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/></div> <div class="crm-profile-name-Powerbase_Sign_Up"> <div id="crm-container" class="crm-container crm-public" lang="en" xml:lang="en">  <div id="editrow-first_name" class="crm-section editrow_first_name-section form-item"><div class="label"><label for="first_name"> First Name <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="30" name="first_name" type="text" id="first_name" class="big crm-form-text required" /></div><div class="clear"></div></div><div id="editrow-last_name" class="crm-section editrow_last_name-section form-item"><div class="label"><label for="last_name"> Last Name <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="30" name="last_name" type="text" id="last_name" class="big crm-form-text required" /></div><div class="clear"></div></div><div id="editrow-email-6" class="crm-section editrow_email-6-section form-item"><div class="label"><label for="email-6"> Email <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="254" size="30" name="email-6" type="text" id="email-6" class="big crm-form-text required" /></div><div class="clear"></div></div><div id="editrow-city-Primary" class="crm-section editrow_city-Primary-section form-item"><div class="label"><label for="city-Primary">City</label></div><div class="edit-value content"><input maxlength="64" size="30" name="city-Primary" type="text" id="city-Primary" class="big crm-form-text" /></div><div class="clear"></div></div><div id="editrow-state_province-Primary" class="crm-section editrow_state_province-Primary-section form-item"><div class="label"><label for="state_province-Primary">State</label></div><div class="edit-value content"><select data-callback="civicrm/ajax/jqState" data-empty-prompt="Choose country first" data-none-prompt="- N/A -" class="crm-select2 crm-form-select" data-select-prompt="- none -" data-name="state_province-Primary" name="state_province-Primary" id="state_province-Primary"><option value="">- none -</option><option value="1000">Alabama</option><option value="1001">Alaska</option><option value="1100">Alberta</option><option value="1052">American Samoa</option><option value="1002">Arizona</option><option value="1003">Arkansas</option><option value="1060">Armed Forces Americas</option><option value="1059">Armed Forces Europe</option><option value="1061">Armed Forces Pacific</option><option value="1101">British Columbia</option><option value="1004">California</option><option value="1005">Colorado</option><option value="1006">Connecticut</option><option value="1007">Delaware</option><option value="1050">District of Columbia</option><option value="1008">Florida</option><option value="1009">Georgia</option><option value="1053">Guam</option><option value="1010">Hawaii</option><option value="1011">Idaho</option><option value="1012">Illinois</option><option value="1013">Indiana</option><option value="1014">Iowa</option><option value="1015">Kansas</option><option value="1016">Kentucky</option><option value="1017">Louisiana</option><option value="1018">Maine</option><option value="1102">Manitoba</option><option value="1019">Maryland</option><option value="1020">Massachusetts</option><option value="1021">Michigan</option><option value="1022">Minnesota</option><option value="1023">Mississippi</option><option value="1024">Missouri</option><option value="1025">Montana</option><option value="1026">Nebraska</option><option value="1027">Nevada</option><option value="1103">New Brunswick</option><option value="1028">New Hampshire</option><option value="1029">New Jersey</option><option value="1030">New Mexico</option><option value="1031">New York</option><option value="1104">Newfoundland and Labrador</option><option value="1032">North Carolina</option><option value="1033">North Dakota</option><option value="1055">Northern Mariana Islands</option><option value="1105">Northwest Territories</option><option value="1106">Nova Scotia</option><option value="1107">Nunavut</option><option value="1034">Ohio</option><option value="1035">Oklahoma</option><option value="1108">Ontario</option><option value="1036">Oregon</option><option value="1037">Pennsylvania</option><option value="1109">Prince Edward Island</option><option value="1056">Puerto Rico</option><option value="1110">Quebec</option><option value="1038">Rhode Island</option><option value="1111">Saskatchewan</option><option value="1039">South Carolina</option><option value="1040">South Dakota</option><option value="1041">Tennessee</option><option value="1042">Texas</option><option value="1058">United States Minor Outlying Islands</option><option value="1043">Utah</option><option value="1044">Vermont</option><option value="1057">Virgin Islands</option><option value="1045">Virginia</option><option value="1046">Washington</option><option value="1047">West Virginia</option><option value="1048">Wisconsin</option><option value="1049">Wyoming</option><option value="1112">Yukon Territory</option></select></div><div class="clear"></div></div><div id="editrow-postal_code-6" class="crm-section editrow_postal_code-6-section form-item"><div class="label"><label for="postal_code-6"> Postal Code <span class="crm-marker" title="This field is required.">*</span></label></div><div class="edit-value content"><input maxlength="64" size="6" name="postal_code-6" type="text" id="postal_code-6" class="six crm-form-text required" /></div><div class="clear"></div></div><div id="editrow-custom_113" class="crm-section editrow_custom_113-section form-item"><div class="label"><label for="custom_113">Union</label></div><div class="edit-value content"><input data-crm-custom="Constituent_Info_Individuals:Union_or_Organization" maxlength="255" name="custom_113" type="text" id="custom_113" class="crm-form-text" /></div><div class="clear"></div></div><div id="editrow-custom_144" class="crm-section editrow_custom_144-section form-item"><div class="label"><label for="custom_144">Organization</label></div><div class="edit-value content"><input data-crm-custom="Constituent_Info_Individuals:Organization" maxlength="255" name="custom_144" type="text" id="custom_144" class="crm-form-text" /></div><div class="clear"></div></div><div id="editrow-custom_112" class="crm-section editrow_custom_112-section form-item"><div class="label"><label for="custom_112">Local</label></div><div class="edit-value content"><input data-crm-custom="Constituent_Info_Individuals:Local" maxlength="255" name="custom_112" type="text" id="custom_112" class="crm-form-text" /></div><div class="clear"></div></div><div id="editrow-custom_133" class="crm-section editrow_custom_133-section form-item"><div class="label"><label for="custom_133">Role or Primary Position at Labor Organization</label></div><div class="edit-value content"><input data-crm-custom="Constituent_Info_Individuals:Title_or_Primary_Position_at_Labor_Organization" maxlength="255" name="custom_133" type="text" id="custom_133" class="crm-form-text" /></div><div class="clear"></div></div><div class="crm-submit-buttons" style=''> <label style="display: none;" for="email-Fako">Fako Email</label><input style="display: none;" name="fako_email" id="fako_email" type="text"><div class="crm-submit-buttons" style=''>   <span class="crm-button crm-button-type-next crm-button_qf_Edit_next crm-i-button"> <i class="crm-i fa-check"></i> <input class="crm-form-submit default validate" accesskey="S" crm-icon="fa-check" name="_qf_Edit_next" value="Submit" type="submit" id="_qf_Edit_next" /> </span> <a class="button cancel" href="https://labor4sustainability.ourpowerbase.net/civicrm/profile?reset=1&gid=18"><span><i class="crm-i fa-times"></i>Cancel</span></a></div></div> <script type="text/javascript"> </script> <script type="text/javascript">CRM.$(function($) { cj('#selector tr:even').addClass('odd-row '); cj('#selector tr:odd ').addClass('even-row');});</script></div>  </form>