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document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub43.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=3643361988&formid=3740&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:3643361988:43:3740\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Sharing Petworth Family History</div></div> <div class=\"bn-form-desc\"><p>To share your Petworth information on this website please fill out and submit this form:</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Your Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your first and last name\" validator=\"\" required=\"required\" value=\"\" style=\"background-image: url(&quot;data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAABHklEQVQ4EaVTO26DQBD1ohQWaS2lg9JybZ+AK7hNwx2oIoVf4UPQ0Lj1FdKktevIpel8AKNUkDcWMxpgSaIEaTVv3sx7uztiTdu2s/98DywOw3Dued4Who/M2aIx5lZV1aEsy0+qiwHELyi+Ytl0PQ69SxAxkWIA4RMRTdNsKE59juMcuZd6xIAFeZ6fGCdJ8kY4y7KAuTRNGd7jyEBXsdOPE3a0QGPsniOnnYMO67LgSQN9T41F2QGrQRRFCwyzoIF2qyBuKKbcOgPXdVeY9rMWgNsjf9ccYesJhk3f5dYT1HX9gR0LLQR30TnjkUEcx2uIuS4RnI+aj6sJR0AM8AaumPaM/rRehyWhXqbFAA9kh3/8/NvHxAYGAsZ/il8IalkCLBfNVAAAAABJRU5ErkJggg==&quot;); background-repeat: no-repeat; background-attachment: scroll; background-size: 16px 18px; background-position: 98% 50%; cursor: auto;\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Today\'s Date <span class=\"bn-required\">*</span></span> <span class=\"bn-input bn-date-input\"><input type=\"text\" name=\"Field-152015944826016\" validator=\"date\" placeholder=\"mm/dd/yyyy\" required=\"required\" value=\"\"> <span class=\"material-icons bn-date-pick\">date_range</span></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Mailing Address </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015946947938\" placeholder=\"optional\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Are you willing to have your e-mail address or this form posted on our website? </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-1520159538255105[]\" value=\"Yes, include my e--mail address on this website\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes, include my e--mail address on this website</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-1520159538255105[]\" value=\"Yes, include this form on this website\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes, include this form on this website</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Are you willing to exchange information with other researchers through e-mail? </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-152015957980989\" value=\"Yes\" checked=\"checked\"> <span class=\"bn-inner-label\">Yes</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-152015957980989\" value=\"No\"> <span class=\"bn-inner-label\">No</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Surname of Petworth Emigrant <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015960420070\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">First Name of Petworth Emigrant </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1520159620066106\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Year of Emigration </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015963296215\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Ship </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015964364051\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">In English, which Parish or Place did the emigrant live? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015966561680\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">County in England </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015967259084\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What is the new information you\'d like to share? </span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"enter your comments here\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What are the sources of your information? </span> <span class=\"bn-input\"><textarea name=\"Field-152015969699381\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Where are these sources found? </span> <span class=\"bn-input\"><textarea name=\"Field-152015971555253\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What letters, family documents, or photographs do you have that are not included or mentioned in our publications? </span> <span class=\"bn-input\"><textarea name=\"Field-152015972456251\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Do you have these letters, documents or photographs ready to share? Please upload to Facebook and paste the share URL here:  </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015978325284\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What is the name of the head of family who emigrated? </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015979691476\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What was the first destination in North America? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015985044015\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Where did the family settle subsequently? </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-152015988298786\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"kinship2@hotmail.com\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"\"> <input type=\"hidden\" name=\"subject\" value=\"Petworth Sharing Family History\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
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