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[gravityform id="9" title="false" description="false" ajax="true"]
<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_9' style='display:none'><div id='gf_9' class='gform_anchor' tabindex='-1'></div> <div class='gform_heading'> <p class='gform_required_legend'>&quot;<span class="gfield_required gfield_required_asterisk">*</span>&quot; indicates required fields</p> </div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_9' id='gform_9' action='/events/today/#gf_9' novalidate> <div id='gf_progressbar_wrapper_9' class='gf_progressbar_wrapper'> <p class="gf_progressbar_title">Step <span class='gf_step_current_page'>1</span> of <span class='gf_step_page_count'>9</span> </p> <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'> <div class='gf_progressbar_percentage percentbar_blue percentbar_11' style='width:11%;'><span>11%</span></div> </div></div> <div class='gform_body gform-body'><div id='gform_page_9_1' class='gform_page' > <div class='gform_page_fields'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below'><div id="field_9_1" class="gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_1"><strong>You may be entitled to maximum compensation. Take this 60-second qualification and find out:</strong> </br> </br><span style="color:#ffffff;">Injured? Take a few moments to fill out this form to find out if you're entitled to compensation.</span></div><fieldset id="field_9_3" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_3"><legend class='gfield_label' >How were you hurt?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_3'> <div class='gchoice gchoice_9_3_0'> <input class='gfield-choice-input' name='input_3' type='radio' value='Car Accident' id='choice_9_3_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_3_0' id='label_9_3_0'>Car Accident</label> </div> <div class='gchoice gchoice_9_3_1'> <input class='gfield-choice-input' name='input_3' type='radio' value='Truck Accident' id='choice_9_3_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_3_1' id='label_9_3_1'>Truck Accident</label> </div> <div class='gchoice gchoice_9_3_2'> <input class='gfield-choice-input' name='input_3' type='radio' value='Bicycle or Pedestrian Accident' id='choice_9_3_2' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_3_2' id='label_9_3_2'>Bicycle or Pedestrian Accident</label> </div> <div class='gchoice gchoice_9_3_3'> <input class='gfield-choice-input' name='input_3' type='radio' value='Motorcycle Accident' id='choice_9_3_3' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_3_3' id='label_9_3_3'>Motorcycle Accident</label> </div> <div class='gchoice gchoice_9_3_4'> <input class='gfield-choice-input' name='input_3' type='radio' value='Other Motor Vehicle Accident or Injury' id='choice_9_3_4' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_3_4' id='label_9_3_4'>Other Motor Vehicle Accident or Injury</label> </div></div></div></fieldset><div id="field_9_31" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_31"><label class='gfield_label screen-reader-text' for='input_9_31' ></label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_9_31' class='textarea large' aria-invalid="false" rows='10' cols='50'></textarea></div></div></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_next_button_9_4' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_2' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_2' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_9_5" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_5"><legend class='gfield_label' >How long ago was your accident?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_5'> <div class='gchoice gchoice_9_5_0'> <input class='gfield-choice-input' name='input_5' type='radio' value='In the last 14 days' id='choice_9_5_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_0' id='label_9_5_0'>In the last 14 days</label> </div> <div class='gchoice gchoice_9_5_1'> <input class='gfield-choice-input' name='input_5' type='radio' value='Within 1-3 months' id='choice_9_5_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_1' id='label_9_5_1'>Within 1-3 months</label> </div> <div class='gchoice gchoice_9_5_2'> <input class='gfield-choice-input' name='input_5' type='radio' value='Within 3-6 months' id='choice_9_5_2' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_2' id='label_9_5_2'>Within 3-6 months</label> </div> <div class='gchoice gchoice_9_5_3'> <input class='gfield-choice-input' name='input_5' type='radio' value='Within 6-12 months' id='choice_9_5_3' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_3' id='label_9_5_3'>Within 6-12 months</label> </div> <div class='gchoice gchoice_9_5_4'> <input class='gfield-choice-input' name='input_5' type='radio' value='More than 1 year ago' id='choice_9_5_4' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_4' id='label_9_5_4'>More than 1 year ago</label> </div> <div class='gchoice gchoice_9_5_5'> <input class='gfield-choice-input' name='input_5' type='radio' value='More than 2 years ago' id='choice_9_5_5' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_5_5' id='label_9_5_5'>More than 2 years ago</label> </div></div></div></fieldset></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_7' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("1"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("1"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_7' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("3"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("3"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_3' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_3' class='gform_fields top_label form_sublabel_below description_below'><div id="field_9_28" class="gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_28"><p style="color:#fff">You may be past the statute of limitations. Call ASAP to see if you still have options available to pursue your case.</p></div><fieldset id="field_9_8" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_8"><legend class='gfield_label' >Was the accident your fault?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_8'> <div class='gchoice gchoice_9_8_0'> <input class='gfield-choice-input' name='input_8' type='radio' value='First No, it was not my fault' id='choice_9_8_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_8_0' id='label_9_8_0'>No, it was not my fault</label> </div> <div class='gchoice gchoice_9_8_1'> <input class='gfield-choice-input' name='input_8' type='radio' value='Yes, it was my fault' id='choice_9_8_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_8_1' id='label_9_8_1'>Yes, it was my fault</label> </div></div></div></fieldset></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_9' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("2"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_9' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("4"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("4"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_4' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_4' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_9_10" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_10"><legend class='gfield_label' >Did the police arrive?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_10'> <div class='gchoice gchoice_9_10_0'> <input class='gfield-choice-input' name='input_10' type='radio' value='Yes' id='choice_9_10_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_10_0' id='label_9_10_0'>Yes</label> </div> <div class='gchoice gchoice_9_10_1'> <input class='gfield-choice-input' name='input_10' type='radio' value='No' id='choice_9_10_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_10_1' id='label_9_10_1'>No</label> </div> <div class='gchoice gchoice_9_10_2'> <input class='gfield-choice-input' name='input_10' type='radio' value='I don&#039;t know' id='choice_9_10_2' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_10_2' id='label_9_10_2'>I don't know</label> </div></div></div></fieldset></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_11' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("3"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("3"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_11' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("5"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("5"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_5' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_5' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_9_12" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_12"><legend class='gfield_label' >What are the extent of your injuries?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_12'> <div class='gchoice gchoice_9_12_0'> <input class='gfield-choice-input' name='input_12' type='radio' value='Fatality or Wrongful Death' id='choice_9_12_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_12_0' id='label_9_12_0'>Fatality or Wrongful Death</label> </div> <div class='gchoice gchoice_9_12_1'> <input class='gfield-choice-input' name='input_12' type='radio' value='Severe Injury: Dismemberment, Broken Bones, Fractures, Body Organ Injury, Concussion' id='choice_9_12_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_12_1' id='label_9_12_1'>Severe Injury: Dismemberment, Broken Bones, Fractures, Body Organ Injury, Concussion</label> </div> <div class='gchoice gchoice_9_12_2'> <input class='gfield-choice-input' name='input_12' type='radio' value='Moderate Injury: Soft Tissue Neck and Back Pain or Whiplash' id='choice_9_12_2' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_12_2' id='label_9_12_2'>Moderate Injury: Soft Tissue Neck and Back Pain or Whiplash</label> </div> <div class='gchoice gchoice_9_12_3'> <input class='gfield-choice-input' name='input_12' type='radio' value='No Physical Injuries' id='choice_9_12_3' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_12_3' id='label_9_12_3'>No Physical Injuries</label> </div></div></div></fieldset></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_13' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("4"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("4"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_13' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("6"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("6"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_6' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_6' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_9_14" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_14"><legend class='gfield_label' >Are you currently represented by an attorney for this accident?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_14'> <div class='gchoice gchoice_9_14_0'> <input class='gfield-choice-input' name='input_14' type='radio' value='No, I do not have an attorney' id='choice_9_14_0' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_14_0' id='label_9_14_0'>No, I do not have an attorney</label> </div> <div class='gchoice gchoice_9_14_1'> <input class='gfield-choice-input' name='input_14' type='radio' value='I have an attorney but I&#039;m looking for someone else to represent my case' id='choice_9_14_1' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_14_1' id='label_9_14_1'>I have an attorney but I'm looking for someone else to represent my case</label> </div> <div class='gchoice gchoice_9_14_2'> <input class='gfield-choice-input' name='input_14' type='radio' value='Yes, I have an attorney' id='choice_9_14_2' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_14_2' id='label_9_14_2'>Yes, I have an attorney</label> </div> <div class='gchoice gchoice_9_14_3'> <input class='gfield-choice-input' name='input_14' type='radio' value='I have already settled my case' id='choice_9_14_3' onchange='gformToggleRadioOther( this )' /> <label for='choice_9_14_3' id='label_9_14_3'>I have already settled my case</label> </div></div></div></fieldset></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_34' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("5"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("5"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_34' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("7"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("7"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_7' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_7' class='gform_fields top_label form_sublabel_below description_below'><div id="field_9_30" class="gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_30"><p style="color:#fff">Thank you for taking this survey but it appears you do not qualify based on one or more of your answers.</p></div><div id="field_9_35" class="gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_35"><label class='gfield_label' for='input_9_35' >Anything else you&#039;d like us to know about your accident?</label><div class='ginput_container ginput_container_textarea'><textarea name='input_35' id='input_9_35' class='textarea large' aria-invalid="false" rows='10' cols='50'></textarea></div></div></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_15' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("6"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("6"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_15' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("8"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("8"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_8' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_8' class='gform_fields top_label form_sublabel_below description_below'><div id="field_9_18" class="gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_18"><label class='gfield_label' for='input_9_18' >What&#039;s your full name?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_9_18' type='text' value='' class='large' aria-required="true" aria-invalid="false" /> </div></div><div id="field_9_20" class="gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_20"><label class='gfield_label' for='input_9_20' >What&#039;s your email?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_20' id='input_9_20' type='email' value='' class='large' aria-required="true" aria-invalid="false" /> </div></div><div id="field_9_22" class="gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_22"><label class='gfield_label' for='input_9_22' >Your cell phone number?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_22' id='input_9_22' type='tel' value='' class='large' aria-required="true" aria-invalid="false" /></div></div></div> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_9_17' class='gform_previous_button button' value='Previous' onclick='jQuery("#gform_target_page_number_9").val("7"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("7"); jQuery("#gform_9").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_9_17' class='gform_next_button button' value='Next' onclick='jQuery("#gform_target_page_number_9").val("9"); jQuery("#gform_9").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_9").val("9"); jQuery("#gform_9").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_9_9' class='gform_page text-uppercase' style='display:none;'> <div class='gform_page_fields'> <div id='gform_fields_9_9' class='gform_fields top_label form_sublabel_below description_below'><div id="field_9_23" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_23"><div class='ginput_container ginput_container_text'><input name='input_23' id='input_9_23' type='hidden' class='gform_hidden' aria-invalid="false" value='27521' /></div></div><div id="field_9_24" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_24"><div class='ginput_container ginput_container_text'><input name='input_24' id='input_9_24' type='hidden' class='gform_hidden' aria-invalid="false" value='https://samandashlaw.com/events/today/' /></div></div><div id="field_9_25" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_25"><div class='ginput_container ginput_container_text'><input name='input_25' id='input_9_25' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></div><div id="field_9_26" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_26"><div class='ginput_container ginput_container_text'><input name='input_26' id='input_9_26' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></div><div id="field_9_27" class="gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_27"><div class='ginput_container ginput_container_text'><input name='input_27' id='input_9_27' type='hidden' class='gform_hidden' aria-invalid="false" value='' /></div></div><div id="field_9_32" class="gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_9_32"><span style="color:#ffffff;">We’re here for you every step of the way and will be in contact shortly.</span> <p style=" color: #fff; 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