<!-- Begin Mailchimp Signup Form --> <link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css"> <style type="text/css"> #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; } /* Add your own Mailchimp form style overrides in your site stylesheet or in this style block. We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */ </style> <style type="text/css"> #mc-embedded-subscribe-form input[type=checkbox]{display: inline; width: auto;margin-right: 10px;} #mergeRow-gdpr {margin-top: 20px;} #mergeRow-gdpr fieldset label {font-weight: normal;} #mc-embedded-subscribe-form .mc_fieldset{border:none;min-height: 0px;padding-bottom:0px;} </style> <div id="mc_embed_signup"> <form action="https://fulbrightga.us13.list-manage.com/subscribe/post?u=cb43dc4856c5da5ab48199c87&id=c3a5953957" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate> <div id="mc_embed_signup_scroll"> <h2>Subscribe to the Georgia Fulbright Association Mailing List</h2> <div class="indicates-required"><span class="asterisk">*</span> indicates required</div> <div class="mc-field-group"> <label for="mce-FNAME">First Name <span class="asterisk">*</span> </label> <input type="text" value="" name="FNAME" class="required" id="mce-FNAME"> </div> <div class="mc-field-group"> <label for="mce-LNAME">Last Name <span class="asterisk">*</span> </label> <input type="text" value="" name="LNAME" class="required" id="mce-LNAME"> </div> <div class="mc-field-group"> <label for="mce-MMERGE3">Prefix <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE3" class="required" id="mce-MMERGE3"> </div> <div class="mc-field-group"> <label for="mce-EMAIL">Email Address <span class="asterisk">*</span> </label> <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL"> </div> <div class="mc-field-group"> <label for="mce-MMERGE4">Expertise </label> <input type="text" value="" name="MMERGE4" class="" id="mce-MMERGE4"> </div> <div class="mc-field-group"> <label for="mce-MMERGE5">Affiliation <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE5" class="required" id="mce-MMERGE5"> </div> <div class="mc-field-group"> <label for="mce-MMERGE6">City <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE6" class="required" id="mce-MMERGE6"> </div> <div class="mc-field-group"> <label for="mce-MMERGE11">State <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE11" class="required" id="mce-MMERGE11"> </div> <div class="mc-field-group"> <label for="mce-MMERGE7">Initial Year (Fulbright Scholarship) <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE7" class="required" id="mce-MMERGE7"> </div> <div class="mc-field-group"> <label for="mce-MMERGE8">End Year (Fulbright Scholarship) <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE8" class="required" id="mce-MMERGE8"> </div> <div class="mc-field-group"> <label for="mce-MMERGE12">Member type <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE12" class="required" id="mce-MMERGE12"> </div> <div class="mc-field-group"> <label for="mce-MMERGE9">Home country <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE9" class="required" id="mce-MMERGE9"> </div> <div class="mc-field-group"> <label for="mce-MMERGE10">Host country <span class="asterisk">*</span> </label> <input type="text" value="" name="MMERGE10" class="required" id="mce-MMERGE10"> </div> <div class="mc-field-group"> <label for="mce-MMERGE13">Full Address </label> <input type="text" value="" name="MMERGE13" class="" id="mce-MMERGE13"> </div> <div id="mergeRow-gdpr" class="mergeRow gdpr-mergeRow content__gdprBlock mc-field-group"> <div class="content__gdpr"> <label>Marketing Permissions</label> <p>Fulbright GA Chapter will use the information you provide on this form to be in touch with you and to provide updates and marketing. Please let us know all the ways you would like to hear from us:</p> <fieldset class="mc_fieldset gdprRequired mc-field-group" name="interestgroup_field"> <label class="checkbox subfield" for="gdpr_7545"><input type="checkbox" id="gdpr_7545" name="gdpr[7545]" value="Y" class="av-checkbox "><span>Email</span> </label><label class="checkbox subfield" for="gdpr_7549"><input type="checkbox" id="gdpr_7549" name="gdpr[7549]" value="Y" class="av-checkbox "><span>Direct Mail</span> </label><label class="checkbox subfield" for="gdpr_7553"><input type="checkbox" id="gdpr_7553" name="gdpr[7553]" value="Y" class="av-checkbox "><span>Customized online advertising</span> </label> </fieldset> <p>You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at georgia@fulbright.org. We will treat your information with respect. For more information about our privacy practices please visit our website. 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