{"id":23377,"date":"2021-11-15T20:10:14","date_gmt":"2021-11-15T17:10:14","guid":{"rendered":"https:\/\/sbs.strathmore.edu\/?page_id=23377"},"modified":"2021-11-15T20:10:14","modified_gmt":"2021-11-15T17:10:14","slug":"managing-healthcare-management-programme-application-form","status":"publish","type":"page","link":"https:\/\/sbs.strathmore.edu\/en_gb\/managing-healthcare-management-programme-application-form\/","title":{"rendered":"Managing Healthcare Management Programme &#8211; Application Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_112' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Managing Healthcare Business Programme - Application Form<\/h3>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_112'  action='\/en_gb\/wp-json\/wp\/v2\/pages\/23377' data-formid='112' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_112' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_112_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">PLEASE COMPLETE IN BLOCK CAPITALS<\/h2><\/li><li id=\"field_112_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_2'>Family Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_112_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_3'>Other Names:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_112_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_11'>Cell Phone Number:<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_112_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_20'>Email address:<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_112_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_68\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_68'>Preferred Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_68' id='input_112_68' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_112_4\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_4'>Date of Birth:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_112_4' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_112_4_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_112_4_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_112_4' class='gform_hidden' value='https:\/\/sbs.strathmore.edu\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_112_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_8'>Country of Residence:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_112_8' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select the country of residence<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/li><li id=\"field_112_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_9'>Nationality:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_112_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_30'>Industry<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_112_30' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select the industry in which you are currently operating<\/option><option value='Accounting\/Finance' >Accounting\/Finance<\/option><option value='Advertising\/Public Relations' >Advertising\/Public Relations<\/option><option value='Agriculture' >Agriculture<\/option><option value='Aerospace\/Aviation' >Aerospace\/Aviation<\/option><option value='Arts\/Entertainment\/Publishing' >Arts\/Entertainment\/Publishing<\/option><option value='Automotive' >Automotive<\/option><option value='Banking\/Mortgage' >Banking\/Mortgage<\/option><option value='Business Development' >Business Development<\/option><option value='Business Opportunity' >Business Opportunity<\/option><option value='Clerical\/Administrative' >Clerical\/Administrative<\/option><option value='Construction\/Facilities' >Construction\/Facilities<\/option><option value='Consumer Goods' >Consumer Goods<\/option><option value='Customer Service' >Customer Service<\/option><option value='Education\/Training' >Education\/Training<\/option><option value='Energy\/Utilities' >Energy\/Utilities<\/option><option value='Engineering' >Engineering<\/option><option value='Government\/Military' >Government\/Military<\/option><option value='Green' >Green<\/option><option value='Healthcare' >Healthcare<\/option><option value='Hospitality\/Travel' >Hospitality\/Travel<\/option><option value='Human Resources' >Human Resources<\/option><option value='Installation\/Maintenance' >Installation\/Maintenance<\/option><option value='Insurance' >Insurance<\/option><option value='Internet' >Internet<\/option><option value='Job Search Aids' >Job Search Aids<\/option><option value='Law Enforcement\/Security' >Law Enforcement\/Security<\/option><option value='Legal' >Legal<\/option><option value='Management\/Executive' >Management\/Executive<\/option><option value='Manufacturing\/Operations' >Manufacturing\/Operations<\/option><option value='Marketing' >Marketing<\/option><option value='Non-Profit\/Volunteer' >Non-Profit\/Volunteer<\/option><option value='Pharmaceutical\/Biotech' >Pharmaceutical\/Biotech<\/option><option value='Professional Services' >Professional Services<\/option><option value='QA\/Quality Control' >QA\/Quality Control<\/option><option value='Real Estate' >Real Estate<\/option><option value='Restaurant\/Food Service' >Restaurant\/Food Service<\/option><option value='Retail' >Retail<\/option><option value='Sales' >Sales<\/option><option value='Science\/Research' >Science\/Research<\/option><option value='Skilled Labour' >Skilled Labour<\/option><option value='Technology' >Technology<\/option><option value='Telecommunications' >Telecommunications<\/option><option value='Transportation\/Logistics' >Transportation\/Logistics<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_112_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_6'>Name of Organization you are currently working at:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_112_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_5'>Designation in the Organization:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_112_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">PROFESSIONAL DEVELOPMENT<\/h2><\/li><li id=\"field_112_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you attended any formal training\/professional program on Managing a Healthcare Business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_31'>\n\t\t\t<li class='gchoice gchoice_112_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Yes'  id='choice_112_31_0'    \/>\n\t\t\t\t<label for='choice_112_31_0' id='label_112_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='No'  id='choice_112_31_1'    \/>\n\t\t\t\t<label for='choice_112_31_1' id='label_112_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you responsible for professional development in your organization? (training, capacity building etc)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_36'>\n\t\t\t<li class='gchoice gchoice_112_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Yes'  id='choice_112_36_0'    \/>\n\t\t\t\t<label for='choice_112_36_0' id='label_112_36_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='No'  id='choice_112_36_1'    \/>\n\t\t\t\t<label for='choice_112_36_1' id='label_112_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Sub-sector in which your healthcare business is operating.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_65'>\n\t\t\t<li class='gchoice gchoice_112_65_0'>\n\t\t\t\t<input name='input_65' type='radio' value='Pharmaceutical Industry'  id='choice_112_65_0'    \/>\n\t\t\t\t<label for='choice_112_65_0' id='label_112_65_0' class='gform-field-label gform-field-label--type-inline'>Pharmaceutical Industry<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_1'>\n\t\t\t\t<input name='input_65' type='radio' value='Hospital - Private sector (both inpatient and outpatient services)'  id='choice_112_65_1'    \/>\n\t\t\t\t<label for='choice_112_65_1' id='label_112_65_1' class='gform-field-label gform-field-label--type-inline'>Hospital - Private sector (both inpatient and outpatient services)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_2'>\n\t\t\t\t<input name='input_65' type='radio' value='Hospital - Public sector (both inpatient and outpatient services)'  id='choice_112_65_2'    \/>\n\t\t\t\t<label for='choice_112_65_2' id='label_112_65_2' class='gform-field-label gform-field-label--type-inline'>Hospital - Public sector (both inpatient and outpatient services)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_3'>\n\t\t\t\t<input name='input_65' type='radio' value='Hospital - Faith based (both inpatient and outpatient services)'  id='choice_112_65_3'    \/>\n\t\t\t\t<label for='choice_112_65_3' id='label_112_65_3' class='gform-field-label gform-field-label--type-inline'>Hospital - Faith based (both inpatient and outpatient services)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_4'>\n\t\t\t\t<input name='input_65' type='radio' value='Hospital - Private sector (outpatient services only)'  id='choice_112_65_4'    \/>\n\t\t\t\t<label for='choice_112_65_4' id='label_112_65_4' class='gform-field-label gform-field-label--type-inline'>Hospital - Private sector (outpatient services only)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_5'>\n\t\t\t\t<input name='input_65' type='radio' value='Hospital - Faith based (outpatient services)'  id='choice_112_65_5'    \/>\n\t\t\t\t<label for='choice_112_65_5' id='label_112_65_5' class='gform-field-label gform-field-label--type-inline'>Hospital - Faith based (outpatient services)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_6'>\n\t\t\t\t<input name='input_65' type='radio' value='Doctor&#039;s stand-alone clinic'  id='choice_112_65_6'    \/>\n\t\t\t\t<label for='choice_112_65_6' id='label_112_65_6' class='gform-field-label gform-field-label--type-inline'>Doctor's stand-alone clinic<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_7'>\n\t\t\t\t<input name='input_65' type='radio' value='Community Pharmacy\/Retail Pharmacy\/Chemist'  id='choice_112_65_7'    \/>\n\t\t\t\t<label for='choice_112_65_7' id='label_112_65_7' class='gform-field-label gform-field-label--type-inline'>Community Pharmacy\/Retail Pharmacy\/Chemist<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_8'>\n\t\t\t\t<input name='input_65' type='radio' value='Nurse Clinic'  id='choice_112_65_8'    \/>\n\t\t\t\t<label for='choice_112_65_8' id='label_112_65_8' class='gform-field-label gform-field-label--type-inline'>Nurse Clinic<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_9'>\n\t\t\t\t<input name='input_65' type='radio' value='Laboratory'  id='choice_112_65_9'    \/>\n\t\t\t\t<label for='choice_112_65_9' id='label_112_65_9' class='gform-field-label gform-field-label--type-inline'>Laboratory<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_10'>\n\t\t\t\t<input name='input_65' type='radio' value='Healthcare Research &amp; Academia'  id='choice_112_65_10'    \/>\n\t\t\t\t<label for='choice_112_65_10' id='label_112_65_10' class='gform-field-label gform-field-label--type-inline'>Healthcare Research &amp; Academia<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_11'>\n\t\t\t\t<input name='input_65' type='radio' value='Healthcare Consultancy'  id='choice_112_65_11'    \/>\n\t\t\t\t<label for='choice_112_65_11' id='label_112_65_11' class='gform-field-label gform-field-label--type-inline'>Healthcare Consultancy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_65_12'>\n\t\t\t\t<input name='input_65' type='radio' value='Other - please specify'  id='choice_112_65_12'    \/>\n\t\t\t\t<label for='choice_112_65_12' id='label_112_65_12' class='gform-field-label gform-field-label--type-inline'>Other - please specify<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_14\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_14'>If Others Kindly Specify:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_112_14' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_112_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Your Healthcare Business Relationship<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_66'>\n\t\t\t<li class='gchoice gchoice_112_66_0'>\n\t\t\t\t<input name='input_66' type='radio' value='Investor in the Business'  id='choice_112_66_0'    \/>\n\t\t\t\t<label for='choice_112_66_0' id='label_112_66_0' class='gform-field-label gform-field-label--type-inline'>Investor in the Business<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_1'>\n\t\t\t\t<input name='input_66' type='radio' value='Owner and Manager running the Business'  id='choice_112_66_1'    \/>\n\t\t\t\t<label for='choice_112_66_1' id='label_112_66_1' class='gform-field-label gform-field-label--type-inline'>Owner and Manager running the Business<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_2'>\n\t\t\t\t<input name='input_66' type='radio' value='Manager in the Business but not owner'  id='choice_112_66_2'    \/>\n\t\t\t\t<label for='choice_112_66_2' id='label_112_66_2' class='gform-field-label gform-field-label--type-inline'>Manager in the Business but not owner<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_3'>\n\t\t\t\t<input name='input_66' type='radio' value='Employee in the business'  id='choice_112_66_3'    \/>\n\t\t\t\t<label for='choice_112_66_3' id='label_112_66_3' class='gform-field-label gform-field-label--type-inline'>Employee in the business<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_4'>\n\t\t\t\t<input name='input_66' type='radio' value='Employee with a healthcare business as a side hustle'  id='choice_112_66_4'    \/>\n\t\t\t\t<label for='choice_112_66_4' id='label_112_66_4' class='gform-field-label gform-field-label--type-inline'>Employee with a healthcare business as a side hustle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_5'>\n\t\t\t\t<input name='input_66' type='radio' value='Employee looking to start a healthcare business'  id='choice_112_66_5'    \/>\n\t\t\t\t<label for='choice_112_66_5' id='label_112_66_5' class='gform-field-label gform-field-label--type-inline'>Employee looking to start a healthcare business<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_66_6'>\n\t\t\t\t<input name='input_66' type='radio' value='Not employed and looking to start a healthcare business'  id='choice_112_66_6'    \/>\n\t\t\t\t<label for='choice_112_66_6' id='label_112_66_6' class='gform-field-label gform-field-label--type-inline'>Not employed and looking to start a healthcare business<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_40\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_40'>How many years have you spent in your role in Q2 above?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_40' id='input_112_40' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Less than 1 year' >Less than 1 year<\/option><option value='1-3 years' >1-3 years<\/option><option value='3-5 years' >3-5 years<\/option><option value='5-10 years' >5-10 years<\/option><option value='More than 10 years' >More than 10 years<\/option><\/select><\/div><\/li><li id=\"field_112_41\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_41'>If you are the owner or investor in the healthcare business, how many years have you had the business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_112_41' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Less than 1 year' >Less than 1 year<\/option><option value='1-3 years' >1-3 years<\/option><option value='3-5 years' >3-5 years<\/option><option value='5-10 years' >5-10 years<\/option><option value='More than 10 years' >More than 10 years<\/option><\/select><\/div><\/li><li id=\"field_112_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_42'>How many employees are in the Healthcare Business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_112_42' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Less than 5' >Less than 5<\/option><option value='5-10' >5-10<\/option><option value='10-15' >10-15<\/option><option value='More than 15' >More than 15<\/option><\/select><\/div><\/li><li id=\"field_112_39\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Where is your Healthcare Business located?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_112_39'><li class='gchoice gchoice_112_39_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.1' type='checkbox'  value='Rural setting'  id='choice_112_39_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_1' id='label_112_39_1' class='gform-field-label gform-field-label--type-inline'>Rural setting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_39_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.2' type='checkbox'  value='Rural\/Urban setting'  id='choice_112_39_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_2' id='label_112_39_2' class='gform-field-label gform-field-label--type-inline'>Rural\/Urban setting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_39_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.3' type='checkbox'  value='Urban setting'  id='choice_112_39_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_3' id='label_112_39_3' class='gform-field-label gform-field-label--type-inline'>Urban setting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_39_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.4' type='checkbox'  value='Low income setting'  id='choice_112_39_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_4' id='label_112_39_4' class='gform-field-label gform-field-label--type-inline'>Low income setting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_39_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.5' type='checkbox'  value='Mid income setting'  id='choice_112_39_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_5' id='label_112_39_5' class='gform-field-label gform-field-label--type-inline'>Mid income setting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_39_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_39.6' type='checkbox'  value='High income setting'  id='choice_112_39_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_39_6' id='label_112_39_6' class='gform-field-label gform-field-label--type-inline'>High income setting<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What mode of payment is used in your Healthcare Business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_112_67'><li class='gchoice gchoice_112_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='Cash - Direct\/Bank Transfer'  id='choice_112_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_67_1' id='label_112_67_1' class='gform-field-label gform-field-label--type-inline'>Cash - Direct\/Bank Transfer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='Mpesa\/Airtel Money'  id='choice_112_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_67_2' id='label_112_67_2' class='gform-field-label gform-field-label--type-inline'>Mpesa\/Airtel Money<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_67_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='Visa\/Mastercard\/Other Card Payments'  id='choice_112_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_67_3' id='label_112_67_3' class='gform-field-label gform-field-label--type-inline'>Visa\/Mastercard\/Other Card Payments<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_67_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.4' type='checkbox'  value='Insurance - private'  id='choice_112_67_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_67_4' id='label_112_67_4' class='gform-field-label gform-field-label--type-inline'>Insurance - private<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_67_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.5' type='checkbox'  value='NHIF'  id='choice_112_67_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_67_5' id='label_112_67_5' class='gform-field-label gform-field-label--type-inline'>NHIF<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What is the dominant mode of payment used in your healthcare business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_63'>\n\t\t\t<li class='gchoice gchoice_112_63_0'>\n\t\t\t\t<input name='input_63' type='radio' value='Cash - Direct\/Bank Transfer'  id='choice_112_63_0'    \/>\n\t\t\t\t<label for='choice_112_63_0' id='label_112_63_0' class='gform-field-label gform-field-label--type-inline'>Cash - Direct\/Bank Transfer<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_63_1'>\n\t\t\t\t<input name='input_63' type='radio' value='Mpesa\/Airtel Money'  id='choice_112_63_1'    \/>\n\t\t\t\t<label for='choice_112_63_1' id='label_112_63_1' class='gform-field-label gform-field-label--type-inline'>Mpesa\/Airtel Money<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_63_2'>\n\t\t\t\t<input name='input_63' type='radio' value='Visa\/Mastercard\/Other Card Payments'  id='choice_112_63_2'    \/>\n\t\t\t\t<label for='choice_112_63_2' id='label_112_63_2' class='gform-field-label gform-field-label--type-inline'>Visa\/Mastercard\/Other Card Payments<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_63_3'>\n\t\t\t\t<input name='input_63' type='radio' value='Insurance - private'  id='choice_112_63_3'    \/>\n\t\t\t\t<label for='choice_112_63_3' id='label_112_63_3' class='gform-field-label gform-field-label--type-inline'>Insurance - private<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_63_4'>\n\t\t\t\t<input name='input_63' type='radio' value='NHIF'  id='choice_112_63_4'    \/>\n\t\t\t\t<label for='choice_112_63_4' id='label_112_63_4' class='gform-field-label gform-field-label--type-inline'>NHIF<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_45'>What percentage does the dominant mode of payment take?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_112_45' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='100%' >100%<\/option><option value='80-100%' >80-100%<\/option><option value='50-80%' >50-80%<\/option><option value='30-50%' >30-50%<\/option><option value='Less than 30%' >Less than 30%<\/option><option value='Credit - company account' >Credit - company account<\/option><\/select><\/div><\/li><li id=\"field_112_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >As a Healthcare Business, which operations do you think need urgent attention?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_112_46'><li class='gchoice gchoice_112_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='IT'  id='choice_112_46_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_1' id='label_112_46_1' class='gform-field-label gform-field-label--type-inline'>IT<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='Finance and Accounts'  id='choice_112_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_2' id='label_112_46_2' class='gform-field-label gform-field-label--type-inline'>Finance and Accounts<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Human Resources'  id='choice_112_46_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_3' id='label_112_46_3' class='gform-field-label gform-field-label--type-inline'>Human Resources<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.4' type='checkbox'  value='Procurement'  id='choice_112_46_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_4' id='label_112_46_4' class='gform-field-label gform-field-label--type-inline'>Procurement<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.5' type='checkbox'  value='Stocks Management'  id='choice_112_46_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_5' id='label_112_46_5' class='gform-field-label gform-field-label--type-inline'>Stocks Management<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.6' type='checkbox'  value='Customer service'  id='choice_112_46_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_6' id='label_112_46_6' class='gform-field-label gform-field-label--type-inline'>Customer service<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_112_46_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.7' type='checkbox'  value='Others, please specify'  id='choice_112_46_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_112_46_7' id='label_112_46_7' class='gform-field-label gform-field-label--type-inline'>Others, please specify<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_17'>If Others please Specify:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_112_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_112_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Does your Healthcare Business Have the following clearly stated?<\/h2><\/li><li id=\"field_112_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Mission<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_47'>\n\t\t\t<li class='gchoice gchoice_112_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='Yes'  id='choice_112_47_0'    \/>\n\t\t\t\t<label for='choice_112_47_0' id='label_112_47_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='No'  id='choice_112_47_1'    \/>\n\t\t\t\t<label for='choice_112_47_1' id='label_112_47_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_51\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Vision<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_51'>\n\t\t\t<li class='gchoice gchoice_112_51_0'>\n\t\t\t\t<input name='input_51' type='radio' value='Yes'  id='choice_112_51_0'    \/>\n\t\t\t\t<label for='choice_112_51_0' id='label_112_51_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_51_1'>\n\t\t\t\t<input name='input_51' type='radio' value='No'  id='choice_112_51_1'    \/>\n\t\t\t\t<label for='choice_112_51_1' id='label_112_51_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Core Values<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_52'>\n\t\t\t<li class='gchoice gchoice_112_52_0'>\n\t\t\t\t<input name='input_52' type='radio' value='Yes'  id='choice_112_52_0'    \/>\n\t\t\t\t<label for='choice_112_52_0' id='label_112_52_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_52_1'>\n\t\t\t\t<input name='input_52' type='radio' value='No'  id='choice_112_52_1'    \/>\n\t\t\t\t<label for='choice_112_52_1' id='label_112_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Code of Conduct<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_53'>\n\t\t\t<li class='gchoice gchoice_112_53_0'>\n\t\t\t\t<input name='input_53' type='radio' value='Yes'  id='choice_112_53_0'    \/>\n\t\t\t\t<label for='choice_112_53_0' id='label_112_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_53_1'>\n\t\t\t\t<input name='input_53' type='radio' value='No'  id='choice_112_53_1'    \/>\n\t\t\t\t<label for='choice_112_53_1' id='label_112_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Service Charter<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_54'>\n\t\t\t<li class='gchoice gchoice_112_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Yes'  id='choice_112_54_0'    \/>\n\t\t\t\t<label for='choice_112_54_0' id='label_112_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_112_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='No'  id='choice_112_54_1'    \/>\n\t\t\t\t<label for='choice_112_54_1' id='label_112_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_56\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_56'>What are the 3 things you think are stopping your healthcare business from growing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_56' id='input_112_56' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_112_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">HEALTHCARE ENTREPRENEUR RELATED<\/h2><\/li><li id=\"field_112_61\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_61'>How many years have you been in business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_112_61' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Less than 1 year' >Less than 1 year<\/option><option value='1-3 years' >1-3 years<\/option><option value='3-5 years' >3-5 years<\/option><option value='5-10 years' >5-10 years<\/option><option value='More than 10 years' >More than 10 years<\/option><\/select><\/div><\/li><li id=\"field_112_58\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_58'>What are the 3 things you hope the MHB Program will help you address?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_112_58' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_112_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_59'>Which MHB Program Option would you be interested in attending?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_112_59' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Masterclass' >Masterclass<\/option><option value='Foundation Healthcare Business Start-up (for those less than 1 year in a healthcare business; takes 3 modules over 18 weeks)' selected='selected'>Foundation Healthcare Business Start-up (for those less than 1 year in a healthcare business; takes 3 modules over 18 weeks)<\/option><option value='Business Growth Development - Potential Building (for those 1-3 years in a healthcare business; takes 4 modules over 1 year)' >Business Growth Development - Potential Building (for those 1-3 years in a healthcare business; takes 4 modules over 1 year)<\/option><option value='Business Growth Development - Trajectory Building (for those 3-5 years in a healthcare business; takes 4 modules over 1 year)' >Business Growth Development - Trajectory Building (for those 3-5 years in a healthcare business; takes 4 modules over 1 year)<\/option><option value='Business Growth Development - Maturity (for those above 5 years in a healthcare business; takes 5 modules over 1 year)' >Business Growth Development - Maturity (for those above 5 years in a healthcare business; takes 5 modules over 1 year)<\/option><\/select><\/div><\/li><li id=\"field_112_60\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_112_60'>Any other information you would like to clarify\/inquire about?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_60' id='input_112_60' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_112_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">CANCELLATION POLICY<\/h2><\/li><li id=\"field_112_22\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>All cancellations must be made in writing to the Program Manager. Cancellations made less than 14 days to thecommencement of the seminar, are subject to a penalty of 25% of total program fee.<\/p><\/li><li id=\"field_112_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' ><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_112_24'>\n\t\t\t<li class='gchoice gchoice_112_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='I agree to the terms of the cancellation policy as detailed above.'  id='choice_112_24_0'    \/>\n\t\t\t\t<label for='choice_112_24_0' id='label_112_24_0' class='gform-field-label gform-field-label--type-inline'>I agree to the terms of the cancellation policy as detailed above.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_112_25\" class=\"gfield 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