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https://viamediapromotions.com/sign_up.html

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1<!DOCTYPE html>
2<html>
3<head>
4<title>Sign Up for the Hardees College Fund Contest</title>
5<meta name="description" content="Register for a chance at winnings Hardees $10,000 College Fund Contest. This is a great scholarship opportunity for one lucky student in Lexington, KY." />
6<meta name="keywords" content="" />
7<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
8<meta name="viewport" content="width=device-width, initial-scale=1.0">
9<link href="./css/reset.css" rel="stylesheet" type="text/css">
10<link href="./css/bootstrap.min.css" rel="stylesheet" type="text/css">
11<link href="./css/global.css" rel="stylesheet" type="text/css">
12<link href="./css/global-y.css" rel="stylesheet" type="text/css">
13<link href="./css/global-m.css" rel="stylesheet" type="text/css">
14<link href="./css/bootstrap-responsive.css" rel="stylesheet" type="text/css">
15
16<link href="./css/validationEngine.jquery.css" rel="stylesheet" type="text/css">
17<link type="text/css" rel="stylesheet" href=".//js/jquery/jquery-ui-1.8.10.custom.css">
18<link type="text/css" rel="stylesheet" href=".//css/colorbox.css">
19
20
21<!-- HTML5 shim for IE backwards compatibility -->
22<!--[if lt IE 9]>
23<script src="http://html5shim.googlecode.com/svn/trunk/html5.js"></script>
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23
24<script src="https://oss.maxcdn.com/libs/respond.js/1.3.0/respond.min.js"></script>
24
25<![endif]-->
26<!--
27<script src="./js/jquery.min.js"></script>
27
28-->
29<script src=".//js/jquery-1.7.1.min.js"></script>
29
30
31<script src="./js/frontend.js"></script>
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31
32<script src=".//js/jquery/jquery-ui-1.8.10.custom.min.js"></script>
vendor: 2 bytes, line 32
32
33<script src=".//js/jquery.simplemodal.js" type="text/javascript"></script>
vendor: 2 bytes, line 33
33
34<script type="text/javascript" src="./js/jquery.validate.min.js"></script>
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34
35<script type="text/javascript" src="./js/jquery.colorbox-min.js"></script>
35
36
37</head>
38<body>
39<div id="wrapper" class="homebg"> <!-- header starts -->
40
41<header>
42
43<div class="container clearfix">
44
45<div id="logo" class="pull-left"><a href="./index.html"><img src="./images/Hardees-white-logo.png" alt="Hardees"></a></div>
46
47<div id="right-head" class="pull-right">
48
49<a href="./sign_up.html" class="signup">Sign Up</a>
50
51<a href="./rules.html" class="rules">The Rules</a>
52
53</div>
54
55</div>
56
57</header>	<!-- end header -->
58
59<div class="header-bg"></div>
60 
60<script type="text/javascript">
61$(document).ready(function(){	
62	$("#signupForm").validationEngine('attach');
63   });
64</script>
64
65
66<!-- home section -->
67
68<section id="home-top">
69
70<div class="container">
71
72	<iframe src="https://services.cognitoforms.com/f/WztVSXS7q0C229twu6rvXg?id=6" style="position:relative;width:1px;min-width:100%;*width:100%;" frameborder="0" scrolling="yes" seamless="seamless" height="1516" width="100%"></iframe>
73	<!--<div class="cognito">
74		
74<script src="https://services.cognitoforms.com/s/WztVSXS7q0C229twu6rvXg"></script>
74
75		
75<script>Cognito.load("forms", { id: "6" });</script>
75
76		</div>-->
77
78<!--<div class="row-fluid">
79
80<div class="inner-content">
81	<h2>CONTEST FORM</h2>
82	
83    
84    <h3>Personal Information </h3>
85
86	<form name="signupForm" id="signupForm" method="post" action="./sign_up.html/save">
87		<div class="row-fluid clearfix form-row">
88			<div class="span6">
89				<label>First Name</label>
90				<input type="text" placeholder="First name" name="first_name" id="first_name" class="input-block-level validate[required, custom[onlyLetterSp]]">
91			</div>
92
93			<div class="span6">
94				<label>Last Name</label>
95				<input type="text" placeholder="Last name" name="last_name" id="last_name" class="input-block-level validate[required, custom[onlyLetterSp]]">
96			</div>
97
98		</div>
99		
100
101		<div class="row-fluid clearfix form-row">
102			<div class="span3">
103    	        <label>Home Address (no P.O. boxes) </label>
104				<input type="text" placeholder="Address" name="address1" id="address1" class="input-block-level validate[required]">
105            </div>
106			<div class="span3">
107    	        <label>Address 2 </label>
108				<input type="text" placeholder="Address 2" name="address2" id="address2" class="input-block-level">
109            </div>
110            <div class="span3">
111    	        <label>City</label>
112				<input type="text" placeholder="City" name="city" id="city" class="input-block-level validate[required]">
113            </div>                       
114
115		</div>
116        
117        <div class="row-fluid clearfix form-row">
118	        <div class="span3">
119    	        <label>State</label>
120				<input type="text" placeholder="State" name="state" id="state" class="input-block-level validate[required]">
121            </div> 
122			<div class="span3">
123    	        <label>Zip Code </label>
124				<input type="text" placeholder="Zip Code" name="zip" id="zip" class="input-block-level validate[required]">
125            </div>
126			<div class="span3">
127    	        <label>County </label>
128				<input type="text" placeholder="County" name="county" id="county" class="input-block-level validate[required]">
129            </div>            
130
131		</div>
132        
133        
134		
135		<div class="row-fluid clearfix form-row">
136			<div class="span1">
137				<label>Daytime </label>
138				<input type="text" placeholder="" name="daytime" id="daytime" class="input-block-level validate[required]">
139			</div>
140
141			<div class="span4">
142				<label>Telephone Number (including area code) </label>
143				<input type="text" placeholder="" name="phone" id="phone" class="input-block-level validate[required, custom[phone]]">
144			</div>
145
146		</div>
147		
148<div class="row-fluid clearfix form-row">
149
150		<label>Date of Birth</label>
151		<span class="span1" style="margin-left:0">
152        	<select class="input-block-level validate[required]" name="dob_month" id="dob_month">
153            	<option value="">Month</option>
154                <option value="01">Jan</option>
155                <option value="02">Feb</option>
156                <option value="03">Mar</option>
157                <option value="04">Apr</option>
158                <option value="05">May</option>
159                <option value="06">Jun</option>
160                <option value="07">Jul</option>
161                <option value="08">Aug</option>
162                <option value="09">Sept</option>
163                <option value="10">Oct</option>
164                <option value="11">Nov</option>
165                <option value="12">Dec</option>
166            </select>
167        </span>
168		<span class="span1">
169        	<select class="input-block-level validate[required]" name="dob_day" id="dob_day">
170            	<option value="">Day</option>
171                                	<option value="01">1</option>
172                                	<option value="02">2</option>
173                                	<option value="03">3</option>
174                                	<option value="04">4</option>
175                                	<option value="05">5</option>
176                                	<option value="06">6</option>
177                                	<option value="07">7</option>
178                                	<option value="08">8</option>
179                                	<option value="09">9</option>
180                                	<option value="10">10</option>
181                                	<option value="11">11</option>
182                                	<option value="12">12</option>
183                                	<option value="13">13</option>
184                                	<option value="14">14</option>
185                                	<option value="15">15</option>
186                                	<option value="16">16</option>
187                                	<option value="17">17</option>
188                                	<option value="18">18</option>
189                                	<option value="19">19</option>
190                                	<option value="20">20</option>
191                                	<option value="21">21</option>
192                                	<option value="22">22</option>
193                                	<option value="23">23</option>
194                                	<option value="24">24</option>
195                                	<option value="25">25</option>
196                                	<option value="26">26</option>
197                                	<option value="27">27</option>
198                                	<option value="28">28</option>
199                                	<option value="29">29</option>
200                                	<option value="30">30</option>
201                                	<option value="31">31</option>
202                            </select>
203        </span>
204		<span class="span1">
205        	<select class="input-block-level validate[required]" name="dob_year" id="dob_year">
206            	<option value="">Year</option>
207                                	<option value="1960">1960</option>
208                                	<option value="1961">1961</option>
209                                	<option value="1962">1962</option>
210                                	<option value="1963">1963</option>
211                                	<option value="1964">1964</option>
212                                	<option value="1965">1965</option>
213                                	<option value="1966">1966</option>
214                                	<option value="1967">1967</option>
215                                	<option value="1968">1968</option>
216                                	<option value="1969">1969</option>
217                                	<option value="1970">1970</option>
218                                	<option value="1971">1971</option>
219                                	<option value="1972">1972</option>
220                                	<option value="1973">1973</option>
221                                	<option value="1974">1974</option>
222                                	<option value="1975">1975</option>
223                                	<option value="1976">1976</option>
224                                	<option value="1977">1977</option>
225                                	<option value="1978">1978</option>
226                                	<option value="1979">1979</option>
227                                	<option value="1980">1980</option>
228                                	<option value="1981">1981</option>
229                                	<option value="1982">1982</option>
230                                	<option value="1983">1983</option>
231                                	<option value="1984">1984</option>
232                                	<option value="1985">1985</option>
233                                	<option value="1986">1986</option>
234                                	<option value="1987">1987</option>
235                                	<option value="1988">1988</option>
236                                	<option value="1989">
2361989</option>
237                                	<option value="1990">1990</option>
238                                	<option value="1991">1991</option>
239                                	<option value="1992">1992</option>
240                                	<option value="1993">1993</option>
241                                	<option value="1994">1994</option>
242                                	<option value="1995">1995</option>
243                                	<option value="1996">1996</option>
244                                	<option value="1997">1997</option>
245                                	<option value="1998">1998</option>
246                                	<option value="1999">1999</option>
247                                	<option value="2000">2000</option>
248                                	<option value="2001">2001</option>
249                                	<option value="2002">2002</option>
250                                	<option value="2003">2003</option>
251                                	<option value="2004">2004</option>
252                                	<option value="2005">2005</option>
253                                	<option value="2006">2006</option>
254                                	<option value="2007">2007</option>
255                                	<option value="2008">2008</option>
256                                	<option value="2009">2009</option>
257                                	<option value="2010">2010</option>
258                                	<option value="2011">2011</option>
259                                	<option value="2012">2012</option>
260                                	<option value="2013">2013</option>
261                                	<option value="2014">2014</option>
262                                	<option value="2015">2015</option>
263                                	<option value="2016">2016</option>
264                                	<option value="2017">2017</option>
265                                	<option value="2018">2018</option>
266                                	<option value="2019">2019</option>
267                            </select>
268        </span>
269</div>
270
271
272
273<div class="row-fluid clearfix form-row">
274	<div class="span5">
275		
276		<label>Email Address </label>
277				<input type="text" placeholder="" name="email" id="email" class="input-block-level validate[required, custom[email]]">
278	</div>
279
280</div>
281
282
283<div id="under18">
284<h5>Oh!  You're under 18.  That's alright!  We just need some more information.</h5>
285
286    <div class="row-fluid clearfix form-row">
287        <div class="span3">
288            
289            <label>Legal Guardian's Name  </label>
290                    <input type="text" placeholder="" name="guardian_name" id="guardian_name" class="input-block-level validate[custom[onlyLetterSp]]">
291        </div>
292    
293        <div class="span3">
294            
295            <label>Email </label>
296                    <input type="text" placeholder="" name="guardian_email" id="guardian_email" class="input-block-level validate[custom[email]">
297        </div>
298    
299        <div class="span3">
300            
301            <label>Phone  </label>
302                    <input type="text" placeholder="" name="guardian_phone" id="guardian_phone" class="input-block-level validate[custom[phone]">
303        </div>
304    
305    </div>   
306</div>
307
308
309<hr />
310
311<h3>Essay Questions </h3>
312<p>Please complete the following essay questions within 250 words. All entries will be judged on the following criteria</p>
313
314<ul class="arrow-list">
315<li>Exemplary community service and commitment to academic excellence </li>
316<li>Creativity and originality </li>
317<li>Quality content, proper grammar, attention to word count </li>
318</ul>
319
320<div class="row-fluid clearfix form-row">
321<div class="span10">
322	<label>How would this college fund help you achieve your education goals?</label>
323	<textarea class="input-block-level validate[required]" name="question_1" id="question_1"></textarea>
324</div>
325</div>
326
327<div class="row-fluid clearfix form-row">
328<div class="span10">
329	<label>How have you impacted your local community?</label>
330	<textarea class="input-block-level validate[required]" name="question_2" id="question_2"></textarea>
331</div>
332</div>
333
334<div class="row-fluid clearfix form-row">
335	<label class="checkbox">
336<input type="checkbox" name="checkbox_gpa" id="checkbox_gpa" value="1" class="validate[required]">
337I verify that I currently have a minimum 2.5 cumulative grade point average (GPA) at my current educational institution
338</label>
339</div>
340
341
342<div class="row-fluid clearfix form-row">
343	<label class="checkbox">
344<input type="checkbox" name="checkbox_resident" id="checkbox_resident" value="1" class="validate[required]">
345I verify that I am a legal resident of one of the following counties in the State of Kentucky: Anderson, Bath, Bourbon, Boyle, Breathitt, Casey, Clark, Clay, Estill, Fayette, Fleming, Franklin, Garrard, Harrison, Jackson, Jessamine, Knott, Knox, Laurel, Lee, Lincoln, Madison, Magoffin, Menifee, Mercer, Montgomery, Morgan, Nicholas, Owsley, Perry, Powell, Pulaski, Rockcastle, Rowan, Russell, Scott, Wayne, Whitley, Wolfe, or Woodford
346</label>
347</div>
348
349<div class="row-fluid clearfix form-row">
350	<label class="checkbox">
351<input type="checkbox" name="checkbox_enrolled" id="checkbox_enrolled" value="1" class="validate[required]">
352I verify that by December 31, 2017 I will be enrolled as candidate for a degree at a Kentucky college, university or eligible educational institution <a href="./requirements.html" target="_blank">(see official rules for qualifying institutions.)</a>
353</label>
354</div>
355
356<div class="row-fluid clearfix form-row">
357	<label class="checkbox">
358<input type="checkbox" name="checkbox_rules" id="checkbox_rules" value="1" class="validate[required]">
359I verify I have read & understand the <a href="./rules.html" target="_blank">official contest rules</a>
360</label>
361</div>
362
363
364<div class="row-fluid clearfix form-row">
365	<label class="checkbox">
366<input type="checkbox" name="checkbox_under18" id="checkbox_under18" value="1" class="validate[required]">
367I verify that if I am under the age of 18, I have consent of my parent or legal guardian to enter.
368</label>
369</div>
370
371<p class="submit-buttons"> <span class="btn-frame">
372            <button type="submit" name="submitButton" id="submitButton" value="submit">Submit</button>            
373            </span><span class="btn-frame">
374            <button type="reset" name="cancelButton" id="cancelButton" value="reset">Cancel</button>
375            </span> </p>
376	</form>
377
378
379
380<div class="disclaimer">
381    	NO PURCHASE NECESSARY TO ENTER OR WIN. Contest period: 9/11/17-11/14/17. Open only to legal residents of the following Kentucky state counties: Anderson, Bath, Bourbon, Boyle, Breathitt, Casey, Clark, Clay, Estill, Fayette, Fleming, Franklin, Garrard, Harrison, Jackson, Jessamine, Knott, Knox, Laurel, Lee, Lincoln, Madison, Magoffin, Menifee, Mercer, Montgomery, Morgan, Nicholas, Owsley, Perry, Powell, Pulaski, Rockcastle, Rowan, Russell, Scott, Wayne, Whitley, Wolfe, or Woodford (excluding residents of all other counties in Kentucky and all other 49 States of the United States, including the District of Columbia, Guam, Puerto Rico) 17 or older, with a minimum 2.5 GPA at current educational institution, and by 12/31/17 are candidate for degree at a KY college, university or eligible educational institution. Permission from parent/legal guardian required for individuals under age of majority. <a href="./rules.html">Official Rules</a>. Winner selected based on the entry that best describes exemplary community service, commitment to academic excellence, creativity and originality, and content quality. Sponsor: Viamedia, Inc., 220 Lexington Green Circle, Suite 300, Lexington, KY 40503.
382</div>
383
384
385
386<h3 style="text-align:center">Contest has ended! </h3>-->
387</div>
388
389
390
391</div>
392
393</div>
394
395</section>	<!-- home section -->
396  <div id="push"></div>
397</div>
398<!-- end wrapper --> 
399<footer>
400
401<div class="container">
402
403<div class="row">
404
405<div class="span8">
406
407<p><a href="./sign_up.html">Sign Up</a> | <a href="./requirements.html">Requirements And Eligibility</a> | <a href="./faq.html">FAQs</a> | <a href="./contact_us.html">Contact Us</a> | <a href="./privacy.html">Privacy Policy</a> | <a href="./terms.html">Terms Of Use</a> | <a href="./rules.html">Contest Rules</a></p>
408
409</div>
410
411<div class="span4 text-right">
412
413<p>Copyright&copy;2021 Viamedia. All Rights Reserved</p>
414
415</div>
416
417</div>
418
419</div>
420
421</footer>
422 
423<script src="https://services.cognitoforms.com/scripts/embed.js"></script>
423 
424<script src="./js/bootstrap.min.js" type="text/jscript"></script>
424 
425<script src="./js/jquery.customSelect.min.js"></script>
425 
426<script type="text/javascript">
427$(function(){
428$('form select').customSelect();
429$('.customSelect').addClass('input-block-level');
430var customWidth = $('span.customSelect').innerWidth();
431$('select.hasCustomSelect').css('width', customWidth + 'px');
432$( window ).resize(function() {
433	var customWidth = $('span.customSelect').innerWidth();
434	$('select.hasCustomSelect').css('width', customWidth + 'px');
435});
436});
437</script>
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437
438<script src="./js/jquery.validationEngine.js"></script>
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438
439<script src="./js/jquery.validationEngine-en.js"></script>
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439
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440
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450</body>
451</html>

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