{"id":7,"date":"2018-02-23T12:15:24","date_gmt":"2018-02-23T19:15:24","guid":{"rendered":"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/our-partners\/"},"modified":"2025-03-14T08:46:37","modified_gmt":"2025-03-14T15:46:37","slug":"register","status":"publish","type":"page","link":"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/register\/?lang=en","title":{"rendered":"Register"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Formulario de inscripci\u00f3n Cancer Cientouno<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/cancercientouno\/wp-json\/wp\/v2\/pages\/7' data-formid='2' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lf7ZCsaAAAAAHmO21w-06e_LWIzd_WTUN7fgNlu' data-tabindex='0'><input id=\"input_82373f5ac5e09977bfd4a6856a47209b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_82373f5ac5e09977bfd4a6856a47209b\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_2_105\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_105'>Facebook<\/label><div class='gfield_description' id='gfield_description_2_105'>Este campo es un campo de validaci\u00f3n y debe quedar sin cambios.<\/div><div class='ginput_container'><input name='input_105' id='input_2_105' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_2_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Cancer CientoUno (101) Consentimiento informado<\/h2><div class='gsection_description' id='gfield_description_2_1'>Este programa de capacitaci\u00f3n en l\u00ednea est\u00e1 siendo ofrecido por el U54 Ponce Health Sciences University-Moffitt Cancer Center (PHSU-MCC) Partnership Outreach Core (dirigido por la Dra. Shannon Christy y el Dr. Julio Jim\u00e9nez). El prop\u00f3sito de este programa en l\u00ednea de C\u00e1ncer CientoUno es capacitar a los miembros de la comunidad sobre c\u00f3mo impartir educaci\u00f3n sobre el c\u00e1ncer en espa\u00f1ol a los miembros de sus comunidades locales. Debido a los datos que se est\u00e1n recopilando como parte de este\nprograma de capacitaci\u00f3n en l\u00ednea, este programa se considera un estudio de investigaci\u00f3n.\nComo participante en el programa en l\u00ednea C\u00e1ncer CientoUno, se le pedir\u00e1 que complete un formulario\nde inscripci\u00f3n y 11 m\u00f3dulos educativos a su propio ritmo. Al final de cada m\u00f3dulo, se le pedir\u00e1 que complete una breve encuesta de evaluaci\u00f3n. Adem\u00e1s, se le pedir\u00e1 que complete una encuesta de evaluaci\u00f3n intermedia y una encuesta de evaluaci\u00f3n de seguimiento de 6 meses. Sus respuestas se mantendr\u00e1n confidenciales. Solo los miembros del equipo de estudio y los socios tendr\u00e1n acceso a la informaci\u00f3n que comparta con nosotros. Sus respuestas al formulario de inscripci\u00f3n\nnos ayudar\u00e1n a entender a qui\u00e9n ha participado en el programa, y el m\u00f3dulo y las encuestas de\nevaluaci\u00f3n de seguimiento de 6 meses nos ayudar\u00e1n a evaluar este programa de capacitaci\u00f3n, refinar su contenido y objetivos de aprendizaje, y adaptar la informaci\u00f3n para satisfacer sus necesidades educativas. El equipo del estudio puede optar por publicar los hallazgos de este estudio para avanzar en\nla investigaci\u00f3n de capacitaci\u00f3n en educaci\u00f3n sobre el c\u00e1ncer, pero los datos publicados no contendr\u00e1n informaci\u00f3n que pueda identificarlo.\nEl sitio web de C\u00e1ncer CientoUno puede utilizar tecnolog\u00eda de recopilaci\u00f3n de datos como Google Analytics y cookies para recopilar y almacenar informaci\u00f3n personal cuando utiliza el sitio web. La informaci\u00f3n que se puede recopilar puede incluir las pesta\u00f1as visitadas, el tipo de navegador, el tipo de dispositivo, la informaci\u00f3n del dominio y del sistema operativo, la direcci\u00f3n IP, el idioma del sistema, el pa\u00eds y la zona horaria, y cu\u00e1ndo visita nuestro sitio web. Por lo tanto, al utilizar este sitio web, usted\nreconoce que dicha informaci\u00f3n puede ser recopilada de usted. Consulte nuestra Pol\u00edtica de privacidad y nuestra declaraci\u00f3n de t\u00e9rminos y condiciones para obtener m\u00e1s informaci\u00f3n. El U54 PHSU-MCC Partnership ha tomado medidas razonables para garantizar la seguridad de su informaci\u00f3n personal. El sitio web y la base de datos del proyecto ser\u00e1n protegidos y accedidos \u00fanicamente por personas autorizadas, incluidos los miembros del equipo de investigaci\u00f3n y los socios. Los datos de los participantes se guardar\u00e1n en computadoras protegidas por contrase\u00f1a que se respaldar\u00e1n diariamente\nen un servidor seguro.\nSu participaci\u00f3n en este programa de capacitaci\u00f3n en l\u00ednea es voluntaria y puede optar por no completar esta capacitaci\u00f3n en cualquier momento. Tambi\u00e9n puede optar por no responder preguntas espec\u00edficas en las encuestas mencionadas anteriormente.\nAl participar en este programa de capacitaci\u00f3n en l\u00ednea y sus encuestas, usted acepta participar en este estudio de investigaci\u00f3n.\nSi tiene alguna pregunta, comun\u00edquese con la Dra. Shannon Christy en shannon.christy@moffitt.org.<\/div><\/li><li id=\"field_2_92\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Secci\u00f3n I: Requisitos de elegibilidad<\/h2><div class='gsection_description' id='gfield_description_2_92'>\u00a1Gracias por su inter\u00e9s en el programa Cancer CientoUno! Como requisito para completar este programa de capacitaci\u00f3n, debe confirmar su capacidad para hablar, leer y escribir en espa\u00f1ol. <\/div><\/li><li id=\"field_2_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfSabes hablar espa\u00f1ol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_10'>\n\t\t\t<li class='gchoice gchoice_2_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='S\u00ed, fluido'  id='choice_2_10_0'    \/>\n\t\t\t\t<label for='choice_2_10_0' id='label_2_10_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed, fluido<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='S\u00ed, intermedio'  id='choice_2_10_1'    \/>\n\t\t\t\t<label for='choice_2_10_1' id='label_2_10_1' class='gform-field-label gform-field-label--type-inline'>S\u00ed, intermedio<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='No'  id='choice_2_10_2'    \/>\n\t\t\t\t<label for='choice_2_10_2' id='label_2_10_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_104\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full disqualified gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Lamentablemente, no puede participar en nuestro programa en este momento a menos que hable, lea o escriba espa\u00f1ol con fluidez. Puede ponerse en contacto con nosotros a trav\u00e9s de la direcci\u00f3n de correo electr\u00f3nico que aparece en la parte superior de esta p\u00e1gina si tiene alguna pregunta o duda.<\/li><li id=\"field_2_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfSabes leer en espa\u00f1ol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_42'>\n\t\t\t<li class='gchoice gchoice_2_42_0'>\n\t\t\t\t<input name='input_42' type='radio' value='S\u00ed, fluido'  id='choice_2_42_0'    \/>\n\t\t\t\t<label for='choice_2_42_0' id='label_2_42_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed, fluido<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_42_1'>\n\t\t\t\t<input name='input_42' type='radio' value='S\u00ed, intermedio'  id='choice_2_42_1'    \/>\n\t\t\t\t<label for='choice_2_42_1' id='label_2_42_1' class='gform-field-label gform-field-label--type-inline'>S\u00ed, intermedio<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_42_2'>\n\t\t\t\t<input name='input_42' type='radio' value='No'  id='choice_2_42_2'    \/>\n\t\t\t\t<label for='choice_2_42_2' id='label_2_42_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_88\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full disqualified gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Lamentablemente, no puedes participar en nuestra programa en este momento a menos que hables, leas, o escribas espa\u00f1ol con fluidez. Puedes comunicarte con nosotros a trav\u00e9s de la direcci\u00f3n de correo electr\u00f3nico en la parte superior de esta p\u00e1gina con cualquier pregunta o inquietud.<\/li><li id=\"field_2_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfSabes escribir en espa\u00f1ol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_43'>\n\t\t\t<li class='gchoice gchoice_2_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='S\u00ed, fluido'  id='choice_2_43_0'    \/>\n\t\t\t\t<label for='choice_2_43_0' id='label_2_43_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed, fluido<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='S\u00ed, intermedio'  id='choice_2_43_1'    \/>\n\t\t\t\t<label for='choice_2_43_1' id='label_2_43_1' class='gform-field-label gform-field-label--type-inline'>S\u00ed, intermedio<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='No'  id='choice_2_43_2'    \/>\n\t\t\t\t<label for='choice_2_43_2' id='label_2_43_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_89\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full disqualified gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Lamentablemente, no puedes participar en nuestra programa en este momento a menos que hables, leas, o escribas espa\u00f1ol con fluidez. Puedes comunicarte con nosotros a trav\u00e9s de la direcci\u00f3n de correo electr\u00f3nico en la parte superior de esta p\u00e1gina con cualquier pregunta o inquietud.<\/li><li id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfTienes acceso a un ordenador o dispositivo electr\u00f3nico y servicio de Internet? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='S\u00ed'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='No'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_90\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full disqualified gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Lamentablemente, necesitas tener acceso a una computadora o tableta con servicio de Internet para participar en nuestro programa en este momento. Puedes comunicarte con nosotros a trav\u00e9s de la direcci\u00f3n de correo electr\u00f3nico en la parte superior de esta p\u00e1gina con cualquier pregunta o inquietud.<\/li><li id=\"field_2_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfSer\u00edas capaz de completar 11 m\u00f3dulos en un periodo aproximado de 15 semanas? <\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_44'>\n\t\t\t<li class='gchoice gchoice_2_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='S\u00ed'  id='choice_2_44_0'    \/>\n\t\t\t\t<label for='choice_2_44_0' id='label_2_44_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='No'  id='choice_2_44_1'    \/>\n\t\t\t\t<label for='choice_2_44_1' id='label_2_44_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_93\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full disqualified gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Si bien no es necesario que complete el programa en un periodo aproximado de 15 semanas, se le recomienda encarecidamente que lo haga. Puedes comunicarte con nosotros a trav\u00e9s de la direcci\u00f3n de correo electr\u00f3nico en la parte superior de esta p\u00e1gina con cualquier pregunta o inquietud.<\/li><li id=\"field_2_94\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Secci\u00f3n II: Informaci\u00f3n Sociodemogr\u00e1fica<\/h2><div class='gsection_description' id='gfield_description_2_94'>Le pedimos que complete este formulario de registro para ayudar a nuestro equipo de investigaci\u00f3n entender mejor a qui\u00e9n complete este programa de capacitaci\u00f3n y evaluar c\u00f3mo la informaci\u00f3n aprendida es utilizada. Mantendremos confidencial la informaci\u00f3n que nos proporcione en este formulario. Solicitamos informaci\u00f3n de contacto para enviar el certificado de finalizaci\u00f3n. <\/div><\/li><li id=\"field_2_96\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_2_96'>Por favor, proporcione su nombre como quiere que aparezca en su certificado de finalizaci\u00f3n del curso. <\/div><\/li><li id=\"field_2_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_2_2'>\n                            \n                            <span id='input_2_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_2_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_2_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            <span id='input_2_2_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.4' id='input_2_2_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_2_4' class='gform-field-label gform-field-label--type-sub '>Segundo nombre<\/label>\n                                                <\/span>\n                            <span id='input_2_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_2_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_2_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_85\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_85'>Tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_85' id='input_2_85' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_81\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Correo electr\u00f3nico<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_2_81_container'>\n                                <span id='input_2_81_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_81' id='input_2_81' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_81' class='gform-field-label gform-field-label--type-sub '>Introduce un email<\/label>\n                                <\/span>\n                                <span id='input_2_81_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_81_2' id='input_2_81_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_81_2' class='gform-field-label gform-field-label--type-sub '>Confirmar email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Direcci\u00f3n postal preferida<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_2_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_2_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_2_3_1' id='input_2_3_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_2_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_2_3_3' id='input_2_3_3_label' class='gform-field-label gform-field-label--type-sub '>Ciudad<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_2_3_4_container' >\n                                        <select name='input_3.4' id='input_2_3_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_2_3_4' id='input_2_3_4_label' class='gform-field-label gform-field-label--type-sub '>Estado<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_2_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_2_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_3_5' id='input_2_3_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_2_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_2_80\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_80'>Edad (en a\u00f1os)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_2_80' type='number' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfEst\u00e1 estudiando actualmente? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_4'>\n\t\t\t<li class='gchoice gchoice_2_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='S\u00ed'  id='choice_2_4_0'    \/>\n\t\t\t\t<label for='choice_2_4_0' id='label_2_4_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='No'  id='choice_2_4_1'    \/>\n\t\t\t\t<label for='choice_2_4_1' id='label_2_4_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_38'>Nombre de la instituci\u00f3n:<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_2_38' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_6'>\u00bfCu\u00e1l es su especializaci\u00f3n\/concentraci\u00f3n actual? <\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Nivel actual de educaci\u00f3n\/clasificaci\u00f3n:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_39'>\n\t\t\t<li class='gchoice gchoice_2_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='Primer a\u00f1o de universidad (Freshman)'  id='choice_2_39_0'    \/>\n\t\t\t\t<label for='choice_2_39_0' id='label_2_39_0' class='gform-field-label gform-field-label--type-inline'>Primer a\u00f1o de universidad (Freshman)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='Segundo a\u00f1o de universidad (Sophomore)'  id='choice_2_39_1'    \/>\n\t\t\t\t<label for='choice_2_39_1' id='label_2_39_1' class='gform-field-label gform-field-label--type-inline'>Segundo a\u00f1o de universidad (Sophomore)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_39_2'>\n\t\t\t\t<input name='input_39' type='radio' value='Tercer a\u00f1o de universidad (Junior)'  id='choice_2_39_2'    \/>\n\t\t\t\t<label for='choice_2_39_2' id='label_2_39_2' class='gform-field-label gform-field-label--type-inline'>Tercer a\u00f1o de universidad (Junior)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_39_3'>\n\t\t\t\t<input name='input_39' type='radio' value='Cuarto a\u00f1o de universidad (Senior)'  id='choice_2_39_3'    \/>\n\t\t\t\t<label for='choice_2_39_3' id='label_2_39_3' class='gform-field-label gform-field-label--type-inline'>Cuarto a\u00f1o de universidad (Senior)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_39_4'>\n\t\t\t\t<input name='input_39' type='radio' value='Maestr\u00eda'  id='choice_2_39_4'    \/>\n\t\t\t\t<label for='choice_2_39_4' id='label_2_39_4' class='gform-field-label gform-field-label--type-inline'>Maestr\u00eda<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_39_5'>\n\t\t\t\t<input name='input_39' type='radio' value='Doctorado'  id='choice_2_39_5'    \/>\n\t\t\t\t<label for='choice_2_39_5' id='label_2_39_5' class='gform-field-label gform-field-label--type-inline'>Doctorado<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_98\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfCu\u00e1l es el nivel m\u00e1s alto de educaci\u00f3n que complet\u00f3? <\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_98'>\n\t\t\t<li class='gchoice gchoice_2_98_0'>\n\t\t\t\t<input name='input_98' type='radio' value='Nunca asisti\u00f3 a la escuela '  id='choice_2_98_0'    \/>\n\t\t\t\t<label for='choice_2_98_0' id='label_2_98_0' class='gform-field-label gform-field-label--type-inline'>Nunca asisti\u00f3 a la escuela <\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_1'>\n\t\t\t\t<input name='input_98' type='radio' value='Primaria (Grados K-5)'  id='choice_2_98_1'    \/>\n\t\t\t\t<label for='choice_2_98_1' id='label_2_98_1' class='gform-field-label gform-field-label--type-inline'>Primaria (Grados K-5)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_2'>\n\t\t\t\t<input name='input_98' type='radio' value='Escuela intermedia (grados 6-8)'  id='choice_2_98_2'    \/>\n\t\t\t\t<label for='choice_2_98_2' id='label_2_98_2' class='gform-field-label gform-field-label--type-inline'>Escuela intermedia (grados 6-8)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_3'>\n\t\t\t\t<input name='input_98' type='radio' value='Algo de escuela secundaria'  id='choice_2_98_3'    \/>\n\t\t\t\t<label for='choice_2_98_3' id='label_2_98_3' class='gform-field-label gform-field-label--type-inline'>Algo de escuela secundaria<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_4'>\n\t\t\t\t<input name='input_98' type='radio' value='Graduado(a) de la escuela secundaria \/ GED o equivalente'  id='choice_2_98_4'    \/>\n\t\t\t\t<label for='choice_2_98_4' id='label_2_98_4' class='gform-field-label gform-field-label--type-inline'>Graduado(a) de la escuela secundaria \/ GED o equivalente<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_5'>\n\t\t\t\t<input name='input_98' type='radio' value='Alguna universidad o escuela t\u00e9cnica'  id='choice_2_98_5'    \/>\n\t\t\t\t<label for='choice_2_98_5' id='label_2_98_5' class='gform-field-label gform-field-label--type-inline'>Alguna universidad o escuela t\u00e9cnica<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_6'>\n\t\t\t\t<input name='input_98' type='radio' value='Grado asociado'  id='choice_2_98_6'    \/>\n\t\t\t\t<label for='choice_2_98_6' id='label_2_98_6' class='gform-field-label gform-field-label--type-inline'>Grado asociado<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_7'>\n\t\t\t\t<input name='input_98' type='radio' value='Licenciatura o bachillerato (por ejemplo, BA, AB, BS, BBA)'  id='choice_2_98_7'    \/>\n\t\t\t\t<label for='choice_2_98_7' id='label_2_98_7' class='gform-field-label gform-field-label--type-inline'>Licenciatura o bachillerato (por ejemplo, BA, AB, BS, BBA)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_8'>\n\t\t\t\t<input name='input_98' type='radio' value='Maestr\u00eda (por ejemplo, MA, MS, MEng, MEd, MBA)'  id='choice_2_98_8'    \/>\n\t\t\t\t<label for='choice_2_98_8' id='label_2_98_8' class='gform-field-label gform-field-label--type-inline'>Maestr\u00eda (por ejemplo, MA, MS, MEng, MEd, MBA)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_98_9'>\n\t\t\t\t<input name='input_98' type='radio' value='T\u00edtulo de Escuela Profesional \/ Doctorado'  id='choice_2_98_9'    \/>\n\t\t\t\t<label for='choice_2_98_9' id='label_2_98_9' class='gform-field-label gform-field-label--type-inline'>T\u00edtulo de Escuela Profesional \/ Doctorado<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfEst\u00e1s actualmente empleado(a) como alguno de los siguientes? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_40'>Marque todas las que apliquen<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_40'><li class='gchoice gchoice_2_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Trabajador(a) de salud comunitaria'  id='choice_2_40_1'   aria-describedby=\"gfield_description_2_40\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_1' id='label_2_40_1' class='gform-field-label gform-field-label--type-inline'>Trabajador(a) de salud comunitaria<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Promotor(a) de salud'  id='choice_2_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_2' id='label_2_40_2' class='gform-field-label gform-field-label--type-inline'>Promotor(a) de salud<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='Navegador(a) de pacientes '  id='choice_2_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_3' id='label_2_40_3' class='gform-field-label gform-field-label--type-inline'>Navegador(a) de pacientes <\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Educador en salud'  id='choice_2_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_4' id='label_2_40_4' class='gform-field-label gform-field-label--type-inline'>Educador en salud<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.5' type='checkbox'  value='Enfermero(a)'  id='choice_2_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_5' id='label_2_40_5' class='gform-field-label gform-field-label--type-inline'>Enfermero(a)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.6' type='checkbox'  value='Trabajador(a) social'  id='choice_2_40_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_6' id='label_2_40_6' class='gform-field-label gform-field-label--type-inline'>Trabajador(a) social<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.7' type='checkbox'  value='Asistente m\u00e9dico\/Auxiliar medico'  id='choice_2_40_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_7' id='label_2_40_7' class='gform-field-label gform-field-label--type-inline'>Asistente m\u00e9dico\/Auxiliar medico<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.8' type='checkbox'  value='Otro oficio '  id='choice_2_40_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_8' id='label_2_40_8' class='gform-field-label gform-field-label--type-inline'>Otro oficio <\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_40_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.9' type='checkbox'  value='No aplica'  id='choice_2_40_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_40_9' id='label_2_40_9' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_41'> Indique su cargo:<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><div class='gsection_description' id='gfield_description_2_14'>Al compartir su informaci\u00f3n sociodemogr\u00e1fica nos ayudar\u00e1 a comprender mejor qui\u00e9n ha completado el programa Cancer CientoUno. Si se crear\u00e1 un resumen de las caracter\u00edsticas sociodemogr\u00e1ficas de los participantes del programa, la informaci\u00f3n de identificaci\u00f3n (ej., nombres e informaci\u00f3n de contacto) no estar\u00e1 incluida.<\/div><\/li><li id=\"field_2_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfTe consideras hispano o latino? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_15'>\n\t\t\t<li class='gchoice gchoice_2_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='S\u00ed'  id='choice_2_15_0'    \/>\n\t\t\t\t<label for='choice_2_15_0' id='label_2_15_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='No'  id='choice_2_15_1'    \/>\n\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_15_2'>\n\t\t\t\t<input name='input_15' type='radio' value='Prefiero no contestar'  id='choice_2_15_2'    \/>\n\t\t\t\t<label for='choice_2_15_2' id='label_2_15_2' class='gform-field-label gform-field-label--type-inline'>Prefiero no contestar<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_19\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfCu\u00e1l es su raza? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_19'>(Marque todas las que apliquen<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_19'><li class='gchoice gchoice_2_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Blanca'  id='choice_2_19_1'   aria-describedby=\"gfield_description_2_19\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_1' id='label_2_19_1' class='gform-field-label gform-field-label--type-inline'>Blanca<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Asi\u00e1tica'  id='choice_2_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_2' id='label_2_19_2' class='gform-field-label gform-field-label--type-inline'>Asi\u00e1tica<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='Ind\u00edgena americana o nativa de Alaska'  id='choice_2_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_3' id='label_2_19_3' class='gform-field-label gform-field-label--type-inline'>Ind\u00edgena americana o nativa de Alaska<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.4' type='checkbox'  value='Negra o afroamericana'  id='choice_2_19_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_4' id='label_2_19_4' class='gform-field-label gform-field-label--type-inline'>Negra o afroamericana<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.5' type='checkbox'  value='Nativa de Haw\u00e1i\/ o de las Islas del Pac\u00edfico '  id='choice_2_19_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_5' id='label_2_19_5' class='gform-field-label gform-field-label--type-inline'>Nativa de Haw\u00e1i\/ o de las Islas del Pac\u00edfico <\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.6' type='checkbox'  value='M\u00e1s de una raza '  id='choice_2_19_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_6' id='label_2_19_6' class='gform-field-label gform-field-label--type-inline'>M\u00e1s de una raza <\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.7' type='checkbox'  value='Ninguno de estas opciones\/Otra'  id='choice_2_19_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_7' id='label_2_19_7' class='gform-field-label gform-field-label--type-inline'>Ninguno de estas opciones\/Otra<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_19_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.8' type='checkbox'  value='Prefiero no contestar'  id='choice_2_19_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_19_8' id='label_2_19_8' class='gform-field-label gform-field-label--type-inline'>Prefiero no contestar<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_20\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_20'> Si ha respondido \u00abM\u00e1s de una raza\u00bb, especifique:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_2_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_99'>&quot; Ninguno de estas opciones\/Otra&quot;,Por favor especifique: <\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_2_99' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfCu\u00e1l es su g\u00e9nero? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_63'>Marque todas las que apliquen<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_63'>\n\t\t\t<li class='gchoice gchoice_2_63_0'>\n\t\t\t\t<input name='input_63' type='radio' value='Mujer cisg\u00e9nero (sexo femenino asignado al nacer y se identifica como mujer)'  id='choice_2_63_0'    \/>\n\t\t\t\t<label for='choice_2_63_0' id='label_2_63_0' class='gform-field-label gform-field-label--type-inline'>Mujer cisg\u00e9nero (sexo femenino asignado al nacer y se identifica como mujer)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_1'>\n\t\t\t\t<input name='input_63' type='radio' value='Hombre cisg\u00e9nero (sexo masculino asignado al nacer y se identifica como hombre)'  id='choice_2_63_1'    \/>\n\t\t\t\t<label for='choice_2_63_1' id='label_2_63_1' class='gform-field-label gform-field-label--type-inline'>Hombre cisg\u00e9nero (sexo masculino asignado al nacer y se identifica como hombre)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_2'>\n\t\t\t\t<input name='input_63' type='radio' value='Mujer transg\u00e9nero'  id='choice_2_63_2'    \/>\n\t\t\t\t<label for='choice_2_63_2' id='label_2_63_2' class='gform-field-label gform-field-label--type-inline'>Mujer transg\u00e9nero<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_3'>\n\t\t\t\t<input name='input_63' type='radio' value='Hombre transg\u00e9nero'  id='choice_2_63_3'    \/>\n\t\t\t\t<label for='choice_2_63_3' id='label_2_63_3' class='gform-field-label gform-field-label--type-inline'>Hombre transg\u00e9nero<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_4'>\n\t\t\t\t<input name='input_63' type='radio' value='G\u00e9nero no binario'  id='choice_2_63_4'    \/>\n\t\t\t\t<label for='choice_2_63_4' id='label_2_63_4' class='gform-field-label gform-field-label--type-inline'>G\u00e9nero no binario<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_5'>\n\t\t\t\t<input name='input_63' type='radio' value='G\u00e9nero queer'  id='choice_2_63_5'    \/>\n\t\t\t\t<label for='choice_2_63_5' id='label_2_63_5' class='gform-field-label gform-field-label--type-inline'>G\u00e9nero queer<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_6'>\n\t\t\t\t<input name='input_63' type='radio' value='Ag\u00e9nero'  id='choice_2_63_6'    \/>\n\t\t\t\t<label for='choice_2_63_6' id='label_2_63_6' class='gform-field-label gform-field-label--type-inline'>Ag\u00e9nero<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_7'>\n\t\t\t\t<input name='input_63' type='radio' value='G\u00e9nero fluido'  id='choice_2_63_7'    \/>\n\t\t\t\t<label for='choice_2_63_7' id='label_2_63_7' class='gform-field-label gform-field-label--type-inline'>G\u00e9nero fluido<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_8'>\n\t\t\t\t<input name='input_63' type='radio' value='Me identifico como:  '  id='choice_2_63_8'    \/>\n\t\t\t\t<label for='choice_2_63_8' id='label_2_63_8' class='gform-field-label gform-field-label--type-inline'>Me identifico como:  <\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_63_9'>\n\t\t\t\t<input name='input_63' type='radio' value='Prefiero no contestar'  id='choice_2_63_9'    \/>\n\t\t\t\t<label for='choice_2_63_9' id='label_2_63_9' class='gform-field-label gform-field-label--type-inline'>Prefiero no contestar<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_64'> Me identifico como:<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_2_64' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_45\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfC\u00f3mo se enter\u00f3 de este programa?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_45'>Marque todas las que apliquen<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_45'><li class='gchoice gchoice_2_45_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='Evento comunitario'  id='choice_2_45_1'   aria-describedby=\"gfield_description_2_45\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_1' id='label_2_45_1' class='gform-field-label gform-field-label--type-inline'>Evento comunitario<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='Seminario en l\u00ednea'  id='choice_2_45_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_2' id='label_2_45_2' class='gform-field-label gform-field-label--type-inline'>Seminario en l\u00ednea<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='Facebook'  id='choice_2_45_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_3' id='label_2_45_3' class='gform-field-label gform-field-label--type-inline'>Facebook<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.4' type='checkbox'  value='Alguien que hab\u00eda tomado el curso'  id='choice_2_45_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_4' id='label_2_45_4' class='gform-field-label gform-field-label--type-inline'>Alguien que hab\u00eda tomado el curso<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.5' type='checkbox'  value='Por mi trabajo'  id='choice_2_45_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_5' id='label_2_45_5' class='gform-field-label gform-field-label--type-inline'>Por mi trabajo<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.6' type='checkbox'  value='Conferencia\/Simposio'  id='choice_2_45_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_6' id='label_2_45_6' class='gform-field-label gform-field-label--type-inline'>Conferencia\/Simposio<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.7' type='checkbox'  value='Amigo'  id='choice_2_45_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_7' id='label_2_45_7' class='gform-field-label gform-field-label--type-inline'>Amigo<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.8' type='checkbox'  value='Listserv'  id='choice_2_45_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_8' id='label_2_45_8' class='gform-field-label gform-field-label--type-inline'>Listserv<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_45_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.9' type='checkbox'  value='Otro'  id='choice_2_45_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_9' id='label_2_45_9' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_46'>Por favor, especifique:<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_65\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >En una escala del 1 al 5: \u00bfcu\u00e1l es su grado de conocimiento de los siguientes temas?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='En una escala del 1 al 5: \u00bfcu\u00e1l es su grado de conocimiento de los siguientes temas?' class='gsurvey-likert' id='input_2_65'><thead><tr><td scope='col' class='gsurvey-likert-row-label'><\/td><th id='likert_col_1_2_65' scope='col'  class='gsurvey-likert-choice-label'>Nada de conocimiento (1)<\/th><th id='likert_col_2_2_65' scope='col'  class='gsurvey-likert-choice-label'> Poco conocimiento (2) <\/th><th id='likert_col_3_2_65' scope='col'  class='gsurvey-likert-choice-label'>Ni mucho ni poco conocimiento (neutral) (3)<\/th><th id='likert_col_4_2_65' scope='col'  class='gsurvey-likert-choice-label'>Mucho conocimiento (4)<\/th><th id='likert_col_5_2_65' scope='col'  class='gsurvey-likert-choice-label'>Experto en el tema (5)<\/th><\/tr><\/thead><tbody><tr><td id='likert_row_1_2_65' data-label='' class='gsurvey-likert-row-label'>Prevenci\u00f3n del c\u00e1ncer:<\/td><td data-label='Nada de conocimiento (1)' class='gsurvey-likert-choice'><input name='input_65.1' type='radio' value='glikertrow296fa75a:glikertcol65fc6ef576'  id='choice_2_65_1_1'    aria-labelledby='likert_row_1_2_65 likert_col_1_2_65'\/><\/td><td data-label='Poco conocimiento (2)' class='gsurvey-likert-choice'><input name='input_65.1' type='radio' value='glikertrow296fa75a:glikertcol65ef4037ae'  id='choice_2_65_1_2'    aria-labelledby='likert_row_1_2_65 likert_col_2_2_65'\/><\/td><td data-label='Ni mucho ni poco conocimiento (neutral) (3)' class='gsurvey-likert-choice'><input name='input_65.1' type='radio' value='glikertrow296fa75a:glikertcol65c70f030b'  id='choice_2_65_1_3'    aria-labelledby='likert_row_1_2_65 likert_col_3_2_65'\/><\/td><td data-label='Mucho conocimiento (4)' class='gsurvey-likert-choice'><input name='input_65.1' type='radio' value='glikertrow296fa75a:glikertcol65adc73d8a'  id='choice_2_65_1_4'    aria-labelledby='likert_row_1_2_65 likert_col_4_2_65'\/><\/td><td data-label='Experto en el tema (5)' class='gsurvey-likert-choice'><input name='input_65.1' type='radio' value='glikertrow296fa75a:glikertcol6509358458'  id='choice_2_65_1_5'    aria-labelledby='likert_row_1_2_65 likert_col_5_2_65'\/><\/td><\/tr><tr><td id='likert_row_2_2_65' data-label='' class='gsurvey-likert-row-label'>Pruebas de detecci\u00f3n temprana de c\u00e1ncer: <\/td><td data-label='Nada de conocimiento (1)' class='gsurvey-likert-choice'><input name='input_65.2' type='radio' value='glikertrow2526a8cd:glikertcol65fc6ef576'  id='choice_2_65_2_1'    aria-labelledby='likert_row_2_2_65 likert_col_1_2_65'\/><\/td><td data-label='Poco conocimiento (2)' class='gsurvey-likert-choice'><input name='input_65.2' type='radio' value='glikertrow2526a8cd:glikertcol65ef4037ae'  id='choice_2_65_2_2'    aria-labelledby='likert_row_2_2_65 likert_col_2_2_65'\/><\/td><td data-label='Ni mucho ni poco conocimiento (neutral) (3)' class='gsurvey-likert-choice'><input name='input_65.2' type='radio' value='glikertrow2526a8cd:glikertcol65c70f030b'  id='choice_2_65_2_3'    aria-labelledby='likert_row_2_2_65 likert_col_3_2_65'\/><\/td><td data-label='Mucho conocimiento (4)' class='gsurvey-likert-choice'><input name='input_65.2' type='radio' value='glikertrow2526a8cd:glikertcol65adc73d8a'  id='choice_2_65_2_4'    aria-labelledby='likert_row_2_2_65 likert_col_4_2_65'\/><\/td><td data-label='Experto en el tema (5)' class='gsurvey-likert-choice'><input name='input_65.2' type='radio' value='glikertrow2526a8cd:glikertcol6509358458'  id='choice_2_65_2_5'    aria-labelledby='likert_row_2_2_65 likert_col_5_2_65'\/><\/td><\/tr><tr><td id='likert_row_3_2_65' data-label='' class='gsurvey-likert-row-label'>Pruebas de diagn\u00f3stico de cancer <\/td><td data-label='Nada de conocimiento (1)' class='gsurvey-likert-choice'><input name='input_65.3' type='radio' value='glikertrowfcb2ccea:glikertcol65fc6ef576'  id='choice_2_65_3_1'    aria-labelledby='likert_row_3_2_65 likert_col_1_2_65'\/><\/td><td data-label='Poco conocimiento (2)' class='gsurvey-likert-choice'><input name='input_65.3' type='radio' value='glikertrowfcb2ccea:glikertcol65ef4037ae'  id='choice_2_65_3_2'    aria-labelledby='likert_row_3_2_65 likert_col_2_2_65'\/><\/td><td data-label='Ni mucho ni poco conocimiento (neutral) (3)' class='gsurvey-likert-choice'><input name='input_65.3' type='radio' value='glikertrowfcb2ccea:glikertcol65c70f030b'  id='choice_2_65_3_3'    aria-labelledby='likert_row_3_2_65 likert_col_3_2_65'\/><\/td><td data-label='Mucho conocimiento (4)' class='gsurvey-likert-choice'><input name='input_65.3' type='radio' value='glikertrowfcb2ccea:glikertcol65adc73d8a'  id='choice_2_65_3_4'    aria-labelledby='likert_row_3_2_65 likert_col_4_2_65'\/><\/td><td data-label='Experto en el tema (5)' class='gsurvey-likert-choice'><input name='input_65.3' type='radio' value='glikertrowfcb2ccea:glikertcol6509358458'  id='choice_2_65_3_5'    aria-labelledby='likert_row_3_2_65 likert_col_5_2_65'\/><\/td><\/tr><tr><td id='likert_row_4_2_65' data-label='' class='gsurvey-likert-row-label'>Tratamiento del c\u00e1ncer:<\/td><td data-label='Nada de conocimiento (1)' class='gsurvey-likert-choice'><input name='input_65.4' type='radio' value='glikertrow66fd867c:glikertcol65fc6ef576'  id='choice_2_65_4_1'    aria-labelledby='likert_row_4_2_65 likert_col_1_2_65'\/><\/td><td data-label='Poco conocimiento (2)' class='gsurvey-likert-choice'><input name='input_65.4' type='radio' value='glikertrow66fd867c:glikertcol65ef4037ae'  id='choice_2_65_4_2'    aria-labelledby='likert_row_4_2_65 likert_col_2_2_65'\/><\/td><td data-label='Ni mucho ni poco conocimiento (neutral) (3)' class='gsurvey-likert-choice'><input name='input_65.4' type='radio' value='glikertrow66fd867c:glikertcol65c70f030b'  id='choice_2_65_4_3'    aria-labelledby='likert_row_4_2_65 likert_col_3_2_65'\/><\/td><td data-label='Mucho conocimiento (4)' class='gsurvey-likert-choice'><input name='input_65.4' type='radio' value='glikertrow66fd867c:glikertcol65adc73d8a'  id='choice_2_65_4_4'    aria-labelledby='likert_row_4_2_65 likert_col_4_2_65'\/><\/td><td data-label='Experto en el tema (5)' class='gsurvey-likert-choice'><input name='input_65.4' type='radio' value='glikertrow66fd867c:glikertcol6509358458'  id='choice_2_65_4_5'    aria-labelledby='likert_row_4_2_65 likert_col_5_2_65'\/><\/td><\/tr><tr><td id='likert_row_5_2_65' data-label='' class='gsurvey-likert-row-label'>Supervivencia al c\u00e1ncer:<\/td><td data-label='Nada de conocimiento (1)' class='gsurvey-likert-choice'><input name='input_65.5' type='radio' value='glikertrow7d642122:glikertcol65fc6ef576'  id='choice_2_65_5_1'    aria-labelledby='likert_row_5_2_65 likert_col_1_2_65'\/><\/td><td data-label='Poco conocimiento (2)' class='gsurvey-likert-choice'><input name='input_65.5' type='radio' value='glikertrow7d642122:glikertcol65ef4037ae'  id='choice_2_65_5_2'    aria-labelledby='likert_row_5_2_65 likert_col_2_2_65'\/><\/td><td data-label='Ni mucho ni poco conocimiento (neutral) (3)' class='gsurvey-likert-choice'><input name='input_65.5' type='radio' value='glikertrow7d642122:glikertcol65c70f030b'  id='choice_2_65_5_3'    aria-labelledby='likert_row_5_2_65 likert_col_3_2_65'\/><\/td><td data-label='Mucho conocimiento (4)' class='gsurvey-likert-choice'><input name='input_65.5' type='radio' value='glikertrow7d642122:glikertcol65adc73d8a'  id='choice_2_65_5_4'    aria-labelledby='likert_row_5_2_65 likert_col_4_2_65'\/><\/td><td data-label='Experto en el tema (5)' class='gsurvey-likert-choice'><input name='input_65.5' type='radio' value='glikertrow7d642122:glikertcol6509358458'  id='choice_2_65_5_5'    aria-labelledby='likert_row_5_2_65 likert_col_5_2_65'\/><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_2_91\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_91'>Por favor, describe un objetivo personal que esperas alcanzar al participar en este programa de capacitaci\u00f3n: <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_91'>1000 caracteres o menos<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_91' id='input_2_91' class='textarea medium'  aria-describedby=\"gfield_description_2_91\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_27\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_27'>Por favor, describe un objetivo profesional que esperas alcanzar al participar en este programa de capacitaci\u00f3n: <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_27'>1000 caracteres o menos<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_2_27' class='textarea medium'  aria-describedby=\"gfield_description_2_27\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"> Secci\u00f3n III: Formas de Impartir Educaci\u00f3n <\/h2><\/li><li id=\"field_2_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfActualmente proporcionas educaci\u00f3n o apoyo relacionado con el c\u00e1ncer a comunidades? (En caso afirmativo, explica e incluye los temas espec\u00edficos sobre el c\u00e1ncer que abordas) <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_100'>\n\t\t\t<li class='gchoice gchoice_2_100_0'>\n\t\t\t\t<input name='input_100' type='radio' value='S\u00ed'  id='choice_2_100_0'    \/>\n\t\t\t\t<label for='choice_2_100_0' id='label_2_100_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_100_1'>\n\t\t\t\t<input name='input_100' type='radio' value='No'  id='choice_2_100_1'    \/>\n\t\t\t\t<label for='choice_2_100_1' id='label_2_100_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_26'>Si la respuesta es afirmativa, indique<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_26'>1000 caracteres o menos<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_2_26' class='textarea medium'  aria-describedby=\"gfield_description_2_26\" maxlength='1000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_66\" class=\"gfield gfield--type-survey gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfEn qu\u00e9 entorno pretendes proporcionar la informaci\u00f3n que aprender\u00e1s en el programa Cancer CientoUno? <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_66'>Marque todas las que apliquen<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_66'><li class='gchoice gchoice_2_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='clinic'  id='choice_2_66_1'   aria-describedby=\"gfield_description_2_66\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_1' id='label_2_66_1' class='gform-field-label gform-field-label--type-inline'>Cl\u00ednica<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_66_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.2' type='checkbox'  value='community'  id='choice_2_66_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_2' id='label_2_66_2' class='gform-field-label gform-field-label--type-inline'>Comunidad<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_66_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.3' type='checkbox'  value='classroom'  id='choice_2_66_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_3' id='label_2_66_3' class='gform-field-label gform-field-label--type-inline'>Aula o sal\u00f3n de clases<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_66_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.4' type='checkbox'  value='individual'  id='choice_2_66_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_4' id='label_2_66_4' class='gform-field-label gform-field-label--type-inline'>Individualmente (uno a uno)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_66_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.5' type='checkbox'  value='institution'  id='choice_2_66_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_66_5' id='label_2_66_5' class='gform-field-label gform-field-label--type-inline'>Instituci\u00f3n<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_68\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Por favor, indique el nombre de la instituci\u00f3n y la ciudad(es) y el estado(s)\/territorio(s) de EE. UU. en los que pretendes proporcionar la informaci\u00f3n que aprendas en el programa Cancer CientoUno:<\/li><li id=\"field_2_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_67'>Nombre de la instituci\u00f3n:<\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_2_67' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_69\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Ciudad(es): <\/label><div class='gfield_description' id='gfield_description_2_69'>A\u00f1adir elementos adicionales mediante el bot\u00f3n &#8220;+&#8221;<\/div><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_69_col1' class='gfield_list_col_odd' \/><col id='gfield_list_69_col2' class='gfield_list_col_even' \/><\/colgroup><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_69_cell1' ><input aria-invalid='false'  aria-describedby=\"gfield_description_2_69\" aria-label='Ciudad(es): , Fila 1' data-aria-label-template='Ciudad(es): , Fila {0}' type='text' name='input_69[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='A\u00f1adir otra fila' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='A\u00f1ade una nueva fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" alt=\"\" title=\"A\u00f1ade una nueva fila\"><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Eliminar esta fila' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='Eliminar esta fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" alt=\"\" title=\"Eliminar esta fila\"><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_2_71\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Estado(s): <\/label><div class='gfield_description' id='gfield_description_2_71'>A\u00f1adir elementos adicionales mediante el bot\u00f3n &#8220;+&#8221;<\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_71_col1' class='gfield_list_col_odd' \/><col id='gfield_list_71_col2' class='gfield_list_col_even' \/><\/colgroup><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_71_cell1' ><input aria-invalid='false'  aria-describedby=\"gfield_description_2_71\" aria-label='Estado(s): , Fila 1' data-aria-label-template='Estado(s): , Fila {0}' type='text' name='input_71[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='A\u00f1adir otra fila' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='A\u00f1ade una nueva fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" alt=\"\" title=\"A\u00f1ade una nueva fila\"><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Eliminar esta fila' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='Eliminar esta fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" alt=\"\" title=\"Eliminar esta fila\"><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_2_101\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Territorio(s) de EE.UU.: <\/label><div class='gfield_description' id='gfield_description_2_101'>A\u00f1adir elementos adicionales mediante el bot\u00f3n \u201c+\u201d <\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_101_col1' class='gfield_list_col_odd' \/><col id='gfield_list_101_col2' class='gfield_list_col_even' \/><\/colgroup><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_101_cell1' ><input aria-invalid='false'  aria-describedby=\"gfield_description_2_101\" aria-label='Territorio(s) de EE.UU.: , Fila 1' data-aria-label-template='Territorio(s) de EE.UU.: , Fila {0}' type='text' name='input_101[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='A\u00f1adir otra fila' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='A\u00f1ade una nueva fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" alt=\"\" title=\"A\u00f1ade una nueva fila\"><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Eliminar esta fila' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='Eliminar esta fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" alt=\"\" title=\"Eliminar esta fila\"><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_2_73\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >\u00bfA qu\u00e9 grupos o audiencias tiene previsto dar la informaci\u00f3n que aprender\u00e1s en el programa Cancer CientoUno? <\/label><div class='gfield_description' id='gfield_description_2_73'>A\u00f1adir elementos adicionales mediante el bot\u00f3n &#8220;+&#8221;<\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_73_col1' class='gfield_list_col_odd' \/><col id='gfield_list_73_col2' class='gfield_list_col_even' \/><\/colgroup><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_73_cell1' ><input aria-invalid='false'  aria-describedby=\"gfield_description_2_73\" aria-label='\u00bfA qu\u00e9 grupos o audiencias tiene previsto dar la informaci\u00f3n que aprender\u00e1s en el programa Cancer CientoUno? , Fila 1' data-aria-label-template='\u00bfA qu\u00e9 grupos o audiencias tiene previsto dar la informaci\u00f3n que aprender\u00e1s en el programa Cancer CientoUno? , Fila {0}' type='text' name='input_73[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='A\u00f1adir otra fila' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='A\u00f1ade una nueva fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-add.svg\" alt=\"\" title=\"A\u00f1ade una nueva fila\"><\/noscript><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Eliminar esta fila' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img decoding=\"async\" class=\"lazyload\" data-src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt='' title='Eliminar esta fila' \/><noscript><img decoding=\"async\" src=\"https:\/\/phsu-mcc.moffitt.org\/cancercientouno\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg\" alt=\"\" title=\"Eliminar esta fila\"><\/noscript><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_2_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  > Grupo o audiencias<\/li><li id=\"field_2_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Al participar en el programa de capacitaci\u00f3n Cancer CientoUno, aceptas ser contactado para que los administradores del programa puedan saber c\u00f3mo has utilizado la informaci\u00f3n presentada en Cancer CientoUno. <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_75'>\n\t\t\t<li class='gchoice gchoice_2_75_0'>\n\t\t\t\t<input name='input_75' type='radio' value='s\u00ed'  id='choice_2_75_0'    \/>\n\t\t\t\t<label for='choice_2_75_0' id='label_2_75_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_75_1'>\n\t\t\t\t<input name='input_75' type='radio' value='No'  id='choice_2_75_1'    \/>\n\t\t\t\t<label for='choice_2_75_1' id='label_2_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Por favor indica cu\u00e1l es el m\u00e9todo preferido para que nos comuniquemos contigo<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_82'>\n\t\t\t<li class='gchoice gchoice_2_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Tel\u00e9fono'  id='choice_2_82_0'    \/>\n\t\t\t\t<label for='choice_2_82_0' id='label_2_82_0' class='gform-field-label gform-field-label--type-inline'>Tel\u00e9fono<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='Correo electr\u00f3nico'  id='choice_2_82_1'    \/>\n\t\t\t\t<label for='choice_2_82_1' id='label_2_82_1' class='gform-field-label gform-field-label--type-inline'>Correo electr\u00f3nico<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_84\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_84'>Tel\u00e9fono opcional<\/label><div class='gfield_description' id='gfield_description_2_84'>Por tel\u00e9fono- Introduzca un n\u00famero de tel\u00e9fono si desea que utilicemos un n\u00famero diferente al que se est\u00e1 usando para registrarse <\/div><div class='ginput_container ginput_container_phone'><input name='input_84' id='input_2_84' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_2_84\"  \/><\/div><\/li><li id=\"field_2_83\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_83'>Direcci\u00f3n de correo electr\u00f3nico opcional<\/label><div class='gfield_description' id='gfield_description_2_83'>Por correo electr\u00f3nico \u2013 Introduzca una direcci\u00f3n de correo electr\u00f3nico si desea utilizar una direcci\u00f3n de correo electr\u00f3nico diferente a la que est\u00e1 usando para registrarse. <\/div><div class='ginput_container ginput_container_email'>\n                            <input name='input_83' id='input_2_83' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_2_83\" \/>\n                        <\/div><\/li><li id=\"field_2_102\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Secci\u00f3n IV: Crear nombre de usuario y contrase\u00f1a<\/h2><div class='gsection_description' id='gfield_description_2_102'>Por favor crea su nombre de usuario y contrase\u00f1a<\/div><\/li><li id=\"field_2_77\" class=\"gfield gfield--type-username gfield--input-type-username gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_77'>Nombre de usuario<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_2_77' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_78\" class=\"gfield gfield--type-password gfield--input-type-password gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Contrase\u00f1a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_password gform-grid-row' id='input_2_78_container'>\n\t\t\t\t\t\t<span id='input_2_78_1_container' class='ginput_password ginput_left gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_78' id='input_2_78' onkeyup='gformShowPasswordStrength(\"input_2_78\");' onchange='gformShowPasswordStrength(\"input_2_78\");' aria-describedby=\"input_2_78_strength_indicator\" value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple' onclick='javascript:gformToggleShowPassword(\"input_2_78\");' aria-live='polite' aria-label='Mostrar contrase\u00f1a' data-label-show='Mostrar contrase\u00f1a' data-label-hide='Ocultar contrase\u00f1a'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_2_78' class='gform-field-label gform-field-label--type-sub '>Introduce la constrase\u00f1a<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_2_78_2_container' class='ginput_password ginput_right gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_78_2' id='input_2_78_2' onkeyup='gformShowPasswordStrength(\"input_2_78\");' onchange='gformShowPasswordStrength(\"input_2_78\");' value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple' onclick='javascript:gformToggleShowPassword(\"input_2_78_2\");' aria-live='polite' aria-label='Mostrar contrase\u00f1a' data-label-show='Mostrar contrase\u00f1a' data-label-hide='Ocultar contrase\u00f1a'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_2_78_2' class='gform-field-label gform-field-label--type-sub '>Confirmar contrase\u00f1a<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><div id='input_2_78_strength_indicator' class='gfield_password_strength'  aria-live='assertive' aria-atomic='true'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tIndicador de fortaleza\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type='hidden' class='gform_hidden' id='input_2_78_strength' name='input_78_strength' \/><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Reg\u00edstrese en Cancer CientoUno'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='NBSgahxbJUyjDHapHO\/HAbXXQPVMlIxVra38ksohGbllQNQtbLJvEPIivgLJHrJkbPm0WNJBBfSt393Up9ANrBQvd+vqODY5hHCUCqqyCZOu4hI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' 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