{"id":670,"date":"2025-10-24T14:32:22","date_gmt":"2025-10-24T21:32:22","guid":{"rendered":"https:\/\/www.veteransrespond.org\/?page_id=670"},"modified":"2026-04-12T14:51:12","modified_gmt":"2026-04-12T21:51:12","slug":"responder-signup-2","status":"publish","type":"page","link":"https:\/\/www.veteransrespond.org\/index.php\/responder-signup-2\/","title":{"rendered":"RESPONDER SIGNUP"},"content":{"rendered":"\n<div id=\"wpmem_reg\"><a id=\"register\"><\/a><form name=\"form\" method=\"post\" enctype=\"multipart\/form-data\" action=\"https:\/\/www.veteransrespond.org\/index.php\/responder-signup-2\/\" id=\"wpmem_register_form\" class=\"form\"><input type=\"hidden\" id=\"_wpmem_register_nonce\" name=\"_wpmem_register_nonce\" value=\"6c57cd41e9\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/670\" \/><fieldset><legend>New User Registration<\/legend><label for=\"username\" class=\"text\">Choose a Username<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"username\" type=\"text\" id=\"username\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"first_name\" class=\"text\">First Name<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"first_name\" type=\"text\" id=\"first_name\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"last_name\" class=\"text\">Last Name<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"last_name\" type=\"text\" id=\"last_name\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_address_1\" class=\"text\">Address 1<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_address_1\" type=\"text\" id=\"billing_address_1\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_address_2\" class=\"text\">Address 2<\/label><div class=\"div_text\"><input name=\"billing_address_2\" type=\"text\" id=\"billing_address_2\" value=\"\" class=\"textbox\" \/><\/div><label for=\"billing_city\" class=\"text\">City<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_city\" type=\"text\" id=\"billing_city\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_state\" class=\"text\">State<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_state\" type=\"text\" id=\"billing_state\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_postcode\" class=\"text\">Zip<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_postcode\" type=\"text\" id=\"billing_postcode\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_country\" class=\"text\">Country<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_country\" type=\"text\" id=\"billing_country\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"billing_phone\" class=\"text\">Phone<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"billing_phone\" type=\"text\" id=\"billing_phone\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"user_email\" class=\"text\">Email<span class=\"req\">*<\/span><\/label><div class=\"div_text\"><input name=\"user_email\" type=\"email\" id=\"user_email\" value=\"\" class=\"textbox\" required  \/><\/div><label for=\"milquestion\" class=\"select\">Are you a veteran, former service or current \/ former member of one of the civilian auxiliaries of the armed forces?<\/label><div class=\"div_select\"><select name=\"milquestion\" id=\"milquestion\" class=\"dropdown\"><option value=\"civilian\">Not Service Affiliated (Civilian)<\/option><option value=\"veteran\">Veteran<\/option><option value=\"former-service\">Former Service<\/option><option value=\"active-or-reserve\">Current Active Duty or Reserve<\/option><option value=\"civ-aux\">Current \/ Former Civ Auxiliary Member<\/option><option value=\"\"><\/option><\/select><\/div><label for=\"mil_documentation\" class=\"file\">Military Status Documentation (DD214, ID Card, etc)<\/label><div class=\"div_file\"><input name=\"mil_documentation\" type=\"file\" id=\"mil_documentation\" value=\"\" class=\"file\" accept=\".jpg,.jpeg,.gif,.pdf\" \/><\/div><label for=\"training_doc1\" class=\"file\">College \/ University Degree or Transcript (if any)<\/label><div class=\"div_file\"><input name=\"training_doc1\" type=\"file\" id=\"training_doc1\" value=\"\" class=\"file\" accept=\".jpg,.jpeg,.gif,.pdf\" \/><\/div><label for=\"disaster_emerg_cert\" class=\"file\">Previous Disaster \/ Emergency Services Certifications (if any)<\/label><div class=\"div_file\"><input name=\"disaster_emerg_cert\" type=\"file\" id=\"disaster_emerg_cert\" value=\"\" class=\"file\" accept=\".jpg,.jpeg,.gif,.pdf\" \/><\/div><label for=\"addl_supporting_doc\" class=\"file\">Any Additional Supporting Documentation<\/label><div class=\"div_file\"><input name=\"addl_supporting_doc\" type=\"file\" id=\"addl_supporting_doc\" value=\"\" class=\"file\" accept=\".jpg,.jpeg,.gif,.pdf\" \/><\/div><label for=\"history_narrative\" class=\"textarea\">Provide a short narrative of your history \/ experience. This may be military, professional or volunteer related.<\/label><div class=\"div_textarea\"><textarea cols=\"20\" rows=\"5\" name=\"history_narrative\" id=\"history_narrative\" class=\"textarea\"><\/textarea><\/div><label for=\"interests_1\" class=\"textarea\">Is there a specific disaster response role or position you are interested in?<\/label><div class=\"div_textarea\"><textarea cols=\"20\" rows=\"10\" name=\"interests_1\" id=\"interests_1\" class=\"textarea\"><\/textarea><\/div><script src=\"https:\/\/www.google.com\/recaptcha\/api.js?render=6LeWZQEsAAAAAGXYhcc7a7j1a7KMlgTagg98o5Sh\"><\/script><script>grecaptcha.ready(function () {grecaptcha.execute('6LeWZQEsAAAAAGXYhcc7a7j1a7KMlgTagg98o5Sh', { action: 'contact' }).then(function (token) {var recaptchaResponse = document.getElementById('recaptchaResponse');recaptchaResponse.value = token;});});<\/script><input type=\"hidden\" name=\"recaptcha_response\" id=\"recaptchaResponse\"><input name=\"a\" type=\"hidden\" value=\"register\" \/><input name=\"wpmem_reg_page\" type=\"hidden\" value=\"https:\/\/www.veteransrespond.org\/index.php\/responder-signup-2\/\" \/><div class=\"button_div\"><input name=\"submit\" type=\"submit\" value=\"Register\" class=\"buttons\" \/><\/div><div class=\"req-text\"><span class=\"req\">*<\/span>Required field<\/div><\/fieldset><\/form><\/div>\r\n<script>\r\n\tvar loadFile = function(event, clicked_id) {\r\n\t\tvar reader = new FileReader();\r\n\t\tvar the_id = clicked_id + \"_img\";\r\n\t\treader.onload = function() {\r\n\t\t\tvar output = document.getElementById(the_id);\r\n\t\t\toutput.src = reader.result;\r\n\t\t};\r\n\t\treader.readAsDataURL(event.target.files[0]);\r\n\t};\r\n<\/script>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/full-width-page.php","meta":{"footnotes":""},"class_list":["post-670","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/pages\/670","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/comments?post=670"}],"version-history":[{"count":4,"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/pages\/670\/revisions"}],"predecessor-version":[{"id":975,"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/pages\/670\/revisions\/975"}],"wp:attachment":[{"href":"https:\/\/www.veteransrespond.org\/index.php\/wp-json\/wp\/v2\/media?parent=670"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}