{"id":97909,"date":"2024-06-07T14:26:31","date_gmt":"2024-06-07T14:26:31","guid":{"rendered":"https:\/\/harbor.in-testing.co.uk\/drug-addiction-self-assessment\/"},"modified":"2024-12-30T15:08:37","modified_gmt":"2024-12-30T15:08:37","slug":"%d8%a7%d8%ae%d8%aa%d8%a8%d8%a7%d8%b1-%d8%a7%d9%84%d8%a5%d9%83%d8%aa%d8%a6%d8%a7%d8%a8","status":"publish","type":"page","link":"https:\/\/harborlondon.com\/oldsite\/ar\/%d8%a7%d8%ae%d8%aa%d8%a8%d8%a7%d8%b1-%d8%a7%d9%84%d8%a5%d9%83%d8%aa%d8%a6%d8%a7%d8%a8\/","title":{"rendered":"\u0627\u062e\u062a\u0628\u0627\u0631 \u0627\u0644\u0627\u0643\u062a\u0626\u0627\u0628 \u0644\u0644\u062a\u0642\u064a\u064a\u0645 \u0627\u0644\u0630\u0627\u062a\u064a"},"content":{"rendered":"\n<!-- Our front-end template -->\n<section\n    id=\"inner-hero-block_f2c81bde5206feae588eb6076d2e4b44\" \n    class=\"inner-hero  page-hero\"\n>\n            <style>\n            #inner-hero-block_f2c81bde5206feae588eb6076d2e4b44 {\n                background-image: 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href=\"https:\/\/harborlondon.com\/oldsite\/ar\/%d8%a7%d9%86%d9%88%d8%a7%d8%b9-%d8%a7%d9%84%d8%a7%d9%83%d8%aa%d8%a6%d8%a7%d8%a8\/\">\u0644\u0639\u0644\u0627\u062c \u0627\u0644\u0627\u0643\u062a\u0626\u0627\u0628<\/a><\/span>.<\/p>\n<p>\u0627\u0644\u0623\u0633\u0626\u0644\u0629 \u0627\u0644\u0648\u0627\u0631\u062f\u0629 \u0623\u062f\u0646\u0627\u0647 \u062a\u062a\u0637\u0644\u0628 \u0645\u0646\u0643 \u0627\u0644\u0635\u062f\u0642 \u0645\u0646 \u0623\u062c\u0644 \u062a\u062d\u0642\u064a\u0642 \u0623\u062f\u0642 \u0627\u0644\u0646\u062a\u0627\u0626\u062c. \u062d\u062f\u062f \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0627\u0644\u0623\u0643\u062b\u0631 \u0645\u0644\u0627\u0621\u0645\u0629 \u0644\u0643\u0644 \u0633\u0624\u0627\u0644. \u064a\u0645\u0643\u0646 \u0623\u0646 \u064a\u0633\u0627\u0639\u062f\u0643 \u0647\u0630\u0627 \u0627\u0644\u0627\u062e\u062a\u0628\u0627\u0631 \u0627\u0644\u0642\u0635\u064a\u0631 \u0641\u064a <span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" 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>\u0623\u0634\u0639\u0631 \u0628\u0627\u0644\u0641\u0634\u0644 \u0627\u0644\u062a\u0627\u0645.<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_19_5'>\n\t\t\t<div class='gchoice gchoice_19_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_19_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_5_0' id='label_19_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_19_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_19_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_5_1' id='label_19_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_19_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_19_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_5_2' id='label_19_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_19_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_19_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_5_3' id='label_19_5_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_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_19_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_19_4' class='gform_page' data-js='page-field-id-65' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0644\u0627 \u0623\u0633\u062a\u0637\u064a\u0639 \u0623\u0646 \u0623\u0634\u0639\u0631 \u0628\u0627\u0644\u0631\u0636\u0627 \u0623\u0648 \u0627\u0644\u0641\u0631\u062d.<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_19_7'>\n\t\t\t<div class='gchoice gchoice_19_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_19_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_7_0' id='label_19_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_19_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_19_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_7_1' id='label_19_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_19_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_19_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_7_2' id='label_19_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_19_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_19_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_7_3' id='label_19_7_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_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_19_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_19_5' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u0634\u0639\u0631 \u0628\u0627\u0644\u0630\u0646\u0628 \u0648\u062a\u0623\u0646\u064a\u0628 \u0627\u0644\u0636\u0645\u064a\u0631.<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_19_10'>\n\t\t\t<div class='gchoice gchoice_19_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_19_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_10_0' id='label_19_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_19_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_19_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_10_1' id='label_19_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_19_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_19_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_10_2' id='label_19_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_19_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_19_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_10_3' id='label_19_10_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_67' 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_19_67' 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 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class='gfield_label gform-field-label' >\u0623\u0634\u0639\u0631 \u0623\u0646\u064a \u0645\u0639\u0627\u0642\u0628 \u0639\u0644\u0649 \u0634\u064a\u0621 \u0645\u0627.<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_19_12'>\n\t\t\t<div class='gchoice gchoice_19_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_19_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_12_0' id='label_19_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_19_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_19_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_12_1' id='label_19_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_19_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_19_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_12_2' id='label_19_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_19_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_19_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_12_3' id='label_19_12_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_68' 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_19_68' 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_19_7' class='gform_page' data-js='page-field-id-68' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u062a\u063a\u0644\u0628\u0646\u064a \u0645\u0634\u0627\u0639\u0631 \u062e\u064a\u0628\u0629 \u0627\u0644\u0623\u0645\u0644 \u0623\u0648 \u0627\u0644\u0627\u0634\u0645\u0626\u0632\u0627\u0632.<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_19_14'>\n\t\t\t<div class='gchoice gchoice_19_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_19_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_14_0' id='label_19_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_19_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_19_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_14_1' id='label_19_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_19_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_19_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_14_2' id='label_19_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_19_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_19_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_14_3' id='label_19_14_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_69' 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_19_69' 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_19_8' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u0646\u0627 \u0645\u064f\u0644\u0627\u0645 \u0639\u0644\u0649 \u0643\u0644 \u0627\u0644\u0623\u0634\u064a\u0627\u0621 \u0627\u0644\u0633\u064a\u0626\u0629 \u0641\u064a \u0627\u0644\u062d\u064a\u0627\u0629<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_19_16'>\n\t\t\t<div class='gchoice gchoice_19_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_19_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_16_0' id='label_19_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_19_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_19_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_16_1' id='label_19_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_19_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_19_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_16_2' id='label_19_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_19_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_19_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_16_3' id='label_19_16_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_70' 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_19_70' 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_19_9' class='gform_page' data-js='page-field-id-70' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0643\u062b\u064a\u0631\u0627 \u0645\u0627 \u0623\u0628\u0643\u064a \u0623\u0648 \u0623\u0634\u0639\u0631 \u0623\u0646\u064a \u0639\u0644\u0649 \u0648\u0634\u0643 \u0627\u0644\u0628\u0643\u0627\u0621.<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_19_18'>\n\t\t\t<div class='gchoice gchoice_19_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_19_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_18_0' id='label_19_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_19_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_19_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_18_1' id='label_19_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_19_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_19_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_18_2' id='label_19_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_19_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_19_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_18_3' id='label_19_18_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_71' 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_19_71' 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_19_10' class='gform_page' data-js='page-field-id-71' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u0646\u0627 \u0633\u0631\u064a\u0639 \u0627\u0644\u063a\u0636\u0628 \u0648\u0633\u0647\u0644 \u0627\u0644\u0627\u0633\u062a\u0641\u0632\u0627\u0632.<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_19_20'>\n\t\t\t<div class='gchoice gchoice_19_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_19_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_0' id='label_19_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_19_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_19_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_1' id='label_19_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_19_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_19_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_2' id='label_19_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_19_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_19_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_3' id='label_19_20_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_72' 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_19_72' 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_19_11' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u0643\u0627\u0641\u062d \u0644\u0623\u0643\u0648\u0646 \u0645\u0647\u0645\u064b\u0627 \u0641\u064a \u062d\u064a\u0627\u0629 \u0627\u0644\u0622\u062e\u0631\u064a\u0646.<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_19_41'>\n\t\t\t<div class='gchoice gchoice_19_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_19_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_41_0' id='label_19_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_19_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_19_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_41_1' id='label_19_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_19_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_19_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_41_2' id='label_19_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_19_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_19_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_41_3' id='label_19_41_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_73' 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_19_73' 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_19_12' class='gform_page' data-js='page-field-id-73' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u0643\u0627\u0641\u062d \u0644\u0627\u062a\u062e\u0627\u0630 \u0623\u064a \u0642\u0631\u0627\u0631- \u0643\u0628\u064a\u0631 \u0643\u0627\u0646 \u0623\u0648 \u0635\u063a\u064a\u0631.<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_19_42'>\n\t\t\t<div class='gchoice gchoice_19_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_19_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_42_0' id='label_19_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_19_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_19_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_42_1' id='label_19_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_19_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_19_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_42_2' id='label_19_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_19_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_19_42_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_42_3' id='label_19_42_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_74' 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_19_74' 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_19_13' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0644\u062f\u064a \u0635\u0648\u0631\u0629 \u0630\u0627\u062a\u064a\u0629 \u0636\u0639\u064a\u0641\u0629\u060c \u0623\u0639\u062a\u0642\u062f \u0623\u0646\u064a \u063a\u064a\u0631 \u062c\u0630\u0627\u0628 \u0623\u0648 \u063a\u064a\u0631 \u0645\u062d\u0628\u0648\u0628.<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_19_43'>\n\t\t\t<div class='gchoice gchoice_19_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_19_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_43_0' id='label_19_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_19_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_19_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_43_1' id='label_19_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_19_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_19_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_43_2' id='label_19_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_19_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_19_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_43_3' id='label_19_43_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_75' 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_19_75' 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_19_14' class='gform_page' data-js='page-field-id-75' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0623\u062c\u062f \u0635\u0639\u0648\u0628\u0629 \u0643\u0628\u064a\u0631\u0629 \u0641\u064a \u062a\u062d\u0641\u064a\u0632 \u0646\u0641\u0633\u064a.<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_19_44'>\n\t\t\t<div class='gchoice gchoice_19_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_19_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_44_0' id='label_19_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_19_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_19_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_44_1' id='label_19_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_19_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_19_44_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_44_2' id='label_19_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_19_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_19_44_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_44_3' id='label_19_44_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_76' 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_19_76' 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_19_15' class='gform_page' data-js='page-field-id-76' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0631\u0648\u062a\u064a\u0646 \u0646\u0648\u0645\u064a \u063a\u064a\u0631 \u0645\u0646\u062a\u0638\u0645.<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_19_46'>\n\t\t\t<div class='gchoice gchoice_19_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_19_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_46_0' id='label_19_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_19_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_19_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_46_1' id='label_19_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_19_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_19_46_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_46_2' id='label_19_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_19_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_19_46_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_46_3' id='label_19_46_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_77' 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_19_77' 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_19_16' class='gform_page' data-js='page-field-id-77' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_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' >\u0644\u064a\u0633 \u0644\u062f\u064a \u0637\u0627\u0642\u0629 \u0644\u0639\u0645\u0644 \u0623\u064a \u0634\u064a\u0621.<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_19_47'>\n\t\t\t<div class='gchoice gchoice_19_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_19_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_47_0' id='label_19_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_19_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_19_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_47_1' id='label_19_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_19_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_19_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_47_2' id='label_19_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_19_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_19_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_47_3' id='label_19_47_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_78' 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_19_78' 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_19_17' class='gform_page' data-js='page-field-id-78' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_54\" 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' >\u064a\u0648\u062c\u062f \u062a\u063a\u064a\u064a\u0631 \u062f\u0627\u0626\u0645 \u0641\u064a \u0634\u0647\u064a\u062a\u064a.<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_19_54'>\n\t\t\t<div class='gchoice gchoice_19_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_19_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_54_0' id='label_19_54_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_19_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_19_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_54_1' id='label_19_54_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_19_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_19_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_54_2' id='label_19_54_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_19_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_19_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_54_3' id='label_19_54_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_79' 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_19_79' 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_19_18' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_56\" 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' >\u064a\u0628\u062f\u0648 \u0623\u0646\u0646\u064a \u0641\u0642\u062f\u062a \/ \u0627\u0643\u062a\u0633\u0628\u062a \u0627\u0644\u0643\u062b\u064a\u0631 \u0645\u0646 \u0627\u0644\u0648\u0632\u0646.<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_19_56'>\n\t\t\t<div class='gchoice gchoice_19_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_19_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_56_0' id='label_19_56_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_19_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_19_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_56_1' id='label_19_56_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_19_56_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_19_56_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_56_2' id='label_19_56_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_19_56_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_19_56_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_56_3' id='label_19_56_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_80' 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_19_80' 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_19_19' class='gform_page' data-js='page-field-id-80' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_58\" 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' >\u0623\u0646\u0627 \u0645\u0646\u0634\u063a\u0644 \u0628\u0635\u062d\u062a\u064a \u0627\u0644\u062c\u0633\u062f\u064a\u0629.<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_19_58'>\n\t\t\t<div class='gchoice gchoice_19_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_19_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_58_0' id='label_19_58_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_19_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_19_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_58_1' id='label_19_58_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_19_58_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_19_58_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_58_2' id='label_19_58_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_19_58_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_19_58_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_58_3' id='label_19_58_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/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_19_81' 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_19_81' 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_19_20' class='gform_page' data-js='page-field-id-81' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_20' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_60\" 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' >\u0627\u0644\u0639\u0644\u0627\u0642\u0627\u062a \u0627\u0644\u062c\u0646\u0633\u064a\u0629 \u0644\u0627 \u062a\u0647\u0645\u0646\u064a.<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_19_60'>\n\t\t\t<div class='gchoice gchoice_19_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u0623\u0628\u062f\u064b\u0627'  id='choice_19_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_60_0' id='label_19_60_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_19_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u0646\u0627\u062f\u0631\u064b\u0627'  id='choice_19_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_60_1' id='label_19_60_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_19_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u0623\u062d\u064a\u0627\u0646\u064b\u0627'  id='choice_19_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_60_2' id='label_19_60_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_19_60_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='\u063a\u0627\u0644\u0628\u064b\u0627'  id='choice_19_60_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_60_3' id='label_19_60_3' class='gform-field-label gform-field-label--type-inline'>\u063a\u0627\u0644\u0628\u064b\u0627<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n             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