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Check at least one box  \\xa0 required\">What are you signing up for? Check at least one box&nbsp;</label><div class=\"inputWrapper\"><span id=\"tfa_143\" class=\"choices horizontal required\" aria-required=\"true\"><span class=\"oneChoice\"><input type=\"checkbox\" value=\"tfa_144\" class=\"\" id=\"tfa_144\" name=\"tfa_144\" data-conditionals=\"#tfa_114\" aria-labelledby=\"tfa_144-L\" data-tfa-labelledby=\"tfa_143-L tfa_144-L\"><label class=\"label postField\" id=\"tfa_144-L\" for=\"tfa_144\"><span class=\"input-checkbox-faux\"></span>I pledge to donate my brain to research after my death</label></span><span class=\"oneChoice\"><input type=\"checkbox\" value=\"tfa_173\" class=\"\" id=\"tfa_173\" name=\"tfa_173\" aria-labelledby=\"tfa_173-L\" data-tfa-labelledby=\"tfa_143-L tfa_173-L\"><label class=\"label postField\" id=\"tfa_173-L\" for=\"tfa_173\"><span class=\"input-checkbox-faux\"></span>I am interested in participating in clinical research while I am alive</label></span></span></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_114-D\">\\n<label id=\"tfa_114-L\" class=\"label preField reqMark\" for=\"tfa_114\">Would you like to make your brain pledge public information?</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_114\" name=\"tfa_114\" data-condition=\"`#tfa_144`\" title=\"Would you like to make your brain pledge public information?\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_115\" id=\"tfa_115\" class=\"\">Yes, please make my pledge public</option>\\n<option value=\"tfa_116\" id=\"tfa_116\" class=\"\">No, please keep my pledge private</option></select></div>\\n</div>\\n</fieldset>\\n<fieldset id=\"tfa_137\" class=\"section highlighted\">\\n<legend id=\"tfa_137-L\">Basic Information</legend>\\n<div class=\"oneField field-container-D    \" id=\"tfa_6-D\">\\n<label id=\"tfa_6-L\" class=\"label preField \" for=\"tfa_6\">Title</label><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_6\" name=\"tfa_6\" value=\"\" title=\"Title\" class=\"\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_24-D\">\\n<label id=\"tfa_24-L\" class=\"label preField reqMark\" for=\"tfa_24\">First Name</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_24\" name=\"tfa_24\" value=\"\" title=\"First Name\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_26-D\">\\n<label id=\"tfa_26-L\" class=\"label preField \" for=\"tfa_26\">Middle Name</label><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_26\" name=\"tfa_26\" value=\"\" title=\"Middle Name\" class=\"\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_25-D\">\\n<label id=\"tfa_25-L\" class=\"label preField reqMark\" for=\"tfa_25\">Last Name</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_25\" name=\"tfa_25\" value=\"\" title=\"Last Name\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_8-D\">\\n<label id=\"tfa_8-L\" class=\"label preField \" for=\"tfa_8\">Suffix</label><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_8\" name=\"tfa_8\" value=\"\" title=\"Suffix\" class=\"\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_11-D\">\\n<label id=\"tfa_11-L\" class=\"label preField reqMark\" for=\"tfa_11\">Country</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_11\" name=\"tfa_11\" title=\"Country\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_12\" id=\"tfa_12\" class=\"\">Australia</option>\\n<option value=\"tfa_13\" id=\"tfa_13\" class=\"\">Brazil</option>\\n<option value=\"tfa_14\" id=\"tfa_14\" class=\"\">Canada</option>\\n<option value=\"tfa_15\" id=\"tfa_15\" class=\"\">France</option>\\n<option value=\"tfa_16\" id=\"tfa_16\" class=\"\">Germany</option>\\n<option value=\"tfa_17\" id=\"tfa_17\" class=\"\">Ireland</option>\\n<option value=\"tfa_18\" id=\"tfa_18\" class=\"\">Italy</option>\\n<option value=\"tfa_189\" id=\"tfa_189\" class=\"\">Netherlands</option>\\n<option value=\"tfa_19\" id=\"tfa_19\" class=\"\">New Zealand</option>\\n<option value=\"tfa_177\" id=\"tfa_177\" class=\"\">South Africa</option>\\n<option value=\"tfa_20\" id=\"tfa_20\" class=\"\">United Kingdom</option>\\n<option value=\"tfa_21\" id=\"tfa_21\" class=\"\">United States</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_154-D\">\\n<label id=\"tfa_154-L\" class=\"label preField reqMark\" for=\"tfa_154\">Address</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_154\" name=\"tfa_154\" value=\"\" title=\"Address\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_22-D\">\\n<label id=\"tfa_22-L\" class=\"label preField reqMark\" for=\"tfa_22\">City</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_22\" name=\"tfa_22\" value=\"\" title=\"City\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D   hintsTooltip \" id=\"tfa_23-D\">\\n<label id=\"tfa_23-L\" class=\"label preField reqMark\" for=\"tfa_23\">State/Province</label><div class=\"inputWrapper\">\\n<input aria-required=\"true\" type=\"text\" id=\"tfa_23\" name=\"tfa_23\" value=\"\" maxlength=\"2\" aria-describedby=\"tfa_23-HH\" title=\"State/Province\" class=\"required\"><span class=\"field-hint-inactive\" id=\"tfa_23-H\"><span id=\"tfa_23-HH\" class=\"hint\">Use abbreviated state name (Ex. New York = NY)</span><button id=\"tfa_23-HH-close-button\" class=\"field-hint-close-button\" type=\"button\" tabindex=\"-1\" aria-hidden=\"true\" aria-label=\"Close\">\\n                    x\\n                </button></span>\\n</div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_27-D\">\\n<label id=\"tfa_27-L\" class=\"label preField reqMark\" for=\"tfa_27\">Postal Code</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_27\" name=\"tfa_27\" value=\"\" title=\"Postal Code\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_31-D\">\\n<label id=\"tfa_31-L\" class=\"label preField reqMark\" for=\"tfa_31\">Phone Number</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_31\" name=\"tfa_31\" value=\"\" title=\"Phone Number\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_29-D\">\\n<label id=\"tfa_29-L\" class=\"label preField reqMark\" for=\"tfa_29\">Email</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_29\" name=\"tfa_29\" value=\"\" title=\"Email\" class=\"validate-email required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_30-D\">\\n<label id=\"tfa_30-L\" class=\"label preField reqMark\" for=\"tfa_30\">Confirm Email</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_30\" name=\"tfa_30\" value=\"\" title=\"Confirm Email\" class=\"validate-email required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_39-D\">\\n<label id=\"tfa_39-L\" class=\"label preField reqMark\" for=\"tfa_39\">Date of Birth (MM/DD/YYYY)</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_39\" name=\"tfa_39\" value=\"\" title=\"Date of Birth (MM/DD/YYYY)\" class=\"validate-date required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_147-D\">\\n<label id=\"tfa_147-L\" class=\"label preField reqMark\" for=\"tfa_147\">Race</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_147\" name=\"tfa_147\" title=\"Race\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_150\" id=\"tfa_150\" class=\"\">American Indian or Alaska Native</option>\\n<option value=\"tfa_151\" id=\"tfa_151\" class=\"\">Asian</option>\\n<option value=\"tfa_149\" id=\"tfa_149\" class=\"\">Black or African American</option>\\n<option value=\"tfa_152\" id=\"tfa_152\" class=\"\">Native Hawaiian and Pacific Islander</option>\\n<option value=\"tfa_153\" id=\"tfa_153\" class=\"\">Some Other Race</option>\\n<option value=\"tfa_148\" id=\"tfa_148\" class=\"\">White</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_40-D\">\\n<label id=\"tfa_40-L\" class=\"label preField reqMark\" for=\"tfa_40\">Sex</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_40\" name=\"tfa_40\" title=\"Sex\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_41\" id=\"tfa_41\" class=\"\">Male</option>\\n<option value=\"tfa_42\" id=\"tfa_42\" class=\"\">Female</option>\\n<option value=\"tfa_130\" id=\"tfa_130\" class=\"\">Other</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_43-D\">\\n<label id=\"tfa_43-L\" class=\"label preField reqMark\" for=\"tfa_43\">Military Service</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_43\" name=\"tfa_43\" title=\"Military Service\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_44\" id=\"tfa_44\" class=\"\">None</option>\\n<option value=\"tfa_45\" id=\"tfa_45\" data-conditionals=\"#tfa_48,#tfa_123,#tfa_162\" class=\"\">Active</option>\\n<option value=\"tfa_46\" id=\"tfa_46\" data-conditionals=\"#tfa_48,#tfa_123,#tfa_162\" class=\"\">Retired</option>\\n<option value=\"tfa_47\" id=\"tfa_47\" data-conditionals=\"#tfa_48,#tfa_123,#tfa_162\" class=\"\">Veteran</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_123-D\">\\n<label id=\"tfa_123-L\" class=\"label preField reqMark\" for=\"tfa_123\">Military Branch</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_123\" name=\"tfa_123\" data-condition=\"`#tfa_47` OR `#tfa_46` OR `#tfa_45`\" title=\"Military Branch\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_125\" id=\"tfa_125\" class=\"\">Air Force</option>\\n<option value=\"tfa_124\" id=\"tfa_124\" class=\"\">Army</option>\\n<option value=\"tfa_127\" id=\"tfa_127\" class=\"\">Coast Guard</option>\\n<option value=\"tfa_128\" id=\"tfa_128\" class=\"\">Marine Corps</option>\\n<option value=\"tfa_126\" id=\"tfa_126\" class=\"\">Navy</option>\\n<option value=\"tfa_129\" id=\"tfa_129\" class=\"\">Space Force</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D   hintsTooltip \" id=\"tfa_48-D\">\\n<label id=\"tfa_48-L\" class=\"label preField reqMark\" for=\"tfa_48\">Military Status - Pre or Post 9/11?</label><div class=\"inputWrapper\">\\n<select aria-required=\"true\" id=\"tfa_48\" name=\"tfa_48\" data-condition=\"`#tfa_45` OR `#tfa_46` OR `#tfa_47`\" title=\"Military Status - Pre or Post 9/11?\" aria-describedby=\"tfa_48-HH\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_49\" id=\"tfa_49\" class=\"\">Pre 9/11</option>\\n<option value=\"tfa_50\" id=\"tfa_50\" class=\"\">Post 9/11</option></select><span class=\"field-hint-inactive\" id=\"tfa_48-H\"><span id=\"tfa_48-HH\" class=\"hint\">If your service ENDED before 9/11/2001, select \"Pre 9/11\"</span><button id=\"tfa_48-HH-close-button\" class=\"field-hint-close-button\" type=\"button\" tabindex=\"-1\" aria-hidden=\"true\" aria-label=\"Close\">\\n                    x\\n                </button></span>\\n</div>\\n</div>\\n<div class=\"oneField field-container-D   hintsTooltip \" id=\"tfa_180-D\">\\n<label id=\"tfa_180-L\" class=\"label preField reqMark\" for=\"tfa_180\">What college or university do you feel most connected to?</label><div class=\"inputWrapper\">\\n<input aria-required=\"true\" type=\"text\" id=\"tfa_180\" name=\"tfa_180\" value=\"\" aria-describedby=\"tfa_180-HH\" title=\"What college or university do you feel most connected to?\" class=\"required\"><span class=\"field-hint-inactive\" id=\"tfa_180-H\"><span id=\"tfa_180-HH\" class=\"hint\">This could be where you attended, graduated, work, or have another connection</span><button id=\"tfa_180-HH-close-button\" class=\"field-hint-close-button\" type=\"button\" tabindex=\"-1\" aria-hidden=\"true\" aria-label=\"Close\">\\n                    x\\n                </button></span>\\n</div>\\n</div>\\n<div class=\"oneField field-container-D   hintsTooltip \" id=\"tfa_182-D\">\\n<label id=\"tfa_182-L\" class=\"label preField \" for=\"tfa_182\">If applicable, list a second college or university that you feel most connected to</label><div class=\"inputWrapper\">\\n<input type=\"text\" id=\"tfa_182\" name=\"tfa_182\" value=\"\" aria-describedby=\"tfa_182-HH\" title=\"If applicable, list a second college or university that you feel most connected to\" class=\"\"><span class=\"field-hint-inactive\" id=\"tfa_182-H\"><span id=\"tfa_182-HH\" class=\"hint\">This could be where you attended, graduated, work, or have another connection</span><button id=\"tfa_182-HH-close-button\" class=\"field-hint-close-button\" type=\"button\" tabindex=\"-1\" aria-hidden=\"true\" aria-label=\"Close\">\\n                    x\\n                </button></span>\\n</div>\\n</div>\\n</fieldset>\\n<fieldset id=\"tfa_138\" class=\"section highlighted\">\\n<legend id=\"tfa_138-L\">Exposure Information</legend>\\n<div class=\"htmlSection\" id=\"tfa_155\"><div class=\"htmlContent\" id=\"tfa_155-HTML\">This section asks about your history of brain trauma exposure. Complete this section to the best of your ability regarding your knowledge of the patient\\'s brain injury history. You do not need to have experienced brain trauma in order to sign up for the Clinical Research Registry or Brain Donation Registry. We encourage you to sign up regardless of your brain trauma history.</div></div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_52-D\">\\n<label id=\"tfa_52-L\" class=\"label preField reqMark\" for=\"tfa_52\">Primary Exposure</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_52\" name=\"tfa_52\" title=\"Primary Exposure\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_53\" id=\"tfa_53\" class=\"\">Amateur Wrestling</option>\\n<option value=\"tfa_54\" id=\"tfa_54\" class=\"\">Australian Rules</option>\\n<option value=\"tfa_55\" id=\"tfa_55\" class=\"\">Auto Racing</option>\\n<option value=\"tfa_56\" id=\"tfa_56\" class=\"\">Baseball</option>\\n<option value=\"tfa_57\" id=\"tfa_57\" class=\"\">Basketball</option>\\n<option value=\"tfa_58\" id=\"tfa_58\" class=\"\">Boxing</option>\\n<option value=\"tfa_59\" id=\"tfa_59\" class=\"\">Bull Riding</option>\\n<option value=\"tfa_60\" id=\"tfa_60\" class=\"\">Cheerleading</option>\\n<option value=\"tfa_61\" id=\"tfa_61\" class=\"\">Cycling</option>\\n<option value=\"tfa_62\" id=\"tfa_62\" class=\"\">Diving</option>\\n<option value=\"tfa_63\" id=\"tfa_63\" class=\"\">Entertainment Wrestling</option>\\n<option value=\"tfa_64\" id=\"tfa_64\" class=\"\">Equestrian</option>\\n<option value=\"tfa_65\" id=\"tfa_65\" class=\"\">Extreme Sports</option>\\n<option value=\"tfa_66\" id=\"tfa_66\" class=\"\">Figure Skating</option>\\n<option value=\"tfa_67\" id=\"tfa_67\" class=\"\">Football</option>\\n<option value=\"tfa_68\" id=\"tfa_68\" class=\"\">Ice Hockey</option>\\n<option value=\"tfa_69\" id=\"tfa_69\" class=\"\">Lacrosse</option>\\n<option value=\"tfa_70\" id=\"tfa_70\" class=\"\">Martial Arts</option>\\n<option value=\"tfa_131\" id=\"tfa_131\" class=\"\">Military</option>\\n<option value=\"tfa_71\" id=\"tfa_71\" class=\"\">MMA</option>\\n<option value=\"tfa_77\" id=\"tfa_77\" class=\"\">No contact sports (control)</option>\\n<option value=\"tfa_78\" id=\"tfa_78\" data-conditionals=\"#tfa_51\" class=\"\">Other</option>\\n<option value=\"tfa_72\" id=\"tfa_72\" class=\"\">Rugby</option>\\n<option value=\"tfa_73\" id=\"tfa_73\" class=\"\">Skiing</option>\\n<option value=\"tfa_74\" id=\"tfa_74\" class=\"\">Snowboarding</option>\\n<option value=\"tfa_75\" id=\"tfa_75\" class=\"\">Soccer</option>\\n<option value=\"tfa_176\" id=\"tfa_176\" class=\"\">Softball</option>\\n<option value=\"tfa_76\" id=\"tfa_76\" class=\"\">Stunt Actor</option>\\n<option value=\"tfa_132\" id=\"tfa_132\" class=\"\">Victim of Abuse</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_51-D\">\\n<label id=\"tfa_51-L\" class=\"label preField \" for=\"tfa_51\">Other - Primary Exposure</label><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_51\" name=\"tfa_51\" value=\"\" data-condition=\"`#tfa_78`\" title=\"Other - Primary Exposure\" class=\"\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_133-D\">\\n<label id=\"tfa_133-L\" class=\"label preField reqMark\" for=\"tfa_133\">Years of Primary Exposure</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_133\" name=\"tfa_133\" value=\"\" title=\"Years of Primary Exposure\" class=\"required\"></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_79-D\">\\n<label id=\"tfa_79-L\" class=\"label preField reqMark\" for=\"tfa_79\">If Primary Exposure was a sport, what is the highest level reached of the primary sport you played?</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_79\" name=\"tfa_79\" title=\"If Primary Exposure was a sport, what is the highest level reached of the primary sport you played?\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_80\" id=\"tfa_80\" class=\"\">Youth</option>\\n<option value=\"tfa_81\" id=\"tfa_81\" class=\"\">Middle School</option>\\n<option value=\"tfa_82\" id=\"tfa_82\" class=\"\">High School</option>\\n<option value=\"tfa_83\" id=\"tfa_83\" class=\"\">College</option>\\n<option value=\"tfa_84\" id=\"tfa_84\" class=\"\">Professional</option>\\n<option value=\"tfa_85\" id=\"tfa_85\" class=\"\">Club/Post-College</option>\\n<option value=\"tfa_86\" id=\"tfa_86\" class=\"\">N/A - I did not play a sport</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_87-D\">\\n<label id=\"tfa_87-L\" class=\"label preField reqMark\" for=\"tfa_87\">Secondary Exposure</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_87\" name=\"tfa_87\" title=\"Secondary Exposure\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_88\" id=\"tfa_88\" class=\"\">Amateur Wrestling</option>\\n<option value=\"tfa_89\" id=\"tfa_89\" class=\"\">Australian Rules</option>\\n<option value=\"tfa_90\" id=\"tfa_90\" class=\"\">Auto Racing</option>\\n<option value=\"tfa_91\" id=\"tfa_91\" class=\"\">Baseball</option>\\n<option value=\"tfa_92\" id=\"tfa_92\" class=\"\">Basketball</option>\\n<option value=\"tfa_93\" id=\"tfa_93\" class=\"\">Boxing</option>\\n<option value=\"tfa_94\" id=\"tfa_94\" class=\"\">Bull Riding</option>\\n<option value=\"tfa_95\" id=\"tfa_95\" class=\"\">Cheerleading</option>\\n<option value=\"tfa_96\" id=\"tfa_96\" class=\"\">Cycling</option>\\n<option value=\"tfa_97\" id=\"tfa_97\" class=\"\">Diving</option>\\n<option value=\"tfa_98\" id=\"tfa_98\" class=\"\">Entertainment Wrestling</option>\\n<option value=\"tfa_99\" id=\"tfa_99\" class=\"\">Equestrian</option>\\n<option value=\"tfa_100\" id=\"tfa_100\" class=\"\">Extreme Sports</option>\\n<option value=\"tfa_101\" id=\"tfa_101\" class=\"\">Figure Skating</option>\\n<option value=\"tfa_102\" id=\"tfa_102\" class=\"\">Football</option>\\n<option value=\"tfa_103\" id=\"tfa_103\" class=\"\">Ice Hockey</option>\\n<option value=\"tfa_104\" id=\"tfa_104\" class=\"\">Lacrosse</option>\\n<option value=\"tfa_105\" id=\"tfa_105\" class=\"\">Martial Arts</option>\\n<option value=\"tfa_134\" id=\"tfa_134\" class=\"\">Military</option>\\n<option value=\"tfa_106\" id=\"tfa_106\" class=\"\">MMA</option>\\n<option value=\"tfa_112\" id=\"tfa_112\" class=\"\">No contact sports (control)</option>\\n<option value=\"tfa_113\" id=\"tfa_113\" class=\"\">Other</option>\\n<option value=\"tfa_107\" id=\"tfa_107\" class=\"\">Rugby</option>\\n<option value=\"tfa_108\" id=\"tfa_108\" class=\"\">Skiing</option>\\n<option value=\"tfa_109\" id=\"tfa_109\" class=\"\">Snowboarding</option>\\n<option value=\"tfa_110\" id=\"tfa_110\" class=\"\">Soccer</option>\\n<option value=\"tfa_111\" id=\"tfa_111\" class=\"\">Stunt Actor</option>\\n<option value=\"tfa_135\" id=\"tfa_135\" class=\"\">Victim of Abuse</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_136-D\">\\n<label id=\"tfa_136-L\" class=\"label preField reqMark\" for=\"tfa_136\">How many concussions would you estimate you have suffered?</label><div class=\"inputWrapper\"><input aria-required=\"true\" type=\"text\" id=\"tfa_136\" name=\"tfa_136\" value=\"\" title=\"How many concussions would you estimate you have suffered?\" class=\"validate-float required\"></div>\\n</div>\\n</fieldset>\\n<fieldset id=\"tfa_146\" class=\"section highlighted\">\\n<legend id=\"tfa_146-L\">Referral Information</legend>\\n<div id=\"tfa_174\" class=\"section inline group\">\\n<div class=\"oneField field-container-D    \" id=\"tfa_32-D\">\\n<label id=\"tfa_32-L\" class=\"label preField reqMark\" for=\"tfa_32\">How did you hear about us?</label><div class=\"inputWrapper\"><select aria-required=\"true\" id=\"tfa_32\" name=\"tfa_32\" title=\"How did you hear about us?\" class=\"required\"><option value=\"\">Please select...</option>\\n<option value=\"tfa_33\" id=\"tfa_33\" class=\"\">Social Media</option>\\n<option value=\"tfa_34\" id=\"tfa_34\" class=\"\">Media/Article</option>\\n<option value=\"tfa_35\" id=\"tfa_35\" class=\"\">Search Engine</option>\\n<option value=\"tfa_36\" id=\"tfa_36\" class=\"\">Friend/Family Member</option>\\n<option value=\"tfa_37\" id=\"tfa_37\" data-conditionals=\"#tfa_169\" class=\"\">Other</option></select></div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_169-D\">\\n<label id=\"tfa_169-L\" class=\"label preField \" for=\"tfa_169\">If you selected other, how did you hear about us?</label><div class=\"inputWrapper\"><input type=\"text\" id=\"tfa_169\" name=\"tfa_169\" value=\"\" data-condition=\"`#tfa_37`\" title=\"If you selected other, how did you hear about us?\" class=\"\"></div>\\n</div>\\n</div>\\n<div class=\"oneField field-container-D    \" id=\"tfa_162-D\">\\n<label id=\"tfa_162-L\" class=\"label preField \" for=\"tfa_162\">If you were referred by a military-related organization(s), which organization(s)? Select all that apply:</label><div class=\"inputWrapper\"><select id=\"tfa_162\" multiple name=\"tfa_162[]\" data-condition=\"`#tfa_45` OR `#tfa_47` OR `#tfa_46`\" title=\"If you were referred by a military-related organization(s), which organization(s)? 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}