<div><!-- [et_pb_line_break_holder] --> <form method="post" name="JoinMailing-InsuranceInnovators" action="https://s2491.t.eloqua.com/e/f2" onsubmit="setTimeout(function(){if(document.querySelector){var s=document.querySelector('form#form2260 input[type=submit]');if(s){s.disabled=true;}}},100);return true;" id="form2260" class="elq-form" ><!-- [et_pb_line_break_holder] --> <input value="JoinMailing-InsuranceInnovators" type="hidden" name="elqFormName" /><!-- [et_pb_line_break_holder] --> <input value="2491" type="hidden" name="elqSiteId" /><!-- [et_pb_line_break_holder] --> <input name="elqCampaignId" type="hidden" /><!-- [et_pb_line_break_holder] --> <div id="formElement0" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <label for="field0" class="label-position top " ><!-- [et_pb_line_break_holder] --> First Name<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <eloqua type='emailfield' syntax='First_Name__Colleague_1' /><!-- [et_pb_line_break_holder] --> <input id="field0" name="firstName" type="text" placeholder="First Name" value="" class="field-size-top-large" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div id="formElement1" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <label for="field1" class="label-position top " ><!-- [et_pb_line_break_holder] --> Last Name<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <eloqua type='emailfield' syntax='LastName' /><!-- [et_pb_line_break_holder] --> <input id="field1" name="lastName" type="text" placeholder="Last Name" value="" class="field-size-top-large" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div id="formElement2" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <label for="field2" class="label-position top " ><!-- [et_pb_line_break_holder] --> Email Address<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <eloqua type='emailfield' syntax='EmailAddress' /><!-- [et_pb_line_break_holder] --> <input id="field2" name="emailAddress" type="text" placeholder="Your Email" value="" class="field-size-top-large" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div id="formElement3" class="sc-view form-design-field sc-static-layout hide sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <input id="field3" type="hidden" name="hiddenCampaignId" value="701D0000001m1pV" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div id="formElement4" class="sc-view form-design-field sc-static-layout hide sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <input id="field4" type="hidden" name="hiddenField" value="0" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div id="formElement5" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" ><!-- [et_pb_line_break_holder] --> <div class="field-wrapper" ><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="individual field-wrapper" ><!-- [et_pb_line_break_holder] --> <div class="_100 field-style" ><!-- [et_pb_line_break_holder] --> <p class="field-p" ><!-- [et_pb_line_break_holder] --> <input type="submit" value="Sign Me Up!" class="submit-button" /><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --> <script src="https://img.en25.com/i/livevalidation_standalone.compressed.js" type="text/javascript" ><!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> <style type="text/css" media="screen" ><!-- [et_pb_line_break_holder] --> .LV_validation_message{<!-- [et_pb_line_break_holder] --> font-weight:bold;<!-- [et_pb_line_break_holder] --> margin: 0 0 0 5px;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .LV_valid{<!-- [et_pb_line_break_holder] --> color:#00CC00;<!-- [et_pb_line_break_holder] --> display:none;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .LV_invalid{<!-- [et_pb_line_break_holder] --> color:#CC0000;<!-- [et_pb_line_break_holder] --> font-size:10px;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .LV_valid_field, input.LV_valid_field:hover, input.LV_valid_field:active, textarea.LV_valid_field:hover, textarea.LV_valid_field:active {<!-- [et_pb_line_break_holder] --> outline: 1px solid #00CC00;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .LV_invalid_field, input.LV_invalid_field:hover, input.LV_invalid_field:active, textarea.LV_invalid_field:hover, textarea.LV_invalid_field:active {<!-- [et_pb_line_break_holder] --> outline: 1px solid #CC0000;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> </style><!-- [et_pb_line_break_holder] --> <script type="text/javascript" ><!-- [et_pb_line_break_holder] --> var dom0 = document.querySelector('#form2260 #field0');<!-- [et_pb_line_break_holder] --> var field0 = new LiveValidation(dom0, {<!-- [et_pb_line_break_holder] --> validMessage: "", onlyOnBlur: false, wait: 300}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> field0.add(Validate.Custom, {<!-- [et_pb_line_break_holder] --> against: function(value) {<!-- [et_pb_line_break_holder] --> return !value.match(/(telnet|ftp|https?)://(?:[a-z0-9][a-z0-9-]{0,61}[a-z0-9].|[a-z0-9].)+[a-z]{2,63}/i);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> , failureMessage: "Value must not contain any URL's"}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> field0.add(Validate.Length, {<!-- [et_pb_line_break_holder] --> tooShortMessage:"Invalid length for field value", tooLongMessage: "Invalid length for field value", minimum: 0, maximum: 35}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> var dom1 = document.querySelector('#form2260 #field1');<!-- [et_pb_line_break_holder] --> var field1 = new LiveValidation(dom1, {<!-- [et_pb_line_break_holder] --> validMessage: "", onlyOnBlur: false, wait: 300}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> field1.add(Validate.Custom, {<!-- [et_pb_line_break_holder] --> against: function(value) {<!-- [et_pb_line_break_holder] --> return !value.match(/(telnet|ftp|https?)://(?:[a-z0-9][a-z0-9-]{0,61}[a-z0-9].|[a-z0-9].)+[a-z]{2,63}/i);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> , failureMessage: "Value must not contain any URL's"}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> field1.add(Validate.Length, {<!-- [et_pb_line_break_holder] --> tooShortMessage:"Invalid length for field value", tooLongMessage: "Invalid length for field value", minimum: 0, maximum: 35}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> var dom2 = document.querySelector('#form2260 #field2');<!-- [et_pb_line_break_holder] --> var field2 = new LiveValidation(dom2, {<!-- [et_pb_line_break_holder] --> validMessage: "", onlyOnBlur: false, wait: 300}<!-- [et_pb_line_break_holder] --> );<!-- [et_pb_line_break_holder] --> function resetSubmitButton(e){<!-- [et_pb_line_break_holder] --> var submitButtons = e.target.form.getElementsByClassName('submit-button');<!-- [et_pb_line_break_holder] --> for(var i=0;i<submitButtons.length;i++){<!-- [et_pb_line_break_holder] --> submitButtons[i].disabled = false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> function addChangeHandler(elements){<!-- [et_pb_line_break_holder] --> for(var i=0; i<elements.length; i++){<!-- [et_pb_line_break_holder] --> elements[i].addEventListener('change', resetSubmitButton);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> var form = document.getElementById('form2260');<!-- [et_pb_line_break_holder] --> addChangeHandler(form.getElementsByTagName('input'));<!-- [et_pb_line_break_holder] --> addChangeHandler(form.getElementsByTagName('select'));<!-- [et_pb_line_break_holder] --> addChangeHandler(form.getElementsByTagName('textarea'));<!-- [et_pb_line_break_holder] --> var nodes = document.querySelectorAll('#form2260 input[data-subscription]');<!-- [et_pb_line_break_holder] --> if (nodes) {<!-- [et_pb_line_break_holder] --> for (i = 0, len = nodes.length; i < len; i++) {<!-- [et_pb_line_break_holder] --> var status = nodes[i].dataset ? nodes[i].dataset.subscription : nodes[i].getAttribute('data-subscription');<!-- [et_pb_line_break_holder] --> if(status ==='true') {<!-- [et_pb_line_break_holder] --> nodes[i].checked = true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var nodes = document.querySelectorAll('#form2260 select[data-value]');<!-- [et_pb_line_break_holder] --> if (nodes) {<!-- [et_pb_line_break_holder] --> for (var i = 0; i < nodes.length; i++) {<!-- [et_pb_line_break_holder] --> var node = nodes[i];<!-- [et_pb_line_break_holder] --> var selectedValue = node.dataset ? node.dataset.value : node.getAttribute('data-value');<!-- [et_pb_line_break_holder] --> if (selectedValue) {<!-- [et_pb_line_break_holder] --> for (var j = 0; j < node.options.length; j++) {<!-- [et_pb_line_break_holder] --> if(node.options[j].value === selectedValue) {<!-- [et_pb_line_break_holder] --> node.options[j].selected = 'selected';<!-- [et_pb_line_break_holder] --> break;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> </p></div><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] --></p><!-- [et_pb_line_break_holder] -->