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	<title>5.18.26 HV South District Event - Game Theory | New York Chapter of the American College of Physicians</title>


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			<p class="form-instructions"><h2 style="text-align: center;">NYACP Hudson Valley South District Event</h2>

<h2 style="text-align: center;">&quot;Game Theory and Its Application to Medicine&quot;</h2>

<p></p>

<h2 style="text-align: center;">RSVP&nbsp;Form</h2>

<p style="text-align: center;">We&#39;re excited to have you join us on May 18th!&nbsp;</p>

<p style="text-align: center;">Please note that space is limited. If after registering, you determine you&nbsp;are unable&nbsp;to attend the event, contact me immediately via email at:&nbsp;&nbsp;pgesner@nyacp.org&nbsp;</p>
</p>
		

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<style>
.has-error {
	color: #f70404 !important;
}
.has-error input {
	border: 1px solid #f70404 !important;
}
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<script>
	function checkInvalidCharacter(objName){
		var obj = document.iform[objName];
		var strFileName = obj.value.replace('C:\\fakepath\\','');
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		if (iTemp > -1) {
			swal({
	  			title: 'Invalid character',
	  			html: true,
	  			text: "Invalid character ':' found in file name. Please change the file name before attempting to upload this file.",
	  			animation: 'slide-from-top',
	  			type: 'info',
	  			confirmButtonText: 'Ok',
	  			confirmButtonColor: '#337ab7'
	  		});
			obj.value = '';
			return false;
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		else {
			iTemp = obj.value.indexOf(",");
			if (iTemp > -1) {
				swal({
		  			title: 'Invalid character',
		  			html: true,
		  			text: "Invalid character ',' found in file name. Please change the file name before attempting to upload this file.",
		  			animation: 'slide-from-top',
		  			type: 'info',
		  			confirmButtonText: 'Ok',
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<div class="form_layout_wrapper" style="max-width:940px;" >

	
			<!-- The inner div, for the sake of IE -->
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		<div id="form-item-12837" class="layout form item outer row-1 item-12837 row_num-20 row_pos-5120 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							ACP Membership #
					

							<input type="text"
								
									id="response_1"
									name="response_1"
								
								
								 style="width:200px;"
								
									
										value=""
									
								
								class="form-control type-Text row-1 item-12837"
							><!-- input -->

							
				<input type="hidden" name="question_1" value="ACP Membership #">
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				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

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			<div class="inner">

				
							First Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_2"
									name="response_2"
								
								
								 style="width:146px;"
								
									
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								class="form-control type-Text row-2 item-12819"
							><!-- input -->

							
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			<div class="inner">

				
							Last Name<span class="text-danger"> *</span>
					

							<input type="text"
								
									id="response_3"
									name="response_3"
								
								
								 style="width:146px;"
								
									
										value=""
									
								
								class="form-control type-Text row-3 item-12816"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_3_required"
							VALUE="The field Last Name is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_3" value="Last Name">
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			<div class="inner">

				
							Credentials
					

							<input type="text"
								
									id="response_4"
									name="response_4"
								
								
								 style="width:80px;"
								
									
										value=""
									
								
								class="form-control type-Text row-4 item-12817"
							><!-- input -->

							
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				<INPUT TYPE="hidden" NAME="label_4" value="Cred.">

				
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				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12820" class="layout form item outer row-5 item-12820 row_num-60 row_pos-5120 rowlength-1 type-Text" style="clear:both;;position:relative;">

			<div class="inner">

				
							Preferred email:<span class="text-danger"> *</span>
					

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									id="response_5"
									name="response_5"
								
								
								 style="width:447px;"
								
									
										value=""
									
								
								class="form-control type-Text row-5 item-12820"
							><!-- input -->

							
						<INPUT
							TYPE="hidden"
							NAME="response_5_required"
							VALUE="The field Preferred email: is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_5" value="Preferred email: ">
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				<INPUT TYPE="hidden" NAME="question_type_5" value="Text">
				<INPUT TYPE="hidden" NAME="label_5" value="Preferred email">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12844" class="layout form item outer row-6 item-12844 row_num-80 row_pos-5120 rowlength-1 type-Select" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Which ACP Membership Anniversary milestone did you/will you reach in 2026?<span class="text-danger"> *</span>
					

								<select
									id="response_6"
									name="response_6"
									
									
									class="form-control type-Select row-6 item-12844"
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										<option value=""></option>
									
									
										<option value="5 Years" >5 Years</option>
									
										<option value="10 Years" >10 Years</option>
									
										<option value="15 Years" >15 Years</option>
									
										<option value="20 Years" >20 Years</option>
									
										<option value="25 Years" >25 Years</option>
									
										<option value="Greater than 25 Years" >Greater than 25 Years</option>
									
										<option value="None of the above" >None of the above</option>
									
								</select>
							
							
						<INPUT
							TYPE="hidden"
							NAME="response_6_required"
							VALUE="The field Which ACP Membership Anniversary milestone did you/will you reach in 2026? is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_6" value="Which ACP Membership Anniversary milestone did you/will you reach in 2026?">
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				<INPUT TYPE="hidden" NAME="label_6" value="ACP Anniversary">

				
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		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12845" class="layout form item outer row-7 item-12845 row_num-100 row_pos-5120 rowlength-1 type-Radio" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Did you become a new ACP member within the past 12 months?<span class="text-danger"> *</span>
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_7"
											id="radioVal_12845_1"
											fieldtype="radioprice"
											price="0"
											value="Yes"

											
											class="item type-radio type-Radio row-7 item-12845 "
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													Yes

												
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							        <label>
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													No

												
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							TYPE="hidden"
							NAME="response_7_required"
							VALUE="The field Did you become a new ACP member within the past 12 months? is required. Please click your browser's back button and provide this value.">
					

				<input type="hidden" name="question_7" value="Did you become a new ACP member within the past 12 months?">
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		</div> <!-- /layout_form_item -->

		
				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

		<div id="form-item-12846" class="layout form item outer row-8 item-12846 row_num-120 row_pos-5120 rowlength-1 type-Radio" style="clear:both;width:100%;position:relative;">

			<div class="inner">

				
							Please indicate if you are a NEW Fellow or Master since March 26, 2025
					

						        <div class="radio">
							        <label>
										<input
											type="radio"
											name="response_8"
											id="radioVal_12846_1"
											fieldtype="radioprice"
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													FACP

												
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							        <label>
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											name="response_8"
											id="radioVal_12846_2"
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													MACP

												
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			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

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							How did you hear about this event?<span class="text-danger"> *</span>
					

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									id="response_9"
									name="response_9"
									
									
										size="3" multiple="multiple"
									
									
									class="form-control type-MultiSelect row-9 item-12818"
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										<option value="NYACP Website" >NYACP Website</option>
									
										<option value="NYACP Email" >NYACP Email</option>
									
										<option value="Colleague/Friend" >Colleague/Friend</option>
									
										<option value="Instagram" >Instagram</option>
									
										<option value="LinkedIn" >LinkedIn</option>
									
										<option value="Facebook" >Facebook</option>
									
										<option value="Other
" >Other
</option>
									
								</select>
							
							
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							TYPE="hidden"
							NAME="response_9_required"
							VALUE="The field How did you hear about this event? is required. Please click your browser's back button and provide this value.">
					

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				</div> <!-- /The inner div, for the sake of IE -->
			
			<!-- The inner div, for the sake of IE -->
			<div id="layout_form_item" style="clear:both;border:0px solid orange;margin:0 0 0px 0;padding:0;min-height:0px;">
		

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			<div class="inner">

				
							Please note any dietary restrictions
(Hold ctrl to select multiple)
					

								<select
									id="response_10"
									name="response_10"
									
									
										size="3" multiple="multiple"
									
									
									class="form-control type-MultiSelect row-10 item-12842"
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										<option value="Nut Allergy" >Nut Allergy</option>
									
										<option value="Gluten Free" >Gluten Free</option>
									
										<option value="Lactose Intolerant" >Lactose Intolerant</option>
									
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(Hold ctrl to select multiple)">
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			<div class="inner">

				
							Other:
					

							<input type="text"
								
									id="response_11"
									name="response_11"
								
								
								 style="width:400px;"
								
									
										value=""
									
								
								class="form-control type-Text row-11 item-12843"
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				<INPUT TYPE="hidden" NAME="label_11" value="Other">

				
			</div> <!-- /inner -->

		</div> <!-- /layout_form_item -->

		
	</div><!-- /The inner div, for the sake of IE -->

	
	<input type="hidden" id="hasOpenPriceField" name="hasOpenPriceField" value="0">

	
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