{"id":3108,"date":"2020-05-19T14:40:33","date_gmt":"2020-05-19T09:10:33","guid":{"rendered":"https:\/\/jrcmp.in\/?page_id=3108"},"modified":"2020-05-28T21:08:36","modified_gmt":"2020-05-28T15:38:36","slug":"request","status":"publish","type":"page","link":"https:\/\/wizadio.com\/jrcfoundation\/request\/","title":{"rendered":"REQUEST"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3108\" class=\"elementor elementor-3108\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e7838e0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e7838e0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-faba0f3\" data-id=\"faba0f3\" data-element_type=\"column\">\n\t\t\t<div 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id=\"nf_save_form_progress\" style=\"display:none;\">false<\/div><div id=\"nex-forms\" class=\"nex-forms request_blood \"><div class=\"theme-default\"><div id=\"confirmation_page\" class=\"confirmation_page\" style=\"display:none;\"><\/div><div id=\"on_form_submmision\" class=\"on_form_submmision\" style=\"display:none;\">message<\/div><div class=\"nex_success_message animated\" style=\"display:none;\">\r\n\t\t\t\t\r\n\t\t\t\t<div class=\"success_header\">\r\n\t\t\t\t<div class=\"success_icon animated\" style=\"display:none;\"><span class=\"fa fa-check\"><\/span><\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"msg_box\"><div class=\"msg_text\" style=\"display:none;\">Thank you for connecting with us. We will respond to you shortly.<\/div><\/div>\r\n\t\t\t\t\r\n\t\t\t\t<\/div><div class=\"ui-nex-forms-container\" id=\"ui-nex-forms-container\"  ><div class=\"current_step\" style=\"display:none;\">1<\/div><div class=\"nf_step_breadcrumb\">\n\t\t\t\t\t\t\t\t\t<ol class=\"basix cd-breadcrumb      md-color-light-blue hidden\" data-text-pos=\"text-bottom\" data-breadcrumb-type=\"basix\" data-theme=\"light-blue\" data-show-front-end=\"yes\" data-show-inside=\"no\"><\/ol>\n\t\t\t\t\t\t\t\t<\/div><div class=\"hidden\" id=\"nf_ajax_url\">https:\/\/wizadio.com\/jrcfoundation\/wp-admin\/admin-ajax.php<\/div><div class=\"hidden\" id=\"paypal_return_url\">https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/pages\/3108<\/div><div class=\"hidden\" id=\"ms_scroll_to_top\">yes<\/div><div class=\"v7_container \" style=\"\"><form id=\"nf_form_94550\" class=\"submit-nex-form\" name=\"nex_form\" action=\"https:\/\/wizadio.com\/jrcfoundation\/wp-admin\/admin-ajax.php\" method=\"post\" enctype=\"multipart\/form-data\"><input type=\"hidden\" name=\"nex_forms_Id\" value=\"20\"><input type=\"hidden\" name=\"page\" value=\"\/jrcfoundation\/wp-json\/wp\/v2\/pages\/3108\"><input type=\"hidden\" name=\"ip\" value=\"104.164.173.142\"><input type=\"text\" name=\"company_url\" value=\"\" placeholder=\"enter company url\" class=\"form-control req\">\n\t\t\t\t\t\t\t<div class=\"form_field hidden\" id=\"_14867\" style=\"\">\n\t\t\t\t\t\t\t\t<input class=\"ms_current_step\" value=\"1\" name=\"ms_current_step\" type=\"hidden\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_73024\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h1 class=\"the_input_element\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\">Request BLood Form<\/h1><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_54393\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  name preset_fields required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_54854\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Name<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix \"><span class=\"fa fa-user\"><\/span><\/span><input type=\"text\" name=\"_name\" class=\"error_message required  form-control the_input_element  aling_left\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_11998\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Blood Group<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"blood_group\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_20539\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Contact Number<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix \"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_number\" class=\"error_message required phone_number form-control the_input_element  aling_left\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_65049\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Hospital<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"hospital\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_91392\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*City<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"city\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_66222\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Age<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"age\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_77060\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Condition<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"condition\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_90943\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*Alternative Number<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix \"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"alternative_number\" class=\"error_message required phone_number form-control the_input_element  aling_left\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"z-index: 1000000;\" id=\"_94743\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*State<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"state\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" style=\"\" id=\"_44348\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\">*State<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"state\" class=\"form-control error_message the_input_element  aling_left required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields submit-button the_submit button_fields common_fields preset_fields special_fields selection_fields\" id=\"_3976\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><button class=\"nex-submit svg_ready the_input_element btn btn-default\" data-ga=\"\">Submit<\/button><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><\/form><\/div><\/div><\/div><\/div><style type=\"text\/css\" class=\"nex-forms-custom-css\"><\/style><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"zakra_page_container_layout":"customizer","zakra_page_sidebar_layout":"customizer","zakra_remove_content_margin":false,"zakra_sidebar":"customizer","zakra_transparent_header":"customizer","zakra_logo":0,"zakra_main_header_style":"default","zakra_menu_item_color":"","zakra_menu_item_hover_color":"","zakra_menu_item_active_color":"","zakra_menu_active_style":"","zakra_page_header":true,"footnotes":""},"class_list":["post-3108","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/pages\/3108","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/comments?post=3108"}],"version-history":[{"count":4,"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/pages\/3108\/revisions"}],"predecessor-version":[{"id":3472,"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/pages\/3108\/revisions\/3472"}],"wp:attachment":[{"href":"https:\/\/wizadio.com\/jrcfoundation\/wp-json\/wp\/v2\/media?parent=3108"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}