label_12_14_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_1' id='label_12_14_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_2' id='label_12_14_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_3' id='label_12_14_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_14_4' id='label_12_14_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_8' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u0623\u062b\u0631\u062a \u0639\u0644\u0627\u0642\u0627\u062a\u0643 \u0627\u0644\u0634\u062e\u0635\u064a\u0629 \u0628\u062a\u0646\u0627\u0648\u0644 \u0627\u0644\u0643\u062d\u0648\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_16'>\n\t\t\t<div class='gchoice gchoice_12_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_0' id='label_12_16_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_1' id='label_12_16_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_2' id='label_12_16_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_3' id='label_12_16_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_4' id='label_12_16_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_59' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_59' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_9' class='gform_page' data-js='page-field-id-59' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u0641\u0648\u062a\u062a \u064a\u0648\u0645\u064b\u0627 \u062d\u062f\u062b\u064b\u0627 \u0647\u0627\u0645\u064b\u0627 \u0644\u062a\u0638\u0644 \u0628\u0627\u0644\u0645\u0646\u0632\u0644 \u0644\u0627\u062d\u062a\u0633\u0627\u0621 \u0627\u0644\u0643\u062d\u0648\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_18'>\n\t\t\t<div class='gchoice gchoice_12_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_0' id='label_12_18_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_1' id='label_12_18_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_2' id='label_12_18_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_3' id='label_12_18_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_4' id='label_12_18_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_10' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u062d\u062a\u0633\u064a \u0627\u0644\u0643\u062d\u0648\u0644 \u0628\u0645\u0641\u0631\u062f\u0643\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_20'>\n\t\t\t<div class='gchoice gchoice_12_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_0' id='label_12_20_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_2' id='label_12_20_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_3' id='label_12_20_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_20_4' id='label_12_20_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_61' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_61' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_11' class='gform_page' data-js='page-field-id-61' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u0623\u0634\u0627\u0631 \u0623\u062d\u062f \u0645\u0646 \u0642\u0628\u0644 \u0623\u0646 \u0627\u062d\u062a\u0633\u0627\u0626\u0643 \u0644\u0644\u0643\u062d\u0648\u0644 \u064a\u0645\u062b\u0644 \u0645\u0634\u0643\u0644\u0629 \u0643\u0628\u064a\u0631\u0629\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_41'>\n\t\t\t<div class='gchoice gchoice_12_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_41_0' id='label_12_41_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_41_1' id='label_12_41_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_41_2' id='label_12_41_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_41_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_41_3' id='label_12_41_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_41_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_41_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_41_4' id='label_12_41_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_62' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_12' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u062d\u062a\u0627\u062c \u0625\u0644\u0649 \u0627\u0644\u0643\u062d\u0648\u0644 \u0644\u064a\u0633\u0627\u0639\u062f\u0643 \u0639\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0631\u062e\u0627\u0621\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_42'>\n\t\t\t<div class='gchoice gchoice_12_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_0' id='label_12_42_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_1' id='label_12_42_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_2' id='label_12_42_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_42_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_3' id='label_12_42_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_42_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_42_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_42_4' id='label_12_42_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_63' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_63' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_13' class='gform_page' data-js='page-field-id-63' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u0641\u0642\u062f\u062a \u0627\u0644\u0648\u0639\u064a \u064a\u0648\u0645\u064b\u0627 \u0628\u0633\u0628\u0628 \u0634\u0631\u0628 \u0627\u0644\u0643\u062d\u0648\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_43'>\n\t\t\t<div class='gchoice gchoice_12_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_0' id='label_12_43_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_1' id='label_12_43_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_2' id='label_12_43_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_3' id='label_12_43_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_43_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_43_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_43_4' id='label_12_43_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_64' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_64' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_14' class='gform_page' data-js='page-field-id-64' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u063a\u0636\u0628\u062a \u0645\u0646 \u0642\u0628\u0644 \u0639\u0646\u062f\u0645\u0627 \u0633\u0624\u0644\u062a \u0639\u0646 \u0627\u062d\u062a\u0633\u0627\u0626\u0643 \u0627\u0644\u0643\u062d\u0648\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_44'>\n\t\t\t<div class='gchoice gchoice_12_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_0' id='label_12_44_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_1' id='label_12_44_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_44_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_2' id='label_12_44_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_44_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_3' id='label_12_44_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_44_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_44_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_44_4' id='label_12_44_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_65' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_65' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_15' class='gform_page' data-js='page-field-id-65' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u064a\u0633\u0628\u0628 \u0644\u0643 \u0627\u0644\u062a\u0641\u0643\u064a\u0631 \u0641\u064a \u0627\u0644\u0627\u0628\u062a\u0639\u0627\u062f \u0639\u0646 \u0634\u0631\u0628 \u0627\u0644\u0643\u062d\u0648\u0644 \u0627\u0644\u062a\u0648\u062a\u0631 \u0623\u0648 \u0627\u0644\u062e\u0648\u0641\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_46'>\n\t\t\t<div class='gchoice gchoice_12_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_46_0' id='label_12_46_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_46_1' id='label_12_46_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_46_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_46_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_46_2' id='label_12_46_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_46_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_46_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_46_3' id='label_12_46_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_46_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_46_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_46_4' id='label_12_46_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_66' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_16' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u0623\u062b\u0631 \u0634\u0631\u0628 \u0627\u0644\u0643\u062d\u0648\u0644 \u0639\u0644\u0649 \u0645\u0633\u0624\u0648\u0644\u064a\u0627\u062a\u0643 \u0627\u0644\u0639\u0627\u0626\u0644\u064a\u0629 \u0623\u0648 \u0645\u0633\u0624\u0648\u0644\u064a\u0627\u062a \u0627\u0644\u0639\u0645\u0644\u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_47'>\n\t\t\t<div class='gchoice gchoice_12_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_12_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_0' id='label_12_47_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_12_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_1' id='label_12_47_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_47_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_12_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_2' id='label_12_47_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_47_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_12_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_3' id='label_12_47_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_47_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646'  id='choice_12_47_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_47_4' id='label_12_47_4' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0623\u063a\u0644\u0628 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_12_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='\u0627\u0644\u0633\u0627\u0628\u0642'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_12_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='\u0627\u0644\u062a\u0627\u0644\u064a'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_17' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_32\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>\u0644\u0642\u062f \u0623\u0643\u0645\u0644\u062a \u0627\u062e\u062a\u0628\u0627\u0631 \u0647\u0627\u0631\u0628\u0648\u0631 \u0644\u0625\u062f\u0645\u0627\u0646 \u0627\u0644\u0643\u062d\u0648\u0644.<\/h3>\n<p><b>\u0644\u0645\u0639\u0631\u0641\u0629 \u0646\u062a\u0627\u0626\u062c \u0627\u062e\u062a\u0628\u0627\u0631\u0643\u060c \u064a\u0631\u062c\u0649 \u0625\u062f\u062e\u0627\u0644 \u0627\u0644\u062a\u0641\u0627\u0635\u064a\u0644 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0643 \u0623\u062f\u0646\u0627\u0647.<\/b><\/p>\n<p>\u0633\u064a\u062a\u0645 \u0627\u0644\u062d\u0641\u0627\u0638 \u0639\u0644\u0649 \u0633\u0631\u064a\u0629 \u0627\u0644\u062a\u0641\u0627\u0635\u064a\u0644 \u062a\u0645\u0627\u0645\u0627 \u0648\u0644\u0646 \u064a\u062a\u0645 \u0645\u0634\u0627\u0631\u0643\u062a\u0647.<\/p><\/div><div id=\"field_12_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_34'>\u0627\u0644\u0627\u0633\u0645<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_12_34' type='text' value='' class='large'    placeholder='Name here' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_35\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_35'>\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_35' id='input_12_35' type='email' value='' class='large'   placeholder='example@email.com' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_36'>\u0627\u0644\u0647\u0627\u062a\u0641<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0645\u0637\u0644\u0648\u0628)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_12_36' type='tel' value='' class='large'  placeholder='00000 000 000' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_37\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below 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' >Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_37.1' id='input_12_37_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_12_37_1' >\u0627\u0646\u0642\u0631 \u0647\u0646\u0627 \u0644\u062a\u0644\u0642\u064a \u0643\u062a\u064a\u0628\u0646\u0627 \u0639\u0628\u0631 \u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a.<\/label><input type='hidden' name='input_37.2' value='\u0627\u0646\u0642\u0631 \u0647\u0646\u0627 \u0644\u062a\u0644\u0642\u064a \u0643\u062a\u064a\u0628\u0646\u0627 \u0639\u0628\u0631 \u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a.' class='gform_hidden' \/><input type='hidden' name='input_37.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_12_38\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below 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' >Contact consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_38.1' id='input_12_38_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_12_38_1' >\u0623\u0648\u062f \u0623\u0646 \u064a\u062a\u0645 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u064a \u0644\u0645\u0646\u0627\u0642\u0634\u0629 \u0646\u062a\u0627\u0626\u062c \u0627\u062e\u062a\u0628\u0627\u0631\u064a.<\/label><input type='hidden' name='input_38.2' value='\u0623\u0648\u062f \u0623\u0646 \u064a\u062a\u0645 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u064a \u0644\u0645\u0646\u0627\u0642\u0634\u0629 \u0646\u062a\u0627\u0626\u062c \u0627\u062e\u062a\u0628\u0627\u0631\u064a.' class='gform_hidden' \/><input type='hidden' name='input_38.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_12_39\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below 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' >Consultation Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_39.1' id='input_12_39_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_12_39_1' >\u0623\u0648\u062f \u0623\u0646 \u064a\u062a\u0645 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u064a \u0644\u062a\u0631\u062a\u064a\u0628 \u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u062e\u0627\u0635\u0629.<\/label><input type='hidden' name='input_39.2' value='\u0623\u0648\u062f \u0623\u0646 \u064a\u062a\u0645 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u064a \u0644\u062a\u0631\u062a\u064a\u0628 \u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u062e\u0627\u0635\u0629.' class='gform_hidden' \/><input type='hidden' name='input_39.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_12_67\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_67' id='input_12_67' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Alcoholism' \/><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'>\n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 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