{"id":97,"date":"2019-02-25T15:16:26","date_gmt":"2019-02-25T15:16:26","guid":{"rendered":"http:\/\/servaplusfs.loc\/?page_id=97"},"modified":"2025-06-30T16:33:11","modified_gmt":"2025-06-30T21:33:11","slug":"edit-your-profile","status":"publish","type":"page","link":"https:\/\/americancourseacademy.com\/foodhandlerspermitutah\/user-profile\/edit-your-profile\/","title":{"rendered":"Edit Your Profile"},"content":{"rendered":"<form class=\"form form--fields form--student_registration\">\n\t<div class=\"form__items profile_block\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"form__item form__item-header\">Student Information<\/h3>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"first_name\"\n\t\t\t\t\t\t\t\t       id=\"first_name\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"names\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"first_name\">\n\t\t\t\t\t\t\t<span class=\"label\">First Name<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"last_name\"\n\t\t\t\t\t\t\t\t       id=\"last_name\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"names\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"last_name\">\n\t\t\t\t\t\t\t<span class=\"label\">Last Name<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"_wld_user_street\"\n\t\t\t\t\t\t\t\t       id=\"_wld_user_street\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"text\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_street\">\n\t\t\t\t\t\t\t<span class=\"label\">Street<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"_wld_user_apt\"\n\t\t\t\t\t\t\t\t       id=\"_wld_user_apt\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"text\"\n\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_apt\">\n\t\t\t\t\t\t\t<span class=\"label\">Apt<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-2\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"_wld_user_city\"\n\t\t\t\t\t\t\t\t       id=\"_wld_user_city\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"text\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_city\">\n\t\t\t\t\t\t\t<span class=\"label\">City<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-2\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<select name=\"_wld_user_states\"\n\t\t\t\t\t\t\t\t        id=\"_wld_user_states\"  required>\n\t\t\t\t\t\t\t\t\t<option value=\"\" >\n\t\t\t\t\t\t\t\t\t\tSelect...\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Alabama\" >\n\t\t\t\t\t\t\t\t\t\t\tAlabama\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Alaska\" >\n\t\t\t\t\t\t\t\t\t\t\tAlaska\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Arizona\" >\n\t\t\t\t\t\t\t\t\t\t\tArizona\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Arkansas\" >\n\t\t\t\t\t\t\t\t\t\t\tArkansas\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"California\" >\n\t\t\t\t\t\t\t\t\t\t\tCalifornia\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Colorado\" >\n\t\t\t\t\t\t\t\t\t\t\tColorado\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Connecticut\" >\n\t\t\t\t\t\t\t\t\t\t\tConnecticut\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Delaware\" >\n\t\t\t\t\t\t\t\t\t\t\tDelaware\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"District Of Columbia\" >\n\t\t\t\t\t\t\t\t\t\t\tDistrict Of Columbia\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Florida\" >\n\t\t\t\t\t\t\t\t\t\t\tFlorida\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Georgia\" >\n\t\t\t\t\t\t\t\t\t\t\tGeorgia\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hawaii\" >\n\t\t\t\t\t\t\t\t\t\t\tHawaii\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Idaho\" >\n\t\t\t\t\t\t\t\t\t\t\tIdaho\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Illinois\" >\n\t\t\t\t\t\t\t\t\t\t\tIllinois\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Indiana\" >\n\t\t\t\t\t\t\t\t\t\t\tIndiana\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iowa\" >\n\t\t\t\t\t\t\t\t\t\t\tIowa\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kansas\" >\n\t\t\t\t\t\t\t\t\t\t\tKansas\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kentucky\" >\n\t\t\t\t\t\t\t\t\t\t\tKentucky\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Louisiana\" >\n\t\t\t\t\t\t\t\t\t\t\tLouisiana\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Maine\" >\n\t\t\t\t\t\t\t\t\t\t\tMaine\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Maryland\" >\n\t\t\t\t\t\t\t\t\t\t\tMaryland\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Massachusetts\" >\n\t\t\t\t\t\t\t\t\t\t\tMassachusetts\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Michigan\" >\n\t\t\t\t\t\t\t\t\t\t\tMichigan\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Minnesota\" >\n\t\t\t\t\t\t\t\t\t\t\tMinnesota\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mississippi\" >\n\t\t\t\t\t\t\t\t\t\t\tMississippi\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Missouri\" >\n\t\t\t\t\t\t\t\t\t\t\tMissouri\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Montana\" >\n\t\t\t\t\t\t\t\t\t\t\tMontana\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nebraska\" >\n\t\t\t\t\t\t\t\t\t\t\tNebraska\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nevada\" >\n\t\t\t\t\t\t\t\t\t\t\tNevada\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Hampshire\" >\n\t\t\t\t\t\t\t\t\t\t\tNew Hampshire\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Jersey\" >\n\t\t\t\t\t\t\t\t\t\t\tNew Jersey\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Mexico\" >\n\t\t\t\t\t\t\t\t\t\t\tNew Mexico\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New York\" >\n\t\t\t\t\t\t\t\t\t\t\tNew York\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"North Carolina\" >\n\t\t\t\t\t\t\t\t\t\t\tNorth Carolina\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"North Dakota\" >\n\t\t\t\t\t\t\t\t\t\t\tNorth Dakota\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ohio\" >\n\t\t\t\t\t\t\t\t\t\t\tOhio\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Oklahoma\" >\n\t\t\t\t\t\t\t\t\t\t\tOklahoma\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Oregon\" >\n\t\t\t\t\t\t\t\t\t\t\tOregon\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pennsylvania\" >\n\t\t\t\t\t\t\t\t\t\t\tPennsylvania\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Rhode Island\" >\n\t\t\t\t\t\t\t\t\t\t\tRhode Island\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Carolina\" >\n\t\t\t\t\t\t\t\t\t\t\tSouth Carolina\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Dakota\" >\n\t\t\t\t\t\t\t\t\t\t\tSouth Dakota\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tennessee\" >\n\t\t\t\t\t\t\t\t\t\t\tTennessee\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Texas\" >\n\t\t\t\t\t\t\t\t\t\t\tTexas\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Utah\"  selected='selected'>\n\t\t\t\t\t\t\t\t\t\t\tUtah\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vermont\" >\n\t\t\t\t\t\t\t\t\t\t\tVermont\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Virginia\" >\n\t\t\t\t\t\t\t\t\t\t\tVirginia\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Washington\" >\n\t\t\t\t\t\t\t\t\t\t\tWashington\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"West Virginia\" >\n\t\t\t\t\t\t\t\t\t\t\tWest Virginia\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Wisconsin\" >\n\t\t\t\t\t\t\t\t\t\t\tWisconsin\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Wyoming\" >\n\t\t\t\t\t\t\t\t\t\t\tWyoming\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_states\">\n\t\t\t\t\t\t\t<span class=\"label\">States<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-2\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"_wld_user_zip\"\n\t\t\t\t\t\t\t\t       id=\"_wld_user_zip\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"zip\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_zip\">\n\t\t\t\t\t\t\t<span class=\"label\">ZIP code<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"email\"\n\t\t\t\t\t\t\t\t       name=\"user_email\"\n\t\t\t\t\t\t\t\t       id=\"user_email\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"user_email\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"user_email\">\n\t\t\t\t\t\t\t<span class=\"label\">Email Address<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"email\"\n\t\t\t\t\t\t\t\t       name=\"user_email\"\n\t\t\t\t\t\t\t\t       id=\"user_email-confirm\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"\"\n\t\t\t\t\t\t\t\t\t required data-confirm=\"user_email\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"user_email-confirm\">\n\t\t\t\t\t\t\t<span class=\"label\">Confirm Email Address<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"tel\"\n\t\t\t\t\t\t\t\t       name=\"_wld_user_phone\"\n\t\t\t\t\t\t\t\t       id=\"_wld_user_phone\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"tel\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_phone\">\n\t\t\t\t\t\t\t<span class=\"label\">Primary Phone Number<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-datepicker form__item-3\">\n\t\t\t<input type=\"text\" name=\"_wld_user_dob\" id=\"_wld_user_dob\"\n\t\t\t       value=\"\"\n\t\t\t       placeholder=\" \" data-validate-rule=\"date_of_birth\"\n\t\t\t       autocomplete=\"off\"\n\t\t\t\t  required>\n\t\t\t<label>\n\t\t\t\t<span class=\"label\">Date of Birth<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<select name=\"_wld_user_local_health_department\"\n\t\t\t\t\t\t\t\t        id=\"_wld_user_local_health_department\"  required>\n\t\t\t\t\t\t\t\t\t<option value=\"\"  selected='selected'>\n\t\t\t\t\t\t\t\t\t\tSelect...\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1\" >\n\t\t\t\t\t\t\t\t\t\t\tBear River Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2\" >\n\t\t\t\t\t\t\t\t\t\t\tCentral Utah Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"3\" >\n\t\t\t\t\t\t\t\t\t\t\tDavis County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"4\" >\n\t\t\t\t\t\t\t\t\t\t\tSalt Lake County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"5\" >\n\t\t\t\t\t\t\t\t\t\t\tSan Juan Public Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"6\" >\n\t\t\t\t\t\t\t\t\t\t\tSoutheast Utah Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"7\" >\n\t\t\t\t\t\t\t\t\t\t\tSoutwest Utah Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"8\" >\n\t\t\t\t\t\t\t\t\t\t\tSummit County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"9\" >\n\t\t\t\t\t\t\t\t\t\t\tTooele County  Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"10\" >\n\t\t\t\t\t\t\t\t\t\t\tTri-County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"11\" >\n\t\t\t\t\t\t\t\t\t\t\tUtah County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"12\" >\n\t\t\t\t\t\t\t\t\t\t\tWasatch County Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"13\" >\n\t\t\t\t\t\t\t\t\t\t\tWeber-Morgan Health Department\t\t\t\t\t\t\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"_wld_user_local_health_department\">\n\t\t\t\t\t\t\t<span class=\"label\">Department<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"form__item form__item-header\">Create Your Course Login<\/h3>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"text\"\n\t\t\t\t\t\t\t\t       name=\"user_login\"\n\t\t\t\t\t\t\t\t       id=\"user_login\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"text\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"user_login\">\n\t\t\t\t\t\t\t<span class=\"label\">Username<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"password\"\n\t\t\t\t\t\t\t\t       name=\"user_pass\"\n\t\t\t\t\t\t\t\t       id=\"user_pass\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"text\"\n\t\t\t\t\t\t\t\t\t required>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"user_pass\">\n\t\t\t\t\t\t\t<span class=\"label\">Password<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"password\"\n\t\t\t\t\t\t\t\t       name=\"user_pass\"\n\t\t\t\t\t\t\t\t       id=\"user_pass-confirm\"\n\t\t\t\t\t\t\t\t       placeholder=\" \"\n\t\t\t\t\t\t\t\t       value=\"\"\n\t\t\t\t\t\t\t\t       data-validate-rule=\"\"\n\t\t\t\t\t\t\t\t\t required data-confirm=\"user_pass\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"user_pass-confirm\">\n\t\t\t\t\t\t\t<span class=\"label\">Confirm Password<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"required\">*<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form__item form__item-6 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