Warning: Undefined array key "mf_page" in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 172

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 172

Warning: Undefined array key "mf_resume" in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 176

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 176

Warning: Undefined array key "mf_edit" in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 188

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 188

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5619

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5620

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5621

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5623

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5624

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5626

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5629

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5630

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5619

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5620

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5621

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5623

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5624

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5626

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5629

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5630

Warning: Undefined property: stdClass::$is_edit_entry in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2037

Warning: Undefined property: stdClass::$is_edit_entry in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2037

Warning: Undefined variable $price_data_tag in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2112

Warning: Undefined property: stdClass::$is_edit_entry in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2037

Warning: Undefined variable $price_data_tag in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2112

Warning: Undefined variable $attr_placeholder in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 3372

Warning: Undefined variable $quantity_link_data_tag in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 3372

Warning: Undefined variable $range_limit_markup in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 3373

Warning: Undefined variable $default_value_1 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2443

Warning: Undefined variable $default_value_2 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2447

Warning: Undefined variable $default_value_3 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 2451

Warning: Undefined variable $attr_placeholder in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 211

Warning: Undefined property: stdClass::$is_edit_entry in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 1706

Warning: Undefined property: stdClass::$is_design_mode in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 1730

Warning: Undefined variable $default_value_1 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 1749

Warning: Undefined variable $default_value_2 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 1753

Warning: Undefined variable $default_value_3 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 1757

Warning: Undefined variable $signature_type_active in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 487

Warning: Undefined variable $signature_text_default_value in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 498

Warning: Undefined variable $signature_text_url_param in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 500

Warning: Undefined variable $signature_default_value_markup in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 513

Warning: Undefined variable $css_timestamp_1 in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5899

Warning: Undefined variable $mf_edit_tag in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 5994

Warning: Undefined variable $html_class_tag in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6672

Warning: Undefined variable $recaptcha2_header in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6684

Warning: Undefined variable $advance_uploader_js in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6685

Warning: Undefined variable $auto_height_js in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6691

Warning: Undefined variable $form_container_class in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6695

Warning: Undefined variable $form_enc_type in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6698

Warning: Undefined variable $ul_class in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6700

Warning: Undefined variable $pagination_header in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6701

Warning: Undefined variable $payment_total_markup_top in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6702

Warning: Undefined property: stdClass::$error_message in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6703

Warning: Undefined variable $custom_element in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6705

Warning: Undefined variable $payment_total_markup_bottom in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6706

Warning: Undefined variable $form_resume_markup in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/includes/view-functions.php on line 6707

Warning: Cannot modify header information - headers already sent by (output started at /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php:172) in /home/httpd/vhosts/digitworks.ch/httpdocs/machform/view.php on line 206
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html lang="en" xml:lang="en"  xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Xi'an Statement of Intent</title>
<link rel="stylesheet" type="text/css" href="./data/form_19346/css/view.css" media="all" />
<link rel="stylesheet" type="text/css" href="view.mobile.css" media="all" />
<link rel="stylesheet" type="text/css" href="./data/themes/theme_23.css" media="all" />

<script type="text/javascript" src="js/jquery.min.js"></script>
<script type="text/javascript" src="js/jquery-ui-1.12/effect.js"></script>
<script type="text/javascript" src="view.js"></script>


<script type="text/javascript" src="js/datepick5/jquery.plugin.min.js"></script>
<script type="text/javascript" src="js/datepick5/jquery.datepick.min.js"></script>

<script type="text/javascript" src="js/datepick5/jquery.datepick.ext.min.js"></script>
<link type="text/css" href="js/datepick5/smoothness.datepick.css" rel="stylesheet" />
<script type="text/javascript" src="js/signature_pad/signature_pad.umd.js"></script>






</head>
<body id="main_body" class=" no_guidelines">
	<div id="form_container" class="">
	
		<h1><a>Xi'an Statement of Intent</a></h1>
		<form id="form_19346" class="appnitro top_label"  method="post" data-highlightcolor="#f5f5f5" action="/machform/view.php">
					<div class="form_description">
			<h2>Xi'an Statement of Intent</h2>
			<p>In the event of a poor connection or other technical issues, we would like to present a pre-recorded movie presentation during your allocated time slot.<br />
<br />
To allow us to display your pre-recorded presentation we do require signoff.<br />
<br />
Please confirm below:</p>
		</div>						
			<ul >
			
			
			
					<li id="li_14"   class="checkboxes">
		<span class="description">During the conference I hereby achknowledge that when necessary GPPS may display my movie during the event. <span id="required_14" class="required">*</span></span>
		<div>
			<fieldset>
				<legend style="display: none">During the conference I hereby achknowledge that when necessary GPPS may display my movie during the event.</legend>
				<span><input id="element_14_2"  name="element_14_2" class="element checkbox" type="checkbox" value="1"  />
<label class="choice" for="element_14_2">Yes</label>
</span>

			</fieldset>
		</div> 
		</li>		<li id="li_10"   class="checkboxes">
		<span class="description">Following the Conference I accept that GPPS can distribute the movie recording of my presentation to all other attendees of the Xi'an21 conference. <span id="required_10" class="required">*</span></span>
		<div>
			<fieldset>
				<legend style="display: none">Following the Conference I accept that GPPS can distribute the movie recording of my presentation to all other attendees of the Xi'an21 conference.</legend>
				<span><input id="element_10_1"  name="element_10_1" class="element checkbox" type="checkbox" value="1"  />
<label class="choice" for="element_10_1">No</label>
</span>
<span><input id="element_10_2"  name="element_10_2" class="element checkbox" type="checkbox" value="1"  />
<label class="choice" for="element_10_2">Yes</label>
</span>

			</fieldset>
		</div> 
		</li>		<li id="li_9"  class="section_break">
			<h3>GPPS Declaration</h3>
			<p>The presenters retain the copyright of their presentation video. The GPPS Xi'an21 organizers have the presenter's consent to show the presentation video during the three conference days (11th - 13th April 2022). <br />
<br />
The video will NOT be shown or distributed to the wider public and those who have not attended the conference.</p>
		</li>		<li id="li_12"  class="section_break">
			<h3>Author Details</h3>
			<p></p>
		</li>		<li id="li_13"  >
		<label class="description" for="element_13">Paper Number <span id="required_13" class="required">*</span></label>
		<div>
			<input id="element_13" name="element_13" class="element text medium"   type="text"   value=""  /> 
			
		</div> 
		</li>		<li id="li_15"  class="simple_name_wmiddle">
		<fieldset>
		<legend style="display: none">Name</legend>
		<span class="description">Name </span>
		<span class="simple_name_wmiddle_1">
			<input id="element_15_1" name="element_15_1"  type="text" class="element text" maxlength="255" size="8" value="" />
			<label for="element_15_1">First</label>
		</span>
		<span class="simple_name_wmiddle_2">
			<input id="element_15_2" name="element_15_2"  type="text" class="element text" maxlength="255" size="8" value="" />
			<label for="element_15_2">Middle</label>
		</span>
		<span class="simple_name_wmiddle_3">
			<input id="element_15_3" name="element_15_3"  type="text" class="element text" maxlength="255" size="14" value="" />
			<label for="element_15_3">Last</label>
		</span></fieldset> 
		</li>		<li id="li_6"  >
		<label class="description" for="element_6">Location <span id="required_6" class="required">*</span></label>
		<div>
			<input id="element_6" name="element_6"    class="element text medium" type="text" value=""   />
			 
		</div> 
		</li>		<li id="li_5"  class="europe_date_field">
		<fieldset>
			<legend style="display: none">Date</legend>
			<span class="description">Date <span id="required_5" class="required">*</span></span>
			<span class="date_dd">
				<input id="element_5_1" name="element_5_1"  class="element text" size="3" maxlength="2" value="" type="text" /> /
				<label for="element_5_1">DD</label>
			</span>
			<span class="date_mm">
				<input id="element_5_2" name="element_5_2"  class="element text" size="3" maxlength="2" value="" type="text" /> /
				<label for="element_5_2">MM</label>
			</span>
			<span class="date_yyyy">
		 		<input id="element_5_3" name="element_5_3"  class="element text" size="5" maxlength="4" value="" type="text" />
				<label for="element_5_3">YYYY</label>
			</span>
		
			<span id="calendar_5">
				<input type="hidden" value="" name="element_5_datepick" id="element_5_datepick">
				<div style="display: none"><img id="cal_img_5" class="datepicker" src="images/calendar.png" width="32" alt="Pick a date." /></div>	
			</span>
		</fieldset>
		<script type="text/javascript">
			
			$('#element_5_datepick').datepick({ 
	    		onSelect: select_europe_date,
	    		showTrigger: '#cal_img_5'
	    		
	    		
	    		
			});
			
</script>
		 
		</li>		<li id="li_11"  class="signature">
		<label class="description" for="element_11">Draw your signature into the box below. <span id="required_11" class="required">*</span></label>
		<div id="mf_signature_pad_11">
						<div class="mf_signature_switch" style="text-align: right">
				<a class="sig_switch_draw active" href="javascript: switch_signature_type(11,'draw');">Draw</a> or 
				<a class="sig_switch_type " href="javascript: switch_signature_type(11,'type');">Type</a>
			</div>
	        <div class="mf_signature_draw" style="display: block">
		        <div class="mf_signature_wrapper medium" style="height: 150px">
		          <canvas id="mf_canvas_signature_pad_11" class="mf_canvas_signature_pad" style="width: 100%; height: 100%"></canvas>
		        </div>
		        <span class="label">I understand this is a legal representation of my signature.</span>
		        <a class="mf_signature_clear element_11_clear" href="javascript:clear_signature(11)">Clear</a>
	        </div>
	        <div class="mf_signature_type" style="display: none">
	        	<label class="description" for="element_11_text_signature">Full Name</label>
				<input id="element_11_text_signature" name="element_11_text_signature" data-elementid="11" class="element text large text_signature" type="text" value="" />
				<div class="mf_signature_wrapper medium" style="height: 100px;margin-top: 20px">
					<img id="element_11_text_signature_img" src="signature_img_renderer.php" style="height: 75px;margin-top: 10px;margin-left: 15px"/>	 
				</div> 
				<span class="label">I understand this is a legal representation of my signature.</span>
	        </div>
	        <input type="hidden" name="element_11" id="element_11" value="">
	        <script type="text/javascript">	   
				var canvas_11 = document.getElementById('mf_canvas_signature_pad_11');
				var signature_pad_11 = new SignaturePad(canvas_11);

				signature_pad_11.onEnd = function(){
					$("#element_" + 11).val(signature_pad_11.toDataURL());
				};
				refresh_signature(signature_pad_11,canvas_11);
				
			</script> 
		</div> 
		</li>
			
			
			
					<li id="li_buttons" class="buttons">
			    <input type="hidden" name="form_id" value="19346" />
			    
			    <input type="hidden" id="mfsid" name="mfsid" value="0b172b2c55492f27e9c487a802196a06" />
			    
			    <input type="hidden" name="submit_form" value="1" />
			    <input type="hidden" name="page_number" value="1" />
				<input id="submit_form" class="button_text" type="submit" name="submit_form" value="Submit" />
		</li>
			</ul>
		</form>	
		<div id="footer">
			Powered by <a href="https://www.machform.com" target="_blank">MachForm</a>
		</div>
	</div>
	
	</body>
</html>