{"id":3947,"date":"2023-03-07T17:15:22","date_gmt":"2023-03-07T17:15:22","guid":{"rendered":"http:\/\/fenorixa.com.br\/?page_id=3947"},"modified":"2023-03-07T17:24:42","modified_gmt":"2023-03-07T17:24:42","slug":"filiacao","status":"publish","type":"page","link":"https:\/\/fenorixa.com.br\/filiacao\/","title":{"rendered":"Filia\u00e7\u00e3o"},"content":{"rendered":"<p>[vc_row][vc_column][vc_empty_space][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]<em><strong><span style=\"font-size: 14pt;\">Filie-se a Fenorix\u00e1:<\/span><\/strong><\/em><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><b>\n<!-- FormmailMakerFormLoader \/ \nForm Admin Panel: https:\/\/fenorixa.com.br\/wp-content\/plugins\/formmail-maker-form-loader\/admin.php -->\n<style type='text\/css'>\r\n\r\nol.phpfmg_form{\r\n    list-style-type:none;\r\n    padding:0px;\r\n    margin:0px;\r\n}\r\n\r\nol.phpfmg_form input, ol.phpfmg_form textarea, ol.phpfmg_form select{\r\n    border: 1px solid #ccc;\r\n    -moz-border-radius: 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dashed #ff0000;\r\n}\r\n\r\ndiv.instruction_error{\r\n    color: red;\r\n    font-weight:bold;\r\n}\r\n\r\nhr.sectionbreak{\r\n    height:1px;\r\n    color: #ccc;\r\n}\r\n\r\n#one_entry_msg{\r\n    background-color: #F4F6E5;\r\n    border: 1px dashed #ff0000;\r\n    padding: 10px;\r\n    margin-bottom: 10px;\r\n}\r\n\r\n\r\n#frmFormMailContainer input[type=\"submit\"]{\r\n    padding: 10px 25px; \r\n    font-weight: bold;\r\n    margin-bottom: 10px;\r\n    background-color: #FAFBFC;\r\n}\r\n\r\n#frmFormMailContainer input[type=\"submit\"]:hover{\r\n    background-color: #E4F0F8;\r\n}\r\n\r\n    \r\n\r\n\r\n\r\n<\/style>\r\n\r\n\n\n<div class='form_description'>\n\n<\/div>\n\n\n\r\n\r\n\r\n\r\n<div id='frmFormMailContainer'>\r\n\r\n<form name=\"frmFormMail\" id=\"frmFormMail\" target=\"submitToFrame\" action='https:\/\/fenorixa.com.br\/wp-content\/plugins\/formmail-maker-form-loader\/admin.php' method='post' enctype='multipart\/form-data' onsubmit='return fmgHandler.onSubmit(this);'>\r\n\r\n<input type='hidden' name='formmail_submit' value='Y'>\r\n<input type='hidden' name='mod' value='ajax'>\r\n<input type='hidden' name='func' value='submit'>\r\n\r\n            \r\n<ol class='phpfmg_form' >\r\n\r\n<li class='field_block' id='field_0_div'><div class='col_label'>\r\n\t<label class='form_field'>Nome<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_0\"  id=\"field_0\" value=\"\" class='text_box'>\r\n\t<div id='field_0_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_1_div'><div class='col_label'>\r\n\t<label class='form_field'>Data de Nascimento<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_1_day' id='field_1_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_1_month' id='field_1_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_1_yyyy' id='field_1_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_1_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_1_separator' value='\/'>\n\r\n\t<div id='field_1_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_2_div'><div class='col_label'>\r\n\t<label class='form_field'>RG<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_2\"  id=\"field_2\" value=\"\" class='text_box'>\r\n\t<div id='field_2_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_3_div'><div class='col_label'>\r\n\t<label class='form_field'>CPF<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_3\"  id=\"field_3\" value=\"\" class='text_box'>\r\n\t<div id='field_3_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_49_div'><div class='col_label'>\r\n\t<label class='form_field'>Nome do Pai<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_49\"  id=\"field_49\" value=\"\" class='text_box'>\r\n\t<div id='field_49_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_48_div'><div class='col_label'>\r\n\t<label class='form_field'>Nome da M\u00e3e<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_48\"  id=\"field_48\" value=\"\" class='text_box'>\r\n\t<div id='field_48_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_4_div'><div class='col_label'>\r\n\t<label class='form_field'>Estado Civil<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<select name='field_4' id='field_4' class='text_select'    >\t\n<option value=\"Casado (a)\" >Casado (a)<\/option>\t\n<option value=\"Solteiro (a)\" >Solteiro (a)<\/option>\t\n<option value=\"Vi\u00favo (a)\" >Vi\u00favo (a)<\/option>\t\n<\/select>\n\t<div id='field_4_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_5_div'><div class='col_label'>\r\n\t<label class='form_field'>Profiss\u00e3o<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_5\"  id=\"field_5\" value=\"\" class='text_box'>\r\n\t<div id='field_5_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_6_div'><div class='col_label'>\r\n\t<label class='form_field'>Naturalidade<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_6\"  id=\"field_6\" value=\"\" class='text_box'>\r\n\t<div id='field_6_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_7_div'><div class='col_label'>\r\n\t<label class='form_field'>Nacionalidade<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<select name='field_7' id='field_7' class='text_select'    >\t\n<option value=\"Brasileiro (a)\" >Brasileiro (a)<\/option>\t\n<option value=\"Estrangeiro (a)\" >Estrangeiro (a)<\/option>\t\n<\/select>\n\t<div id='field_7_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_8_div'><div class='col_label'>\r\n\t<label class='form_field'>Endere\u00e7o<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_8\"  id=\"field_8\" value=\"\" class='text_box'>\r\n\t<div id='field_8_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_9_div'><div class='col_label'>\r\n\t<label class='form_field'>Bairro<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_9\"  id=\"field_9\" value=\"\" class='text_box'>\r\n\t<div id='field_9_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_10_div'><div class='col_label'>\r\n\t<label class='form_field'>CEP<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_10\"  id=\"field_10\" value=\"\" class='text_box'>\r\n\t<div id='field_10_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_11_div'><div class='col_label'>\r\n\t<label class='form_field'>Cidade<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_11\"  id=\"field_11\" value=\"\" class='text_box'>\r\n\t<div id='field_11_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_12_div'><div class='col_label'>\r\n\t<label class='form_field'>Estado<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<select name='field_12' id='field_12' class='text_select'    >\t\n<option value=\"Acre\" >Acre<\/option>\t\n<option value=\"Alagoas\" >Alagoas<\/option>\t\n<option value=\"Amap\u00e1\" >Amap\u00e1<\/option>\t\n<option value=\"Amazonas\" >Amazonas<\/option>\t\n<option value=\"Bahia\" >Bahia<\/option>\t\n<option value=\"Cear\u00e1\" >Cear\u00e1<\/option>\t\n<option value=\"Distrito Federal\" >Distrito Federal<\/option>\t\n<option value=\"Esp\u00edrito Santo\" >Esp\u00edrito Santo<\/option>\t\n<option value=\"Goi\u00e1s\" >Goi\u00e1s<\/option>\t\n<option value=\"Maranh\u00e3o\" >Maranh\u00e3o<\/option>\t\n<option value=\"Mato Grosso\" >Mato Grosso<\/option>\t\n<option value=\"Mato Grosso do Sul\" >Mato Grosso do Sul<\/option>\t\n<option value=\"Minas Gerais\" >Minas Gerais<\/option>\t\n<option value=\"Par\u00e1\" >Par\u00e1<\/option>\t\n<option value=\"Para\u00edba\" >Para\u00edba<\/option>\t\n<option value=\"Paran\u00e1\" >Paran\u00e1<\/option>\t\n<option value=\"Pernambuco\" >Pernambuco<\/option>\t\n<option value=\"Piau\u00ed\" >Piau\u00ed<\/option>\t\n<option value=\"Rio de Janeiro\" >Rio de Janeiro<\/option>\t\n<option value=\"Rio Grande do Norte\" >Rio Grande do Norte<\/option>\t\n<option value=\"Rio Grande do Sul\" >Rio Grande do Sul<\/option>\t\n<option value=\"Rond\u00f4nia\" >Rond\u00f4nia<\/option>\t\n<option value=\"Roraima\" >Roraima<\/option>\t\n<option value=\"Santa Catarina\" >Santa Catarina<\/option>\t\n<option value=\"S\u00e3o Paulo\" >S\u00e3o Paulo<\/option>\t\n<option value=\"Sergipe\" >Sergipe<\/option>\t\n<option value=\"Tocantins\" >Tocantins<\/option>\t\n<\/select>\n\t<div id='field_12_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_13_div'><div class='col_label'>\r\n\t<label class='form_field'>E-mail<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_13\"  id=\"field_13\" value=\"\" class='text_box'>\r\n\t<div id='field_13_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_14_div'><div class='col_label'>\r\n\t<label class='form_field'>Tel. Residencial<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_14\"  id=\"field_14\" value=\"\" class='text_box'>\r\n\t<div id='field_14_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_15_div'><div class='col_label'>\r\n\t<label class='form_field'>Tel. Celular ( WhatsApp )<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_15\"  id=\"field_15\" value=\"\" class='text_box'>\r\n\t<div id='field_15_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_16_div'><div class='col_label'>\r\n\t<label class='form_field'>R\u00e1dio ID<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_16\"  id=\"field_16\" value=\"\" class='text_box'>\r\n\t<div id='field_16_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_17_div'><div class='col_label'>\r\n\t<label class='form_field'>Nome do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_17\"  id=\"field_17\" value=\"\" class='text_box'>\r\n\t<div id='field_17_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_18_div'><div class='col_label'>\r\n\t<label class='form_field'>Endere\u00e7o do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_18\"  id=\"field_18\" value=\"\" class='text_box'>\r\n\t<div id='field_18_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_19_div'><div class='col_label'>\r\n\t<label class='form_field'>Bairro do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_19\"  id=\"field_19\" value=\"\" class='text_box'>\r\n\t<div id='field_19_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_20_div'><div class='col_label'>\r\n\t<label class='form_field'>CEP do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_20\"  id=\"field_20\" value=\"\" class='text_box'>\r\n\t<div id='field_20_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_21_div'><div class='col_label'>\r\n\t<label class='form_field'>Cidade do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_21\"  id=\"field_21\" value=\"\" class='text_box'>\r\n\t<div id='field_21_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_22_div'><div class='col_label'>\r\n\t<label class='form_field'>Estado do Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<select name='field_22' id='field_22' class='text_select'    >\t\n<option value=\"Acre\" >Acre<\/option>\t\n<option value=\"Alagoas\" >Alagoas<\/option>\t\n<option value=\"Amap\u00e1\" >Amap\u00e1<\/option>\t\n<option value=\"Amazonas\" >Amazonas<\/option>\t\n<option value=\"Bahia\" >Bahia<\/option>\t\n<option value=\"Cear\u00e1\" >Cear\u00e1<\/option>\t\n<option value=\"Distrito Federal\" >Distrito Federal<\/option>\t\n<option value=\"Esp\u00edrito Santo\" >Esp\u00edrito Santo<\/option>\t\n<option value=\"Goi\u00e1s\" >Goi\u00e1s<\/option>\t\n<option value=\"Maranh\u00e3o\" >Maranh\u00e3o<\/option>\t\n<option value=\"Mato Grosso\" >Mato Grosso<\/option>\t\n<option value=\"Mato Grosso do Sul\" >Mato Grosso do Sul<\/option>\t\n<option value=\"Minas Gerais\" >Minas Gerais<\/option>\t\n<option value=\"Par\u00e1\" >Par\u00e1<\/option>\t\n<option value=\"Para\u00edba\" >Para\u00edba<\/option>\t\n<option value=\"Paran\u00e1\" >Paran\u00e1<\/option>\t\n<option value=\"Pernambuco\" >Pernambuco<\/option>\t\n<option value=\"Piau\u00ed\" >Piau\u00ed<\/option>\t\n<option value=\"Rio de Janeiro\" >Rio de Janeiro<\/option>\t\n<option value=\"Rio Grande do Norte\" >Rio Grande do Norte<\/option>\t\n<option value=\"Rio Grande do Sul\" >Rio Grande do Sul<\/option>\t\n<option value=\"Rond\u00f4nia\" >Rond\u00f4nia<\/option>\t\n<option value=\"Roraima\" >Roraima<\/option>\t\n<option value=\"Santa Catarina\" >Santa Catarina<\/option>\t\n<option value=\"S\u00e3o Paulo\" >S\u00e3o Paulo<\/option>\t\n<option value=\"Sergipe\" >Sergipe<\/option>\t\n<option value=\"Tocantins\" >Tocantins<\/option>\t\n<\/select>\n\t<div id='field_22_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_23_div'><div class='col_label'>\r\n\t<label class='form_field'>Tel. Fixo Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_23\"  id=\"field_23\" value=\"\" class='text_box'>\r\n\t<div id='field_23_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_24_div'><div class='col_label'>\r\n\t<label class='form_field'>Tel. Celular Templo<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_24\"  id=\"field_24\" value=\"\" class='text_box'>\r\n\t<div id='field_24_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_25_div'><div class='col_label'>\r\n\t<label class='form_field'>Sacerdote Iniciador<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_25\"  id=\"field_25\" value=\"\" class='text_box'>\r\n\t<div id='field_25_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_26_div'><div class='col_label'>\r\n\t<label class='form_field'>Na\u00e7\u00e3o<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<select name='field_26' id='field_26' class='text_select'    >\t\n<option value=\"Ketu\" >Ketu<\/option>\t\n<option value=\"Angola\" >Angola<\/option>\t\n<option value=\"Umbanda\" >Umbanda<\/option>\t\n<\/select>\n\t<div id='field_26_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_27_div'><div class='col_label'>\r\n\t<label class='form_field'>Sacerdote Atual<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_27\"  id=\"field_27\" value=\"\" class='text_box'>\r\n\t<div id='field_27_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_28_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Incia\u00e7\u00e3o<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_28_day' id='field_28_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_28_month' id='field_28_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_28_yyyy' id='field_28_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_28_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_28_separator' value='\/'>\n\r\n\t<div id='field_28_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_29_div'><div class='col_label'>\r\n\t<label class='form_field'>\u00d2r\u00ecs\u00e0s<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<textarea name=\"field_29\" id=\"field_29\" rows=4 cols=25 class='text_area'><\/textarea>\r\n\r\n\t<div id='field_29_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_30_div'><div class='col_label'>\r\n\t<label class='form_field'>Morunk\u00f3<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_30\"  id=\"field_30\" value=\"\" class='text_box'>\r\n\t<div id='field_30_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_31_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 01 Ano<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_31_day' id='field_31_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_31_month' id='field_31_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_31_yyyy' id='field_31_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_31_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_31_separator' value='\/'>\n\r\n\t<div id='field_31_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_32_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_32\"  id=\"field_32\" value=\"\" class='text_box'>\r\n\t<div id='field_32_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_33_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 03 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_33_day' id='field_33_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_33_month' id='field_33_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_33_yyyy' id='field_33_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_33_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_33_separator' value='\/'>\n\r\n\t<div id='field_33_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_34_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_34\"  id=\"field_34\" value=\"\" class='text_box'>\r\n\t<div id='field_34_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_35_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 05 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_35_day' id='field_35_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_35_month' id='field_35_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_35_yyyy' id='field_35_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_35_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_35_separator' value='\/'>\n\r\n\t<div id='field_35_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_36_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_36\"  id=\"field_36\" value=\"\" class='text_box'>\r\n\t<div id='field_36_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_37_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 07 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_37_day' id='field_37_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_37_month' id='field_37_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_37_yyyy' id='field_37_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_37_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_37_separator' value='\/'>\n\r\n\t<div id='field_37_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_38_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_38\"  id=\"field_38\" value=\"\" class='text_box'>\r\n\t<div id='field_38_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_39_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 14 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_39_day' id='field_39_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_39_month' id='field_39_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_39_yyyy' id='field_39_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_39_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_39_separator' value='\/'>\n\r\n\t<div id='field_39_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_40_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_40\"  id=\"field_40\" value=\"\" class='text_box'>\r\n\t<div id='field_40_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_41_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 21 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_41_day' id='field_41_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_41_month' id='field_41_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_41_yyyy' id='field_41_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_41_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_41_separator' value='\/'>\n\r\n\t<div id='field_41_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_42_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_42\"  id=\"field_42\" value=\"\" class='text_box'>\r\n\t<div id='field_42_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_43_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 25 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_43_day' id='field_43_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_43_month' id='field_43_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_43_yyyy' id='field_43_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_43_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_43_separator' value='\/'>\n\r\n\t<div id='field_43_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_44_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_44\"  id=\"field_44\" value=\"\" class='text_box'>\r\n\t<div id='field_44_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_45_div'><div class='col_label'>\r\n\t<label class='form_field'>Data Obriga\u00e7\u00e3o de 50 Anos<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t\r\n<select name='field_45_day' id='field_45_day' class=''    >\t\n<option value=\"\" selected>-DD-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<option value=\"13\" >13<\/option>\t\n<option value=\"14\" >14<\/option>\t\n<option value=\"15\" >15<\/option>\t\n<option value=\"16\" >16<\/option>\t\n<option value=\"17\" >17<\/option>\t\n<option value=\"18\" >18<\/option>\t\n<option value=\"19\" >19<\/option>\t\n<option value=\"20\" >20<\/option>\t\n<option value=\"21\" >21<\/option>\t\n<option value=\"22\" >22<\/option>\t\n<option value=\"23\" >23<\/option>\t\n<option value=\"24\" >24<\/option>\t\n<option value=\"25\" >25<\/option>\t\n<option value=\"26\" >26<\/option>\t\n<option value=\"27\" >27<\/option>\t\n<option value=\"28\" >28<\/option>\t\n<option value=\"29\" >29<\/option>\t\n<option value=\"30\" >30<\/option>\t\n<option value=\"31\" >31<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_45_month' id='field_45_month' class=''    >\t\n<option value=\"\" selected>-MM-<\/option>\t\n<option value=\"01\" >01<\/option>\t\n<option value=\"02\" >02<\/option>\t\n<option value=\"03\" >03<\/option>\t\n<option value=\"04\" >04<\/option>\t\n<option value=\"05\" >05<\/option>\t\n<option value=\"06\" >06<\/option>\t\n<option value=\"07\" >07<\/option>\t\n<option value=\"08\" >08<\/option>\t\n<option value=\"09\" >09<\/option>\t\n<option value=\"10\" >10<\/option>\t\n<option value=\"11\" >11<\/option>\t\n<option value=\"12\" >12<\/option>\t\n<\/select>\n\/&nbsp;<select name='field_45_yyyy' id='field_45_yyyy' class=''    >\t\n<option value=\"\" selected>-YYYY-<\/option>\t\n<option value=\"1924\" >1924<\/option>\t\n<option value=\"1925\" >1925<\/option>\t\n<option value=\"1926\" >1926<\/option>\t\n<option value=\"1927\" >1927<\/option>\t\n<option value=\"1928\" >1928<\/option>\t\n<option value=\"1929\" >1929<\/option>\t\n<option value=\"1930\" >1930<\/option>\t\n<option value=\"1931\" >1931<\/option>\t\n<option value=\"1932\" >1932<\/option>\t\n<option value=\"1933\" >1933<\/option>\t\n<option value=\"1934\" >1934<\/option>\t\n<option value=\"1935\" >1935<\/option>\t\n<option value=\"1936\" >1936<\/option>\t\n<option value=\"1937\" >1937<\/option>\t\n<option value=\"1938\" >1938<\/option>\t\n<option value=\"1939\" >1939<\/option>\t\n<option value=\"1940\" >1940<\/option>\t\n<option value=\"1941\" >1941<\/option>\t\n<option value=\"1942\" >1942<\/option>\t\n<option value=\"1943\" >1943<\/option>\t\n<option value=\"1944\" >1944<\/option>\t\n<option value=\"1945\" >1945<\/option>\t\n<option value=\"1946\" >1946<\/option>\t\n<option value=\"1947\" >1947<\/option>\t\n<option value=\"1948\" >1948<\/option>\t\n<option value=\"1949\" >1949<\/option>\t\n<option value=\"1950\" >1950<\/option>\t\n<option value=\"1951\" >1951<\/option>\t\n<option value=\"1952\" >1952<\/option>\t\n<option value=\"1953\" >1953<\/option>\t\n<option value=\"1954\" >1954<\/option>\t\n<option value=\"1955\" >1955<\/option>\t\n<option value=\"1956\" >1956<\/option>\t\n<option value=\"1957\" >1957<\/option>\t\n<option value=\"1958\" >1958<\/option>\t\n<option value=\"1959\" >1959<\/option>\t\n<option value=\"1960\" >1960<\/option>\t\n<option value=\"1961\" >1961<\/option>\t\n<option value=\"1962\" >1962<\/option>\t\n<option value=\"1963\" >1963<\/option>\t\n<option value=\"1964\" >1964<\/option>\t\n<option value=\"1965\" >1965<\/option>\t\n<option value=\"1966\" >1966<\/option>\t\n<option value=\"1967\" >1967<\/option>\t\n<option value=\"1968\" >1968<\/option>\t\n<option value=\"1969\" >1969<\/option>\t\n<option value=\"1970\" >1970<\/option>\t\n<option value=\"1971\" >1971<\/option>\t\n<option value=\"1972\" >1972<\/option>\t\n<option value=\"1973\" >1973<\/option>\t\n<option value=\"1974\" >1974<\/option>\t\n<option value=\"1975\" >1975<\/option>\t\n<option value=\"1976\" >1976<\/option>\t\n<option value=\"1977\" >1977<\/option>\t\n<option value=\"1978\" >1978<\/option>\t\n<option value=\"1979\" >1979<\/option>\t\n<option value=\"1980\" >1980<\/option>\t\n<option value=\"1981\" >1981<\/option>\t\n<option value=\"1982\" >1982<\/option>\t\n<option value=\"1983\" >1983<\/option>\t\n<option value=\"1984\" >1984<\/option>\t\n<option value=\"1985\" >1985<\/option>\t\n<option value=\"1986\" >1986<\/option>\t\n<option value=\"1987\" >1987<\/option>\t\n<option value=\"1988\" >1988<\/option>\t\n<option value=\"1989\" >1989<\/option>\t\n<option value=\"1990\" >1990<\/option>\t\n<option value=\"1991\" >1991<\/option>\t\n<option value=\"1992\" >1992<\/option>\t\n<option value=\"1993\" >1993<\/option>\t\n<option value=\"1994\" >1994<\/option>\t\n<option value=\"1995\" >1995<\/option>\t\n<option value=\"1996\" >1996<\/option>\t\n<option value=\"1997\" >1997<\/option>\t\n<option value=\"1998\" >1998<\/option>\t\n<option value=\"1999\" >1999<\/option>\t\n<option value=\"2000\" >2000<\/option>\t\n<option value=\"2001\" >2001<\/option>\t\n<option value=\"2002\" >2002<\/option>\t\n<option value=\"2003\" >2003<\/option>\t\n<option value=\"2004\" >2004<\/option>\t\n<option value=\"2005\" >2005<\/option>\t\n<option value=\"2006\" >2006<\/option>\t\n<option value=\"2007\" >2007<\/option>\t\n<option value=\"2008\" >2008<\/option>\t\n<option value=\"2009\" >2009<\/option>\t\n<option value=\"2010\" >2010<\/option>\t\n<option value=\"2011\" >2011<\/option>\t\n<option value=\"2012\" >2012<\/option>\t\n<option value=\"2013\" >2013<\/option>\t\n<option value=\"2014\" >2014<\/option>\t\n<option value=\"2015\" >2015<\/option>\t\n<option value=\"2016\" >2016<\/option>\t\n<option value=\"2017\" >2017<\/option>\t\n<option value=\"2018\" >2018<\/option>\t\n<option value=\"2019\" >2019<\/option>\t\n<option value=\"2020\" >2020<\/option>\t\n<option value=\"2021\" >2021<\/option>\t\n<option value=\"2022\" >2022<\/option>\t\n<option value=\"2023\" >2023<\/option>\t\n<option value=\"2024\" >2024<\/option>\t\n<\/select>\n\n<input type='hidden' name='field_45_format' value='dd\/mm\/yyyy'>\n<input type='hidden' name='field_45_separator' value='\/'>\n\r\n\t<div id='field_45_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_46_div'><div class='col_label'>\r\n\t<label class='form_field'>Com<\/label> <label class='form_required' >&nbsp;<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type=\"text\" name=\"field_46\"  id=\"field_46\" value=\"\" class='text_box'>\r\n\t<div id='field_46_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n<li class='field_block' id='field_47_div'><div class='col_label'>\r\n\t<label class='form_field'>Autoriza\u00e7\u00e3o<\/label> <label class='form_required' >*<\/label> <\/div>\r\n\t<div class='col_field'>\r\n\t<input type='checkbox' name='Checkbox01_field_47' id='field_47_0'  value=\"1- Declaro estar ciente dos meus direitos e das minhas obriga\u00e7\u00f5es perante a Federa\u00e7\u00e3o, aceitando e efetivando minha filia\u00e7\u00e3o junto a FENORIX\u00c1, assumindo o compromisso e respeitando na integra o estatuto.             Assumo o compromisso de efetuar os pagamentos das mensalidades que ser\u00e1 cobrada atrav\u00e9s de carn\u00ea banc\u00e1rio. Estou ciente que o n\u00e3o pagamento de 03 (tr\u00eas) contribui\u00e7\u00f5es implicar\u00e1 no cancelamento da minha filia\u00e7\u00e3o, perdendo todos os benef\u00edcios e facilidades adquiridas, devendo devolver toda documenta\u00e7\u00e3o Fenorix\u00e1. O meu v\u00ednculo com a FENORIX\u00c1 \u00e9 de Associado, caso em qualquer momento eu desejar efetuar a abertura jur\u00eddica, com registro de um estatuto pr\u00f3prio, terei que arcar com as despesas pertinentes ao registro JUNTO AO CART\u00d3RIO. Autorizo a publica\u00e7\u00e3o de mat\u00e9rias e Imagens sobre minha casa de As\u00e9 e sobre minha pessoa f\u00edsica\/Sacerd\u00f3cio nos Informes Fenorix\u00e1 e Internet.<\/p>2 - Autorizo que os dados fornecidos neste formul\u00e1rio, seja utilizados exclusivamente para Filia\u00e7\u00e3o junto a FENORIX\u00c1, em conformidade a Lei n\u00ba 13.709\/2018 - LGPG - Lei Geral de Prote\u00e7\u00e3o de Dados.\"   class='form_checkbox'  ><label class='form_choice_text' for='field_47_0'>1- Declaro estar ciente dos meus direitos e das minhas obriga\u00e7\u00f5es perante a Federa\u00e7\u00e3o, aceitando e efetivando minha filia\u00e7\u00e3o junto a FENORIX\u00c1, assumindo o compromisso e respeitando na integra o estatuto.             Assumo o compromisso de efetuar os pagamentos das mensalidades que ser\u00e1 cobrada atrav\u00e9s de carn\u00ea banc\u00e1rio. Estou ciente que o n\u00e3o pagamento de 03 (tr\u00eas) contribui\u00e7\u00f5es implicar\u00e1 no cancelamento da minha filia\u00e7\u00e3o, perdendo todos os benef\u00edcios e facilidades adquiridas, devendo devolver toda documenta\u00e7\u00e3o Fenorix\u00e1. O meu v\u00ednculo com a FENORIX\u00c1 \u00e9 de Associado, caso em qualquer momento eu desejar efetuar a abertura jur\u00eddica, com registro de um estatuto pr\u00f3prio, terei que arcar com as despesas pertinentes ao registro JUNTO AO CART\u00d3RIO. Autorizo a publica\u00e7\u00e3o de mat\u00e9rias e Imagens sobre minha casa de As\u00e9 e sobre minha pessoa f\u00edsica\/Sacerd\u00f3cio nos Informes Fenorix\u00e1 e Internet.<\/p>2 - Autorizo que os dados fornecidos neste formul\u00e1rio, seja utilizados exclusivamente para Filia\u00e7\u00e3o junto a FENORIX\u00c1, em conformidade a Lei n\u00ba 13.709\/2018 - LGPG - Lei Geral de Prote\u00e7\u00e3o de Dados.<\/label><br>\t\n<input type='hidden' name='field_47_length' value='1'>\t<div id='field_47_tip' class='instruction'><\/div>\r\n\t<\/div>\r\n<\/li>\r\n\r\n\r\n            <li>\r\n            <div class='col_label'>&nbsp;<\/div>\r\n            <div class='form_submit_block col_field'>\r\n\t\r\n\r\n                <input type='submit' value='Enviar Inscri\u00e7\u00e3o' class='form_button'>\r\n\r\n\t\t\t\t<div id='err_required' class=\"form_error\" style='display:none;'>\r\n\t\t\t\t    <label class='form_error_title'>Por Favor !!! Verifique todos os campos !!!<\/label>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t\r\n\r\n\r\n                <span id='phpfmg_processing' style='display:none;'>\r\n                    <img id='phpfmg_processing_gif' src='https:\/\/fenorixa.com.br\/wp-content\/plugins\/formmail-maker-form-loader\/admin.php?mod=image&amp;func=processing' border=0 alt='Processando... aguarde !'> <label id='phpfmg_processing_dots'><\/label>\r\n                <\/span>\r\n            <\/div>\r\n            <\/li>\r\n\r\n<\/ol>\r\n<\/form>\r\n\r\n<iframe name=\"submitToFrame\" id=\"submitToFrame\" src=\"javascript:false\" style=\"position:absolute;top:-10000px;left:-10000px;\" \/><\/iframe>\r\n\r\n<\/div>\r\n<!-- end of form container -->\r\n\r\n\r\n<!-- [Your confirmation message goes here] -->\r\n<div id='thank_you_msg' style='display:none;'>\r\nObrigado... sua inscri\u00e7\u00e3o foi enviada para a Fenorix\u00e1, aguarde contato.\r\n<\/div>\r\n\r\n\r\n            \r\n\r\n\r\n\r\n\r\n\r\n\r\n<script type=\"text\/javascript\">\n \/**\n*\n*  UTF-8 data encode \/ decode\n*  http:\/\/www.webtoolkit.info\/\n*\n**\/\n\nvar Utf8 = {\n\n\t\/\/ public method for url encoding\n\tencode : function (string) {\n\t\tstring = string.replace(\/\\r\\n\/g,\"\\n\");\n\t\tvar utftext = \"\";\n\n\t\tfor (var n = 0; n < string.length; n++) {\n\n\t\t\tvar c = string.charCodeAt(n);\n\n\t\t\tif (c < 128) {\n\t\t\t\tutftext += String.fromCharCode(c);\n\t\t\t}\n\t\t\telse if((c > 127) && (c < 2048)) {\n\t\t\t\tutftext += String.fromCharCode((c >> 6) | 192);\n\t\t\t\tutftext += String.fromCharCode((c & 63) | 128);\n\t\t\t}\n\t\t\telse {\n\t\t\t\tutftext += String.fromCharCode((c >> 12) | 224);\n\t\t\t\tutftext += String.fromCharCode(((c >> 6) & 63) | 128);\n\t\t\t\tutftext += String.fromCharCode((c & 63) | 128);\n\t\t\t}\n\n\t\t}\n\n\t\treturn utftext;\n\t},\n\n\t\/\/ public method for url decoding\n\tdecode : function (utftext) {\n\t\tvar string = \"\";\n\t\tvar i = 0;\n\t\tvar c = c1 = c2 = 0;\n\n\t\twhile ( i < utftext.length ) {\n\n\t\t\tc = utftext.charCodeAt(i);\n\n\t\t\tif (c < 128) {\n\t\t\t\tstring += String.fromCharCode(c);\n\t\t\t\ti++;\n\t\t\t}\n\t\t\telse if((c > 191) && (c < 224)) {\n\t\t\t\tc2 = utftext.charCodeAt(i+1);\n\t\t\t\tstring += String.fromCharCode(((c & 31) << 6) | (c2 & 63));\n\t\t\t\ti += 2;\n\t\t\t}\n\t\t\telse {\n\t\t\t\tc2 = utftext.charCodeAt(i+1);\n\t\t\t\tc3 = utftext.charCodeAt(i+2);\n\t\t\t\tstring += String.fromCharCode(((c & 15) << 12) | ((c2 & 63) << 6) | (c3 & 63));\n\t\t\t\ti += 3;\n\t\t\t}\n\n\t\t}\n\n\t\treturn string;\n\t}\n\n}\n\n function dd_change( n, max, prefix ){\n    if( n >= max-1 )\n        return; \/\/ the last dropdown, no need to query\n\n    \/\/var prefix = 'dd_' ;\n    \/\/ reset all other dropdown options\n    var next = n+1;\n    for( var i = next; i < max; i ++ ){\n        var dd = document.getElementById(prefix +'_' + i );\n        if( dd && dd.length >= 1 ) dd.length = 1 ; \/\/ keep the first one '- select -'\n    };\n\n\n    \/\/ request drop down data from server\n    var me = this;\n    var http;\n    var isIE = navigator.appName == \"Microsoft Internet Explorer\";\n    if(isIE){\n        me.http = new ActiveXObject(\"Microsoft.XMLHTTP\");\n    }else{\n        me.http = new XMLHttpRequest();\n    };\n\n\n    \/\/ build query string\n    var lookup = [];\n    for( var i = 0; i < next; i ++ ){\n        var v = document.getElementById(prefix +'_' +  i ).value ;\n        lookup.push( \"lookup[\" + i + \"]=\" + escape( isIE ? 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