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                        function mpmFormInitc1006da91afc4cce82172924656a0777 ()
                        {
                            var subscriberData = undefined;
                            var form = '<style>.mpm-field-error {border-color: red !important;}</style><form name="mpForm-c1006da91afc4cce82172924656a0777" method="post" id="mpform-c1006da91afc4cce82172924656a0777" class="mpform" onSubmit="mpFormc1006da91afc4cce82172924656a0777Submit(event)"><style type="text/css">                     @font-face {                        font-family: Inter;                        src: url(https://cdn1.ourmailsender.com/fonts/inter/Inter-Regular.ttf);                      }                      </style>                    <style type="text/css">                     @font-face {                        font-family: Play;                        src: url(https://cdn1.ourmailsender.com/fonts/play/Play-Regular.ttf);                      }                      </style>                    <style>.mpm-container a {color:#c2c2c2; text-decoration:underline; }.mpm-container h1 {color:#000000; font-size:40px; font-style:normal; text-align:left; font-family:arial; font-weight:bold; line-height:150%; letter-spacing:normal; }.mpm-container h2 {color:#c2c2c2; font-size:30px; font-style:normal; text-align:left; font-family:arial; font-weight:bold; line-height:150%; letter-spacing:normal; }.mpm-container h3 {color:#000000; font-size:20px; font-style:normal; text-align:left; font-family:arial; font-weight:bold; line-height:150%; letter-spacing:normal; }.mpm-container h4 {color:#000000; font-size:14px; font-style:italic; text-align:left; font-family:arial; font-weight:bold; line-height:100%; letter-spacing:normal; }#mpmInnerForm input::placeholder {color:#a9acb4; }#mpmInnerForm input::-moz-placeholder {color:#a9acb4; }.mpm-container a[x-apple-data-detectors] {color:inherit!important; font-size:inherit !important; font-family:inherit !important; font-weight:inherit !important; line-height:inherit !important; text-decoration:none !important; }#mpmInnerForm input:-ms-input-placeholder {color:#a9acb4; }#mpmInnerForm input::webkit-input-placeholder {color:#a9acb4; }.mpm-container  a[href^=tel], .mpm-container  [href^=sms] {color:inherit; cursor:default; text-decoration:none; }.mpm-container h1,  .mpm-container h2, .mpm-container h3, .mpm-container h4, .mpm-container h5,  .mpm-container h6 {margin:0; display:block; padding:0; }</style><div class="mpm-container" style="width: 100%; height: 100%; padding: 0px; box-sizing: border-box; background-size: cover; background-color: #ffffff; background-image: url(); background-repeat: no-repeat; background-position: center; "><div id="mpmInnerForm" style="margin: 0 auto; max-width: 100%; border-style: none; border-width: 2px; border-radius: 3px; background-size: cover; background-color: #FFFFFF; background-image: url(); background-repeat: no-repeat; background-position: center; "><div class="mpm-row" style="padding: 20px; "><div class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 10px; margin-left: 10px; padding-top: 0px; margin-right: 10px; padding-left: 0px; margin-bottom: 0px; padding-right: 0px; flex-direction: column; padding-bottom: 0px; "><div style="color: #000000; position: relative; font-size: 14px; font-family: arial; font-weight: normal; "><h3>QPCC - Roller Disco 5th Mayl 2025</h3></div></div></div></div><div id="mpmInnerForm" style="margin: 0 auto; max-width: 100%; border-style: none; border-width: 2px; border-radius: 3px; background-size: cover; background-color: #FFFFFF; background-image: url(); background-repeat: no-repeat; background-position: center; "><style>.mpm-col-sm-4-col1 {max-width:33%; flex-basis:33%; }.mpm-col-sm-4-col2 {max-width:33%; flex-basis:33%; }.mpm-col-sm-4-col3 {max-width:33%; flex-basis:33%; }</style><div class="mpm-row"><div class="mpm-col-xs-12 mpm-col-sm-4 mpm-col-sm-4-col1 mpm-col-custom" style="padding: 20px; padding-bottom: 0px; "><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-631709" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" placeholder="First Name"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-631725" type="TELNO" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Phone Number (Direct)"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-839070" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 0px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 30px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Do you receive any means-tested benefits? If so, please specify. "/></div></div><div class="mpm-col-xs-12 mpm-col-sm-4 mpm-col-sm-4-col2 mpm-col-custom" style="padding: 20px; padding-bottom: 0px; "><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-631710" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Last Name"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-631718" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Street"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-838937" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="How would you describe your Ethnicity?"/></div></div><div class="mpm-col-xs-12 mpm-col-sm-4 mpm-col-sm-4-col3 mpm-col-custom" style="padding: 20px; padding-bottom: 0px; "><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="emailAddress" type="email" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Email Address"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-656750" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" required="required" placeholder="Emergency Contact Name & Number"/></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><input name="customField-838938" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; font-weight: normal; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; -webkit-appearance: none; " width="100%" placeholder="How would you describe your Religion?"/></div></div></div><div class="mpm-row"><div align="right" class="mpm-col-xs-12 mpm-col-sm-12" style="padding: 20px; padding-top: 0px; " colSpan="3"><div class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 0px; margin-left: 10px; padding-top: 0px; margin-right: 10px; padding-left: 0px; margin-bottom: 0px; padding-right: 0px; flex-direction: column; padding-bottom: 0px; "><div style="color: #000000; position: relative; font-size: 14px; font-family: arial; font-weight: normal; "><div style="text-align: left;" data-mce-style="text-align: left;">Tell us below the <strong>NAME, AGE, GENDER</strong> and <strong>SHOE SIZE</strong>&nbsp;of all participants and chaperones.</div><div style="text-align: left;" data-mce-style="text-align: left;">Please note: Participants must be at least 11 years old and parent/guardians must chaperone children under the age of 14.&nbsp;</div></div></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><textarea name="customField-665191" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 10px; font-family: arial; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 10px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; " width="100%" required="required" placeholder="Name, age, gender and shoe sizes of all participants"/></textarea></div><div class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 0px; margin-left: 10px; padding-top: 0px; margin-right: 10px; padding-left: 0px; margin-bottom: 0px; padding-right: 0px; flex-direction: column; padding-bottom: 0px; "><div style="color: #000000; position: relative; font-size: 14px; font-family: arial; font-weight: normal; "><div style="text-align: left;">Does anyone being registered have access requirements or health condition?</div></div></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><textarea name="customField-656746" type="TEXT" style="color: #000000; width: 100%; display: block; font-size: 14px; box-sizing: border-box; margin-top: 0px; font-family: arial; margin-left: 0; padding-top: 10px; border-color: #e9e7e8; border-style: solid; border-width: 1px; margin-right: 0; padding-left: 15px; border-radius: 3px; margin-bottom: 0px; padding-right: 15px; padding-bottom: 10px; background-color: #FFFFFF; " width="100%" required="required" placeholder="Health Conditions"/></textarea></div><div class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 20px; margin-left: 10px; padding-top: 0px; margin-right: 10px; padding-left: 0px; margin-bottom: 0px; padding-right: 0px; flex-direction: column; padding-bottom: 0px; "><div style="color: #000000; position: relative; font-size: 14px; font-family: arial; font-weight: normal; "><h3><strong><span style="font-size: 17px;" data-mce-style="font-size: 17px;">Privacy &amp; Consent</span></strong></h3></div></div><div class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 10px; margin-left: 10px; padding-top: 0px; margin-right: 10px; padding-left: 0px; margin-bottom: 10px; padding-right: 0px; flex-direction: column; padding-bottom: 0px; "><div style="color: #000000; position: relative; font-size: 14px; font-family: arial; font-weight: normal; "><div style="text-align: left;">Queen\'s Park Community Council is committed to processing information in accordance with the General Data Protection Regulation (GDPR) as outlined in our<a href="http://queensparkcommunitycouncil.gov.uk/privacy/" target="_blank" rel="noopener" style="color: #c2c2c2;">&nbsp;Privacy Statement.</a></div></div></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><table style="margin-top: 10px; margin-bottom: 10px; " cellpadding="0" cellspacing="0"><tr><td width="25" valign="top"><input name="customField-825861" type="checkbox" class="mp_checkbox" style="color: #000000; width: 15px; height: 15px; margin: 0px; display: block; box-sizing: border-box; visibility: visible; border-color: #e9e7e8; border-style: solid; border-width: 1px; border-radius: 3px; background-color: #FFFFFF; " value="0" required="required"/></td><td valign="top"><div style="color: #000000; font-size: 14px; text-align: left; font-family: arial; ">I have read and understand the Council\'s Privacy Statement.</div></td></tr></table></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><table style="margin-top: 10px; margin-bottom: 10px; " cellpadding="0" cellspacing="0"><tr><td width="25" valign="top"><input name="customField-834388" type="checkbox" class="mp_checkbox" style="color: #000000; width: 15px; height: 15px; margin: 0px; display: block; box-sizing: border-box; visibility: visible; border-color: #e9e7e8; border-style: solid; border-width: 1px; border-radius: 3px; background-color: #FFFFFF; " value="0"/></td><td valign="top"><div style="color: #000000; font-size: 14px; text-align: left; font-family: arial; ">I wish to receive the Council\'s monthly e-bulletin containing local events, news and more!</div></td></tr></table></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><table style="margin-top: 10px; margin-bottom: 10px; " cellpadding="0" cellspacing="0"><tr><td width="25" valign="top"><input name="customField-825862" type="checkbox" class="mp_checkbox" style="color: #000000; width: 15px; height: 15px; margin: 0px; display: block; box-sizing: border-box; visibility: visible; border-color: #e9e7e8; border-style: solid; border-width: 1px; border-radius: 3px; background-color: #FFFFFF; " value="0" required="required"/></td><td valign="top"><div style="color: #000000; font-size: 14px; text-align: left; font-family: arial; ">I understand that Queen\'s Park Community Council will take photographs and/or video recordings of this event and consent to the use of photographs and/or video recordings including images of me both internally and externally to promote the Council and it\'s activities. I understand that these images could be used in print and digital media formats including print publications, websites, e-marketing, posters banners, advertising, film, social media, teaching and research purposes. I understand that images on websites can be viewed throughout the world and not just in the United Kingdom and that some overseas countries may not provide the same level of protection to the rights of individuals as EU/UK legislation provides. I understand that some images or recordings may be kept permanently once they are published and be kept as an archive of Community life. I recognize that I can request on the day of the event that photographs and/or video recordings of me are not be taken, and that the Council will endeavor but cannot guarantee that I will not be featured in any photographs and/or video recordings of the event.    I have read and understand the conditions and consent to my images being used as described.</div></td></tr></table></div><div class="mpm-col-xs-12" style="display: flex; position: relative; flex-direction: column; "><table style="margin-top: 10px; margin-bottom: 10px; " cellpadding="0" cellspacing="0"><tr><td width="25" valign="top"><input name="customField-825861" type="checkbox" class="mp_checkbox" style="color: #000000; width: 15px; height: 15px; margin: 0px; display: block; box-sizing: border-box; visibility: visible; border-color: #e9e7e8; border-style: solid; border-width: 1px; border-radius: 3px; background-color: #FFFFFF; " value="0" required="required"/></td><td valign="top"><div style="color: #000000; font-size: 14px; text-align: left; font-family: arial; ">By submitting this form, you agree to have your personal details and demographic information processed and stored securely according to Envoy Partnership and Westminster City Council\'s privacy policies and in line with the UK Data Protection Act 2018 and GDPR. You have a right to withdraw your information at any time and your data will only be retained only as long as necessary. Please tick the box to indicate that you understand and agree.</div></td></tr></table></div><div class="mpm-col-xs-12" style="display: flex; position: relative; align-items: center; flex-direction: column; "><button class="" style="color: #FFFFFF; width: 100%; cursor: pointer; display: block; font-size: 14px; box-sizing: border-box; margin-top: 20px; text-align: center; word-break: break-word; font-family: arial; font-weight: normal; margin-left: 0px; padding-top: 10px; border-color: #543881; border-style: solid; border-width: 1px; margin-right: 0px; padding-left: 10px; border-radius: 3px; margin-bottom: 0px; padding-right: 10px; padding-bottom: 10px; background-color: #543881; " width="100%">SUBSCRIBE</button></div><div id="mpmessageholder" class="mpm-col-xs-12" style="display: flex; position: relative; margin-top: 0px; margin-left: 0px; margin-right: 0px; margin-bottom: 10px; flex-direction: column; "><div id="mpmessage" class="mpmessageholder" style="color: #FF0000; position: relative; font-size: 14px; text-align: left; font-family: arial; padding-top: 0px; padding-left: 0px; padding-right: 0px; padding-bottom: 0px; "></div></div></div></div></div></div></form>';
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