media_prevent-domestic-violence

<div class="wpforms-container wpforms-container-full" id="wpforms-1892"><form id="wpforms-form-1892" class="wpforms-validate wpforms-form" data-formid="1892" method="post" enctype="multipart/form-data" action="/issues/media_prevent-domestic-violence/" data-token="5f21ae83c79d5308ac044657bae87167"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-1892-field_0-container" class="wpforms-field wpforms-field-name" data-field-id="0"><label class="wpforms-field-label" for="wpforms-1892-field_0">Name <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-large"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-1892-field_0" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][0][first]" required><label for="wpforms-1892-field_0" class="wpforms-field-sublabel after ">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-1892-field_0-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][0][last]" required><label for="wpforms-1892-field_0-last" class="wpforms-field-sublabel after ">Last</label></div></div></div><div id="wpforms-1892-field_1-container" class="wpforms-field wpforms-field-email" data-field-id="1"><label class="wpforms-field-label" for="wpforms-1892-field_1">Email <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-1892-field_1" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][1]" required></div><div id="wpforms-1892-field_3-container" class="wpforms-field wpforms-field-phone" data-field-id="3"><label class="wpforms-field-label" for="wpforms-1892-field_3">Mobile phone <span class="wpforms-required-label">*</span></label><input type="tel" id="wpforms-1892-field_3" class="wpforms-field-medium wpforms-field-required wpforms-masked-input" data-inputmask="&#039;mask&#039;: &#039;(999) 999-9999&#039;" data-rule-us-phone-field="true" name="wpforms[fields][3]" required></div><div id="wpforms-1892-field_4-container" class="wpforms-field wpforms-field-text" data-field-id="4"><label class="wpforms-field-label" for="wpforms-1892-field_4">Zip Code</label><input type="text" id="wpforms-1892-field_4" class="wpforms-field-medium" name="wpforms[fields][4]" ></div><div id="wpforms-1892-field_5-container" class="wpforms-field wpforms-field-checkbox" data-field-id="5"><ul id="wpforms-1892-field_5"><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-1892-field_5_1" name="wpforms[fields][5][]" value="I agree to receive texts and/or emails from Anna Pletcher for District Attorney about ways to get involved and support the campaign. Opt out at any time. Message and data rates may apply." ><label class="wpforms-field-label-inline" for="wpforms-1892-field_5_1">I agree to receive texts and/or emails from Anna Pletcher for District Attorney about ways to get involved and support the campaign. Opt out at any time. Message and data rates may apply.</label></li></ul></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-1892-field-hp" class="wpforms-field-label">Phone</label><input type="text" name="wpforms[hp]" id="wpforms-1892-field-hp" class="wpforms-field-medium"></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="1892"><input type="hidden" name="wpforms[author]" value="1"><input type="hidden" name="wpforms[post_id]" value="644"><button type="submit" name="wpforms[submit]" class="wpforms-submit om-trigger-conversion" id="wpforms-submit-1892" value="wpforms-submit" aria-live="assertive" data-alt-text="Sending..." data-submit-text="Submit">Submit</button></div></form></div> <!-- .wpforms-container -->