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<div class='gform_heading'>
<h3 class="gform_title">Get your POCUS Guide - POPUP</h3>
<span class='gform_description'></span>
</div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_66' id='gform_66' action='/location/worldwide/#gf_66' novalidate>
<div class='gform_body gform-body'><ul id='gform_fields_66' class='gform_fields top_label form_sublabel_below description_below'><li id="field_66_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_66_1"><label class='gfield_label screen-reader-text' for='input_66_1' >Email Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
<input name='input_1' id='input_66_1' type='email' value='' class='form-control medium' placeholder='Email Address' aria-required="true" aria-invalid="false" />
</div></li><li id="field_66_3" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_66_3"><div class='ginput_container ginput_container_text'><input name='input_3' id='input_66_3' type='hidden' class='gform_hidden' aria-invalid="false" value='https://www.pocus.org/location/worldwide/' /></div></li><li id="field_66_4" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_66_4"><label class='gfield_label' for='input_66_4' >Comments</label><div class='ginput_container'><input name='input_4' id='input_66_4' type='text' value='' autocomplete='new-password'/></div><div class='gfield_description' id='gfield_description_66_4'>This field is for validation purposes and should be left unchanged.</div></li></ul></div>
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<input type='hidden' class='gform_hidden' name='gform_target_page_number_66' id='gform_target_page_number_66' value='0' />
<input type='hidden' class='gform_hidden' name='gform_source_page_number_66' id='gform_source_page_number_66' value='1' />
<input type='hidden' name='gform_field_values' value='' />
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<p style="display: none !important;"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_2" name="ak_js" value="244"/><script>document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form>
</div>
<iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_66' id='gform_ajax_frame_66' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'></iframe>
<script type="text/javascript">
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