Share your information with Eightfold Collective Agency

Eightfold Collective Agency

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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of Birth" name="date-of-birth" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Tier &amp;amp; Payment Selection" description="First payment includes a one-time $45 onboarding fee.   After that  you&#39;re billed only your regular membership rate — no onboarding fee ever again.  The onboarding fee is a one-time charge applied only to your first monthly payment. Choose annual billing and it&#39;s waived entirely." name="tier-selection">&#13;
			<option label="Basic → $74 ($45 onboarding + $29 first month)" value="basic-74-45-onboarding-29-first-month">Basic → $74 ($45 onboarding + $29 first month)</option>&#13;
			<option label="Pro → $104 ($45 onboarding + $59 first month)" value="pro-104-45-onboarding-59-first-month">Pro → $104 ($45 onboarding + $59 first month)</option>&#13;
			<option label="Elite → $144 ($45 onboarding + $99 first month)" value="elite-144-45-onboarding-99-first-month" selected="selected">Elite → $144 ($45 onboarding + $99 first month)</option>&#13;
			<option label="Basic → $290/yr (onboarding fee waived — you save $45!)" value="basic-290yr-onboarding-fee-waived-you-save-45">Basic → $290/yr (onboarding fee waived — you save $45!)</option>&#13;
			<option label="Pro → $550/yr (onboarding fee waived — you save $45!)" value="pro-550yr-onboarding-fee-waived-you-save-45">Pro → $550/yr (onboarding fee waived — you save $45!)</option>&#13;
			<option label="Elite → $990/yr (onboarding fee waived — you save $45!)" value="elite-990yr-onboarding-fee-waived-you-save-45">Elite → $990/yr (onboarding fee waived — you save $45!)</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="blockquote" label="First payment includes a one-time $45 onboarding fee (waived on annual plans). After that, you&#39;re billed your regular rate.&amp;nbsp;"/>&#13;
	</fields>&#13;
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