{"id":53,"date":"2019-09-11T13:22:49","date_gmt":"2019-09-11T13:22:49","guid":{"rendered":"https:\/\/exitinternational.net\/pegasos\/?page_id=53"},"modified":"2023-11-16T07:43:27","modified_gmt":"2023-11-16T07:43:27","slug":"online-application","status":"publish","type":"page","link":"https:\/\/staging.pegasos-association.com\/de\/online-application\/","title":{"rendered":"Online Application"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\">    <style> div.pdb-tabs-instance-imyuikl { opacity: 1; } <\/style>\n    <script type=\"text\/javascript\" defer>\n    PDb_Field_Group_Tabs_imyuikl = (function ($) {\n        var container;\n        var tab_content_fields;\n        var setup_tabs = function () {\n          tab_content_fields.each(function () {\n            set_content_id(this);\n          });\n          tab_content_fields.length > 1 ? show_next() : show_submit();\n          container.animate({'opacity' : 1}, 0);\n        }\n        var set_content_id = function (el) {\n          var el = $(el);\n          var tab_anchor = tab_anchor_string(el);\n          el.attr('id', tab_anchor);\n        }\n        var tab_anchor_string = function (el) {\n          return el.prop('class').match(\/field-group-[^ \"']+\/)[0];\n        }\n        var id_string = function (el) {\n          var unique_id = el.prop('class').match(\/field-group-([^ \"']+)\/);\n          return unique_id[1];\n        }\n        var find_title = function (el) {\n          var title_el = el.find('legend').first();\n          return title_el.length ? title_el.text() : id_string(el);\n        }\n        var next = function (e) {\n          e.preventDefault();\n          var selected = container.tabs(\"option\", \"active\") + 1;\n          container.tabs(\"option\", \"active\", selected);\n                go_top();\n            }\n        var go_top = function () {\n          if (container.offset().top < $(document).scrollTop()) {\n            $('html, body').animate({\n              scrollTop : container.offset().top\n            }, 1000);\n          }\n        }\n        var handle_invalid = function (el) {\n          $('.ui-tabs-submit').off('mouseup.scrolltop');\n          var invalid_field = container.find(':invalid').length ? container.find(':invalid') : find_invalid_field();\n          if (invalid_field) {\n            var tablabel = invalid_field.closest('.field-group').attr('aria-labelledby');\n            var this_tab = container.find('.ui-tabs-nav li[aria-labelledby=' + tablabel + ']');\n            container.tabs('option', 'active', this_tab.index());\n          }\n        }\n        var find_invalid_field = function () {\n          var error_msg = container.find('.pdb-error');\n          if (error_msg.length) {\n            var field = error_msg.find('[data-field-name]').first().data('field-name');\n            return container.find('[name=' + field + ']');\n          }\n          return false;\n        }\n        var set_invalid_tab = function () {\n          var invalid_field = find_invalid_field();\n          if (invalid_field.length) {\n            handle_invalid();\n          }\n        }\n        var button_switch = function (selected) {\n          if (selected === tab_content_fields.length - 1) {\n            show_submit();\n          } else {\n            show_next();\n          }\n        }\n        var show_submit = function () {\n          $('.force-step.ui-tabs-next').hide();\n          $('.force-step.ui-tabs-submit').show();\n        }\n        var show_next = function () {\n          $('.force-step.ui-tabs-next').show();\n          $('.force-step.ui-tabs-submit').hide();\n        }\n        return {\n          init : function () {\n            container = $('.pdb-tabs-instance-imyuikl');\n            tab_content_fields = container.find('.field-group:not([class*=submit])');\n            setup_tabs();\n            container.tabs({\n        heightStyle: \"content\",\n        hide: false,\n        show: false,\n        activate: function () {\n          button_switch(container.tabs(\"option\", \"active\"));\n        }\n        });\n            $('.ui-tabs-next').click(next);\n                $('.ui-tabs-submit').on('mouseup.scrolltop',go_top);\n                if (container.find('[required]').length) {\n              container.find('form [type=submit]').on('click', handle_invalid);\n            }\n            set_invalid_tab();\n          }\n        }\n      }(jQuery));\n      jQuery(function () {\n    PDb_Field_Group_Tabs_imyuikl.init();\n      });\n    <\/script>\n    <style type=\"text\/css\">.ui-tabs .ui-tabs-nav {\n  background-image: none;\n  background-color: inherit;\n  border: none;\n  border-bottom: 1px solid #ccc;\n  height: auto;\n  margin: 18px 0 20px;\n  padding: 0 10px;\n  overflow: visible;\n}\n.ui-tabs .ui-tabs-nav li {\n  background-color: transparent;\n  background-image: none;\n  border:none;\n  display: inline-block;\n  position: relative;\n  margin: 1px 0 2px;\n  height: auto;\n  width: auto;\n}\n.ui-tabs .ui-tabs-nav li.ui-tabs-active.ui-state-active {\n  margin-bottom:0;\n}\n.ui-tabs .ui-tabs-nav .ui-state-default a {\n  background-color: rgba(0,0,0,0.1);\n text-shadow: none;\n  padding-bottom: 9px;\n}\n.ui-tabs .ui-tabs-nav .ui-tabs-active.ui-state-active a {\n  background-color: rgba(0,0,0,0);\n  padding-bottom: 11px;\n}\n.ui-tabs .ui-tabs-nav li a {\n  padding: 4px 20px 6px;\n  font-weight: normal;\n}\n.ui-tabs .ui-tabs-nav li a {\n  line-height: 1.4;\n  display: inline-block;\n  padding: 9px 12px 5px;\n  margin: 0 4px 0 0;\n  border-style: solid;\n  border-color: #CCC #CCC #F9F9F9;\n  border-width: 1px 1px 0;\n  color: #888888;\n  background-color:#eeeeee;\n  text-shadow: rgba(255, 255, 255, 1) 0 1px 0;\n  text-decoration: none;\n  border-top-left-radius: 2px;\n  border-top-right-radius: 2px;\n}\n.ui-tabs .ui-tabs-nav li a:hover {\n  color: #000000;\n  background-color: #F3F3F3;\n  \n}\n.ui-tabs .ui-tabs-nav li.ui-tabs-selected a, \n.ui-tabs .ui-tabs-nav li.ui-state-active a,\n.ui-tabs .ui-tabs-nav li a:focus {\n  color: #333333;\n  outline:none;\n}\n.pdb-tab-control {\n  display: none;\n}\n.pdb-tab-control.ui-tabs-nav {\n  display: block;\n}\n\n.pdb-signup.ui-widget.ui-widget-content,\n.pdb-record.ui-widget.ui-widget-content,\n.pdb-single.ui-widget.ui-widget-content {\n    border: none;\n    background-color: transparent;\n}<\/style> \n<div class=\"wrap pdb-signup pdb-instance-2 pdb-tabs-instance-imyuikl\" >\n\n  \n  <form method=\"post\" enctype=\"multipart\/form-data\"  autocomplete=\"off\" action=\"\/de\/wp-json\/wp\/v2\/pages\/53\" ><input name=\"ip_address\" type=\"hidden\" value=\"216.73.217.162\" \/>\n\n<input name=\"action\" type=\"hidden\" value=\"signup\" \/>\n\n<input name=\"subsource\" type=\"hidden\" value=\"participants-database\" \/>\n\n<input name=\"shortcode_page\" type=\"hidden\" value=\"\/de\/wp-json\/wp\/v2\/pages\/53\" \/>\n\n<input name=\"thanks_page\" type=\"hidden\" value=\"https:\/\/staging.pegasos-association.com\/de\/online-application\/\" \/>\n\n<input name=\"instance_index\" type=\"hidden\" value=\"2\" \/>\n\n<input name=\"pdb_data_keys\" type=\"hidden\" value=\"1.2.27.3.38.4.7.5.6.8.205.206.204.37.53.130.132.54.131.56.57.229.136.259.137.138.207.209.208.210.211.52.260.135.193.41.60.39.230\" \/>\n\n<input name=\"session_hash\" type=\"hidden\" value=\"2f2b8f41f7\" \/>\n  \n  <ul class=\"pdb-tab-control\"><li><a href=\"#field-group-main_information\">Kontakt<\/a><\/li><li><a href=\"#field-group-personal\">Pers\u00f6nliche Informationen<\/a><\/li><\/ul>\n    <div class=\"form-horizontal pdb-signup\">\n\n            \n        \n        <fieldset class=\"field-group field-group-main_information\">\n\t\t\t\t\t\t\t\t\n                \n        \n        <div class=\"text-line first_name-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-first_name-2\" >Vorname <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"first_name\" size=\"40%\" required minlength=\"3\" id=\"pdb-first_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line last_name-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-last_name-2\" >Nachname <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"last_name\" size=\"40%\" required minlength=\"3\" id=\"pdb-last_name-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line date_of_birth-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-date_of_birth-2\" >Geburtsdatum:<br>Format: Tag\/Monat\/Jahr<br>Beispiel: 04 JULI 1948 <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"date_of_birth\" size=\"20%\" required id=\"pdb-date_of_birth-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line address-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-address-2\" >Adresse <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"address\" size=\"40%\" required id=\"pdb-address-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line address_line_2-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-address_line_2-2\" >Adresse Linee 2<\/label>\n          <div class=\"controls\"><input name=\"address_line_2\" size=\"40%\" id=\"pdb-address_line_2-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line city-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-city-2\" >Ortschaft <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"city\" size=\"40%\" required id=\"pdb-city-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line zip-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-zip-2\" >Postleitzahl <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"zip\" size=\"20%\" required id=\"pdb-zip-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line state-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-state-2\" >Region <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"state\" size=\"40%\" required id=\"pdb-state-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line country-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-country-2\" >Land <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"country\" size=\"40%\" required id=\"pdb-country-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line phone-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-phone-2\" >Telefon (inkl. Landes- und Ortsvorwahl) <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"phone\" size=\"40%\" required id=\"pdb-phone-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"checkbox whatsapp_number-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-whatsapp_number-2\" ><\/label>\n          <div class=\"controls\"><input name=\"whatsapp_number\" id=\"pdb-whatsapp_number-2-default\" type=\"hidden\" value=\"\" \/>\n<label>\n<input name=\"whatsapp_number\" id=\"pdb-whatsapp_number-2\" type=\"checkbox\" value=\"YES\" \/>\nIch verwende Whatsapp\n<\/label>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"checkbox signal_number-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-signal_number-2\" ><\/label>\n          <div class=\"controls\"><input name=\"signal_number\" id=\"pdb-signal_number-2-default\" type=\"hidden\" value=\"\" \/>\n<label>\n<input name=\"signal_number\" id=\"pdb-signal_number-2\" type=\"checkbox\" value=\"YES\" \/>\nIch verwende Signal\n<\/label>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line skype-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-skype-2\" >Mein Skype-Benutzername lautet:<\/label>\n          <div class=\"controls\"><input name=\"skype\" id=\"pdb-skype-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"html note-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-note-2\" ><\/label>\n          <div class=\"controls\"><span class=\"html-element-container\"><\/span>\n\n\t\t\t\t\t\t              <span class=\"help-block\">\n                Bitte stellen Sie sicher, dass alle Felder korrekt sind und klicken Sie auf NEXT bzw. SPEICHERN, um fortzufahren.              <\/span>\n            \n          <\/div>\n          \n        <\/div>\n\n                  \n        <div id=\"submit-button\" class=\"controls\">\n          <button type=\"submit\" class=\"btn btn-default force-step ui-tabs-submit pdb-submit\" >Sign Up<\/button><button class=\"btn btn-default force-step ui-tabs-next\" >Next<\/button>        <\/div>\n        \n        <\/fieldset>\n      \n        \n            \n        \n        <fieldset class=\"field-group field-group-personal\">\n\t\t\t\t\t\t\t\t\n                \n        \n        <div class=\"text-line your_email_address-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-your_email_address-2\" >Ihre Emailadresse <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"your_email_address\" size=\"40%\" required id=\"pdb-your_email_address-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line confirm_your_email_address-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-confirm_your_email_address-2\" >Ema <span class=\"astrick_red\">*<\/span>iladresse best\u00e4tigen <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"confirm_your_email_address\" size=\"40%\" required id=\"pdb-confirm_your_email_address-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"html please_choose_a_password-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-please_choose_a_password-2\" >Bitte w\u00e4hlen Sie ein Kennwort - min. 8 Zeichen <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><span class=\"html-element-container\"><\/span>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"password password-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-password-2\" >Kennwort <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"password\" size=\"40%\" required minlength=\"8\" id=\"pdb-password-2\" class=\"required-field\" type=\"password\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"password confirm_password_-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-confirm_password_-2\" >Kennwort best\u00e4tigen <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"confirm_password_\" size=\"40%\" required minlength=\"8\" id=\"pdb-confirm_password_-2\" class=\"required-field\" type=\"password\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line nationality-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-nationality-2\" > Staatsangeh\u00f6rigkeit <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"nationality\" required id=\"pdb-nationality-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line country_of_birth-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-country_of_birth-2\" >Geburtsland <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"country_of_birth\" required id=\"pdb-country_of_birth-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line language-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-language-2\" >Welche Sprachen sprechen Sie, bzw. Ihre Kontaktperson oder Begleiter*in? <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><input name=\"language\" size=\"40%\" required id=\"pdb-language-2\" class=\"required-field regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"html rtd_organization_heading-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-rtd_organization_heading-2\" ><\/label>\n          <div class=\"controls\"><span class=\"html-element-container\"><\/span>\n\n\t\t\t\t\t\t              <span class=\"help-block\">\n                Wenn Sie Mitglied einer Sterbehilfe-Organisation teilen Sie uns bitte mit, um welche Gruppe es sich handelt:              <\/span>\n            \n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"radio are_you_a_member_of_a_right_to_die_rtd_organization_-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-are_you_a_member_of_a_right_to_die_rtd_organization_-2\" >Are you a member of a Right To Die (RTD) Organization ?<\/label>\n          <div class=\"controls\"><div class=\"radio-group\">\n<fieldset class=\"no-border\">\n<legend class=\"screen-reader-text\">Are you a member of a Right To Die (RTD) Organization ?<\/legend>\n<label>\n<input name=\"are_you_a_member_of_a_right_to_die_rtd_organization_\" id=\"pdb-are_you_a_member_of_a_right_to_die_rtd_organization_-yes-2\" type=\"radio\" value=\"YES\" \/>\nJA<\/label>\n<label>\n<input name=\"are_you_a_member_of_a_right_to_die_rtd_organization_\" id=\"pdb-are_you_a_member_of_a_right_to_die_rtd_organization_-no-2\" type=\"radio\" value=\"NO\" \/>\nNEIN<\/label>\n<\/fieldset><!-- .no-border --><\/div><!-- .radio-group -->\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line rtd_membership-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-rtd_membership-2\" >Mitglied von:<\/label>\n          <div class=\"controls\"><input name=\"rtd_membership\" id=\"pdb-rtd_membership-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-line occupation-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-occupation-2\" >Beruf (vor der Pensionierung)<\/label>\n          <div class=\"controls\"><input name=\"occupation\" id=\"pdb-occupation-2\" class=\" regular-text\" type=\"text\" value=\"\" \/>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"radio mental_illness-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-mental_illness-2\" >Wurde bei Ihnen jemals eine Geisteskrankheit diagnostiziert? <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><div class=\"radio-group\">\n<fieldset class=\"no-border\">\n<legend class=\"screen-reader-text\">Wurde bei Ihnen jemals eine Geisteskrankheit diagnostiziert? *<\/legend>\n<label>\n<input name=\"mental_illness\" required id=\"pdb-mental_illness-yes-2\" type=\"radio\" value=\"YES\" \/>\nJA<\/label>\n<label>\n<input name=\"mental_illness\" required id=\"pdb-mental_illness-no-2\" type=\"radio\" value=\"NO\" \/>\nNEIN<\/label>\n<\/fieldset><!-- .no-border --><\/div><!-- .radio-group -->\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-area mantal__illness_diagnosis-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-mantal__illness_diagnosis-2\" >Diagnose (max. 300 Zeichen)<\/label>\n          <div class=\"controls\"><textarea name=\"mantal__illness_diagnosis\" rows=\"2\" cols=\"40\" maxlength=\"300\" id=\"pdb-mantal__illness_diagnosis-2\"><\/textarea>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"radio neurological_condition-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-neurological_condition-2\" >Wurde bei Ihnen jemals eine neurologische Erkrankung diagnostiziert? <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><div class=\"radio-group\">\n<fieldset class=\"no-border\">\n<legend class=\"screen-reader-text\">Wurde bei Ihnen jemals eine neurologische Erkrankung diagnostiziert? *<\/legend>\n<label>\n<input name=\"neurological_condition\" required id=\"pdb-neurological_condition-yes-2\" type=\"radio\" value=\"YES\" \/>\nJA<\/label>\n<label>\n<input name=\"neurological_condition\" required id=\"pdb-neurological_condition-no-2\" type=\"radio\" value=\"NO\" \/>\nNEIN<\/label>\n<\/fieldset><!-- .no-border --><\/div><!-- .radio-group -->\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-area neurological_condition_diagnosis-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-neurological_condition_diagnosis-2\" >Diagnose (max. 300 Zeichen)<\/label>\n          <div class=\"controls\"><textarea name=\"neurological_condition_diagnosis\" rows=\"2\" cols=\"40\" maxlength=\"300\" id=\"pdb-neurological_condition_diagnosis-2\"><\/textarea>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"html heading_mental_illness-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-heading_mental_illness-2\" >Bitte beachten Sie:<\/label>\n          <div class=\"controls\"><span class=\"html-element-container\"><\/span>\n\n\t\t\t\t\t\t              <span class=\"help-block\">\n                Eine Geisteskrankheit allein verhindert nicht, dass ein Antrag von Pegasos angenommen wird. Es bleibt jedoch Pegasos \u00fcberlassen, ob eine Konsultation mit einem Psychiater in der Schweiz erforderlich ist.              <\/span>\n            \n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"select-other nature_of_interest_in_joining_pegasos-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-nature_of_interest_in_joining_pegasos-2\" >Hauptgrund Ihrer Registrierung<\/label>\n          <div class=\"controls\"><div class=\"selectother radio-other-control-group\">\n<div class=\"radio-group\">\n<fieldset class=\"no-border\">\n<legend class=\"screen-reader-text\">Hauptgrund Ihrer Registrierung<\/legend>\n<label>\n<input name=\"nature_of_interest_in_joining_pegasos\" id=\"pdb-nature_of_interest_in_joining_pegasos-general-interest-2\" type=\"radio\" value=\"General interest\" \/>\nAllgemeines Interesse<\/label>\n<label>\n<input name=\"nature_of_interest_in_joining_pegasos\" id=\"pdb-nature_of_interest_in_joining_pegasos-support-the-work-of-pegasos-2\" type=\"radio\" value=\"Support the work of Pegasos\" \/>\nUm die Arbeit von Pegasos zu unterst\u00fctzen<\/label>\n<label>\n<input name=\"nature_of_interest_in_joining_pegasos\" id=\"pdb-nature_of_interest_in_joining_pegasos-insurance-policy-for-the-future-2\" type=\"radio\" value=\"Insurance policy for the future\" \/>\nVersicherung f\u00fcr die Zukunft<\/label>\n<label>\n<input name=\"nature_of_interest_in_joining_pegasos\" id=\"pdb-nature_of_interest_in_joining_pegasos-to-use-the-service-in-the-coming-12-months-2\" type=\"radio\" value=\"To use the service in the coming 12 months\" \/>\nNutzung in den kommenden 12 Monaten<\/label>\n<div class=\"othercontrol\">\n<label>\n<input type=\"radio\" name=\"nature_of_interest_in_joining_pegasos\" value=\"Andere\" id=\"pdb-nature_of_interest_in_joining_pegasos-2_otherselect\" class=\"otherselect\" \/>\nAndere:\n<\/label>\n<input type=\"text\" name=\"\" value=\"\" id=\"pdb-nature_of_interest_in_joining_pegasos-2_other\" class=\"otherfield\" \/>\n<\/div><!-- .othercontrol -->\n<\/fieldset><!-- .no-border --><\/div><!-- .radio-group -->\n<\/div><!-- .radio-other-control-group -->\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-area how_did_you_hear_about_pegasos_-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-how_did_you_hear_about_pegasos_-2\" >How did you hear about pegasos ? <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><textarea name=\"how_did_you_hear_about_pegasos_\" rows=\"2\" cols=\"40\" required id=\"pdb-how_did_you_hear_about_pegasos_-2\" class=\"required-field\"><\/textarea>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"file-upload photo_id-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-photo_id-2\" >F\u00fcr Pegasos ist es wichtig zu wissen, mit wem wir es zu tun haben. Laden Sie bitte Ihren Personalausweis hier hoch<br> (Reisepass, F\u00fchrerschein usw.).<br>Max. 5 MB <span class=\"astrick_red\">*<\/span><\/label>\n          <div class=\"controls\"><div class=\"pdb-upload\">\n<input name=\"MAX_FILE_SIZE\" type=\"hidden\" value=\"67108864\" \/>\n\n<input name=\"photo_id\" type=\"hidden\" value=\"\" \/>\n\n<input name=\"photo_id\" id=\"pdb-photo_id-2\" class=\"required-field\" type=\"file\" value=\"\" \/>\n<\/div>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"file-upload living_will-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-living_will-2\" >Falls Sie eine Patientenverf\u00fcgung verfasst haben, k\u00f6nnen sie diese hier hochladen.<\/label>\n          <div class=\"controls\"><div class=\"pdb-upload\">\n<input name=\"MAX_FILE_SIZE\" type=\"hidden\" value=\"67108864\" \/>\n\n<input name=\"living_will\" type=\"hidden\" value=\"\" \/>\n\n<input name=\"living_will\" id=\"pdb-living_will-2\" type=\"file\" value=\"\" \/>\n<\/div>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"radio i_have_read_the_privacy_policy-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-i_have_read_the_privacy_policy-2\" >Bitte \u00fcberpr\u00fcfen und akzeptieren Sie die <a href=\"\/privacy\/\" target=\"blank\">Datenschutzbestimmungen<\/a> hier:<\/label>\n          <div class=\"controls\"><div class=\"radio-group\">\n<fieldset class=\"no-border\">\n<legend class=\"screen-reader-text\">Bitte \u00fcberpr\u00fcfen und akzeptieren Sie die Datenschutzbestimmungen hier:<\/legend>\n<label class=\"required-field\">\n<input name=\"i_have_read_the_privacy_policy\" required id=\"pdb-i_have_read_the_privacy_policy-yes-2\" class=\"required-field\" type=\"radio\" value=\"YES\" \/>\nJA<\/label>\n<label class=\"required-field\">\n<input name=\"i_have_read_the_privacy_policy\" required id=\"pdb-i_have_read_the_privacy_policy-no-2\" class=\"required-field\" type=\"radio\" value=\"NO\" \/>\nNEIN<\/label>\n<\/fieldset><!-- .no-border --><\/div><!-- .radio-group -->\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"text-area here_you_may_write_an_optional_message_to_pegasus-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-here_you_may_write_an_optional_message_to_pegasus-2\" >Gibt es noch etwas, das Sie Pegasos an dieser Stelle mitteilen m\u00f6chten?<\/label>\n          <div class=\"controls\"><textarea name=\"here_you_may_write_an_optional_message_to_pegasus\" rows=\"2\" cols=\"40\" id=\"pdb-here_you_may_write_an_optional_message_to_pegasus-2\"><\/textarea>\n\n\t\t\t\t\t\t\n          <\/div>\n          \n        <\/div>\n\n                \n        \n        <div class=\"html dd-input-group control-group \">\n\n          <label class=\"control-label\" for=\"pdb-dd-2\" ><\/label>\n          <div class=\"controls\"><span class=\"html-element-container\"><\/span>\n\n\t\t\t\t\t\t              <span class=\"help-block\">\n                Stellen Sie sicher, dass Sie Ihre richtige E-Mail-Adresse eingegeben haben und notieren Sie das gew\u00e4hlte Kennwort.<br><br>Wenn Sie fertig sind, klicken Sie bitte auf SPEICHERN.              <\/span>\n            \n          <\/div>\n          \n        <\/div>\n\n                  \n        <div id=\"submit-button\" class=\"controls\">\n          <button type=\"submit\" class=\"btn btn-default force-step ui-tabs-submit pdb-submit\" >Sign Up<\/button><button class=\"btn btn-default force-step ui-tabs-next\" >Next<\/button>        <\/div>\n        \n        <\/fieldset>\n      \n        \n                <\/div>\n  <\/form><\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/pages\/53"}],"collection":[{"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/comments?post=53"}],"version-history":[{"count":13,"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/pages\/53\/revisions"}],"predecessor-version":[{"id":33317,"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/pages\/53\/revisions\/33317"}],"wp:attachment":[{"href":"https:\/\/staging.pegasos-association.com\/de\/wp-json\/wp\/v2\/media?parent=53"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}