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				<div class="et_pb_text_inner">Oh, no &#8211; don&#8217;t go!</div>
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				<div class="et_pb_code_inner"><div id="quform-5c905b" class="quform quform-34 quform-theme-react quform-support-page-caching"><form id="quform-form-5c905b" class="quform-form quform-form-34" action="/page/2/?s#quform-5c905b" method="post" enctype="multipart/form-data" novalidate="novalidate" data-options="{&quot;id&quot;:34,&quot;uniqueId&quot;:&quot;5c905b&quot;,&quot;theme&quot;:&quot;react&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:{&quot;265&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;271&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Membership Cancellation &quot;}]},&quot;273&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;271&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;Membership On Hold&quot;}]}},&quot;dependents&quot;:{&quot;271&quot;:[265,273]},&quot;elementIds&quot;:[265,273],&quot;dependentElementIds&quot;:[&quot;271&quot;],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}"><button class="quform-default-submit" name="quform_submit" type="submit" value="submit"></button><div class="quform-form-inner quform-form-inner-34"><input type="hidden" name="quform_form_id" value="34" /><input type="hidden" name="quform_form_uid" value="5c905b" /><input type="hidden" name="quform_count" value="1" /><input type="hidden" name="form_url" value="https://dev.beyondchai.com/page/2/?s" /><input type="hidden" name="referring_url" value="" /><input type="hidden" name="post_id" value="" /><input type="hidden" name="post_title" value="" /><input type="hidden" name="quform_current_page_id" value="1" /><input type="hidden" name="quform_csrf_token" value="KQUQ869tsKPVaT5BxORN7SHBW20zQlBI6gkVd0K7" /><div class="quform-elements quform-elements-34 quform-cf quform-responsive-elements-phone-landscape"><div class="quform-element quform-element-page quform-page-1 quform-page-34_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page"><div class="quform-page-title-description"><h1 class="quform-page-title">Taking a Break?</h1><p class="quform-page-description">You may cancel your BeyondChai Membership; this will terminate your services before your next billing date if this form is submitted three business days prior to your next billing cycle.
<br><br>
Alternatively, you may select to go on Hold, this will retain your Matchmaker for the duration of your Hold, and it will cost you 20% of your subscription fee per month.
<br><br></p></div><div class="quform-child-elements"><div class="quform-element quform-element-group quform-element-34_270 quform-cf quform-group-style-plain"><div class="quform-spacer"><div class="quform-child-elements"><div class="quform-element quform-element-radio quform-element-34_271 quform-cf quform-element-optional"><div class="quform-spacer"><div class="quform-label quform-label-34_271"><label  class="quform-label-text">Please select an option: </label></div><div class="quform-inner quform-inner-radio quform-inner-34_271 quform-field-size-medium"><div class="quform-input quform-input-radio quform-input-34_271 quform-cf"><div class="quform-options quform-cf quform-options-inline quform-options-style-button quform-button-style-pills quform-button-icon-right"><div class="quform-option"><input type="radio" name="quform_34_271" id="quform_34_271_5c905b_1" class="quform-field quform-field-radio quform-field-34_271 quform-field-34_271_1 quform-submit" value="Membership Cancellation " /><label for="quform_34_271_5c905b_1" class="quform-option-label quform-option-label-34_271_1"><span class="quform-option-text">Membership Cancellation </span></label></div><div class="quform-option"><input type="radio" name="quform_34_271" id="quform_34_271_5c905b_2" class="quform-field quform-field-radio quform-field-34_271 quform-field-34_271_2 quform-submit" value="Membership On Hold" /><label for="quform_34_271_5c905b_2" class="quform-option-label quform-option-label-34_271_2"><span class="quform-option-text">Membership On Hold</span></label></div></div></div></div></div></div></div></div></div><div class="quform-element quform-element-group quform-element-34_265 quform-cf quform-group-style-plain"><div class="quform-spacer"><div class="quform-child-elements"><div class="quform-element quform-element-html quform-element-34_285 quform-cf"><div class="quform-spacer"><h2 class="quform-page-title" style="margin-bottom: 0px;">Cancellation</h2>
Submit this form if you desire to terminate your BeyondChai Subscription. If you choose to return to Our Services in the future, we cannot guarantee that you will be reassigned to your current matchmaker; consider the On Hold Option if you think you will return in the near future.</div></div><div class="quform-element quform-element-name quform-element-34_232 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_232"><label  class="quform-label-text" id="quform_34_232_5c905b_label">Name<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-name quform-inner-34_232 quform-field-size-medium"><div class="quform-input quform-input-name quform-input-34_232 quform-cf"><div class="quform-element-row quform-element-row-size-fixed quform-2-columns"><div class="quform-element-column"><div class="quform-element quform-element-text quform-element-34_232_2 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-inner quform-inner-text quform-inner-34_232_2 quform-field-size-medium"><div class="quform-input quform-input-text quform-input-34_232_2 quform-cf"><input type="text" id="quform_34_232_2_5c905b" value="" name="quform_34_232[2]" class="quform-field quform-field-text quform-field-34_232_2" aria-labelledby="quform_34_232_5c905b_label quform_34_232_2_5c905b_sub_label" /></div><label id="quform_34_232_2_5c905b_sub_label" class="quform-sub-label">First</label></div></div></div></div><div class="quform-element-column"><div class="quform-element quform-element-text quform-element-34_232_4 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-inner quform-inner-text quform-inner-34_232_4 quform-field-size-medium"><div class="quform-input quform-input-text quform-input-34_232_4 quform-cf"><input type="text" id="quform_34_232_4_5c905b" value="" name="quform_34_232[4]" class="quform-field quform-field-text quform-field-34_232_4" aria-labelledby="quform_34_232_5c905b_label quform_34_232_4_5c905b_sub_label" /></div><label id="quform_34_232_4_5c905b_sub_label" class="quform-sub-label">Last</label></div></div></div></div></div></div></div></div></div><div class="quform-element quform-element-email quform-element-34_233 quform-cf quform-labels-inside quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_233"><label  class="quform-label-text" for="quform_34_233_5c905b">Email address<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-email quform-inner-34_233 quform-field-size-medium"><div class="quform-input quform-input-email quform-input-34_233 quform-cf"><input type="email" id="quform_34_233_5c905b" name="quform_34_233" value="" class="quform-field quform-field-email quform-field-34_233" /></div></div></div></div><div class="quform-element quform-element-select quform-element-34_252 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_252"><label  class="quform-label-text" for="quform_34_252_5c905b">Please select your package<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-select quform-inner-34_252 quform-field-size-medium"><div class="quform-input quform-input-select quform-input-34_252 quform-cf"><select id="quform_34_252_5c905b" name="quform_34_252" class="quform-field quform-field-select quform-field-34_252"><option value="" selected="selected" ">Please select</option><option value="Basic Package" ">Basic Package</option><option value="Professional Package" ">Professional Package</option><option value="Premier Package" ">Premier Package</option><option value="Companionship Package" ">Companionship Package</option></select></div></div></div></div><div class="quform-element quform-element-select quform-element-34_234 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_234"><label  class="quform-label-text" for="quform_34_234_5c905b">Matchmaker<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-select quform-inner-34_234 quform-field-size-medium"><div class="quform-input quform-input-select quform-input-34_234 quform-cf"><select id="quform_34_234_5c905b" name="quform_34_234" class="quform-field quform-field-select quform-field-34_234"><option value="" selected="selected" ">Please select</option><option value="Aasia" ">Aasia</option><option value="Alisa" ">Alisa</option><option value="Juwairiyyah" ">Juwairiyyah</option><option value="Kamila" ">Kamila</option><option value="Khadija" ">Khadija</option><option value="Rumana" ">Rumana</option><option value="Saman" ">Saman</option><option value="Sharifa" ">Sharifa</option><option value="Samiya" ">Samiya</option><option value="Shorouk" ">Shorouk</option></select></div></div></div></div><div class="quform-element quform-element-html quform-element-34_253 quform-cf"><div class="quform-spacer"><span style="height: 25px;"></span>
<span style="font-weight: 400;">On a scale of  1-5, please rate your experiences with us with <strong>1 being </strong></span><strong>Poor </strong><span style="font-weight: 400;">and <strong>5 being </strong></span><span style="font-weight: 400;"><strong>Excellent</strong>.</span></div></div><div class="quform-element quform-element-radio quform-element-34_256 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_256"><label  class="quform-label-text">How was your experience with the matchmaker?<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-radio quform-inner-34_256 quform-field-size-medium"><p class="quform-description quform-description-above">On a scale of 1-5, please rate your experiences with us with 1 being Poor and 5 being Excellent.</p><div class="quform-input quform-input-radio quform-input-34_256 quform-cf"><div class="quform-options quform-cf quform-options-inline"><div class="quform-option"><input type="radio" name="quform_34_256" id="quform_34_256_5c905b_1" class="quform-field quform-field-radio quform-field-34_256 quform-field-34_256_1" value="1" /><label for="quform_34_256_5c905b_1" class="quform-option-label quform-option-label-34_256_1"><span class="quform-option-text">1</span></label></div><div class="quform-option"><input type="radio" name="quform_34_256" id="quform_34_256_5c905b_2" class="quform-field quform-field-radio quform-field-34_256 quform-field-34_256_2" value="2" /><label for="quform_34_256_5c905b_2" class="quform-option-label quform-option-label-34_256_2"><span class="quform-option-text">2</span></label></div><div class="quform-option"><input type="radio" name="quform_34_256" id="quform_34_256_5c905b_3" class="quform-field quform-field-radio quform-field-34_256 quform-field-34_256_3" value="3" /><label for="quform_34_256_5c905b_3" class="quform-option-label quform-option-label-34_256_3"><span class="quform-option-text">3</span></label></div><div class="quform-option"><input type="radio" name="quform_34_256" id="quform_34_256_5c905b_4" class="quform-field quform-field-radio quform-field-34_256 quform-field-34_256_4" value="4" /><label for="quform_34_256_5c905b_4" class="quform-option-label quform-option-label-34_256_4"><span class="quform-option-text">4</span></label></div><div class="quform-option"><input type="radio" name="quform_34_256" id="quform_34_256_5c905b_5" class="quform-field quform-field-radio quform-field-34_256 quform-field-34_256_5" value="5" /><label for="quform_34_256_5c905b_5" class="quform-option-label quform-option-label-34_256_5"><span class="quform-option-text">5</span></label></div></div></div></div></div></div><div class="quform-element quform-element-radio quform-element-34_288 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_288"><label  class="quform-label-text">Have the periodic check-ins and communications (text, email, etc) with your matchmaker been helpful?<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-radio quform-inner-34_288 quform-field-size-medium"><p class="quform-description quform-description-above">On a scale of 1-5, please rate your experiences with us with 1 being Poor and 5 being Excellent.</p><div class="quform-input quform-input-radio quform-input-34_288 quform-cf"><div class="quform-options quform-cf quform-options-inline"><div class="quform-option"><input type="radio" name="quform_34_288" id="quform_34_288_5c905b_1" class="quform-field quform-field-radio quform-field-34_288 quform-field-34_288_1" value="1" /><label for="quform_34_288_5c905b_1" class="quform-option-label quform-option-label-34_288_1"><span class="quform-option-text">1</span></label></div><div class="quform-option"><input type="radio" name="quform_34_288" id="quform_34_288_5c905b_2" class="quform-field quform-field-radio quform-field-34_288 quform-field-34_288_2" value="2" /><label for="quform_34_288_5c905b_2" class="quform-option-label quform-option-label-34_288_2"><span class="quform-option-text">2</span></label></div><div class="quform-option"><input type="radio" name="quform_34_288" id="quform_34_288_5c905b_3" class="quform-field quform-field-radio quform-field-34_288 quform-field-34_288_3" value="3" /><label for="quform_34_288_5c905b_3" class="quform-option-label quform-option-label-34_288_3"><span class="quform-option-text">3</span></label></div><div class="quform-option"><input type="radio" name="quform_34_288" id="quform_34_288_5c905b_4" class="quform-field quform-field-radio quform-field-34_288 quform-field-34_288_4" value="4" /><label for="quform_34_288_5c905b_4" class="quform-option-label quform-option-label-34_288_4"><span class="quform-option-text">4</span></label></div><div class="quform-option"><input type="radio" name="quform_34_288" id="quform_34_288_5c905b_5" class="quform-field quform-field-radio quform-field-34_288 quform-field-34_288_5" value="5" /><label for="quform_34_288_5c905b_5" class="quform-option-label quform-option-label-34_288_5"><span class="quform-option-text">5</span></label></div></div></div></div></div></div><div class="quform-element quform-element-radio quform-element-34_287 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_287"><label  class="quform-label-text">Overall, how satisfied are you with Beyond Chai's approach to matchmaking?<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-radio quform-inner-34_287 quform-field-size-medium"><p class="quform-description quform-description-above">On a scale of 1-5, please rate your experiences with us with 1 being Poor and 5 being Excellent.</p><div class="quform-input quform-input-radio quform-input-34_287 quform-cf"><div class="quform-options quform-cf quform-options-inline"><div class="quform-option"><input type="radio" name="quform_34_287" id="quform_34_287_5c905b_1" class="quform-field quform-field-radio quform-field-34_287 quform-field-34_287_1" value="1" /><label for="quform_34_287_5c905b_1" class="quform-option-label quform-option-label-34_287_1"><span class="quform-option-text">1</span></label></div><div class="quform-option"><input type="radio" name="quform_34_287" id="quform_34_287_5c905b_2" class="quform-field quform-field-radio quform-field-34_287 quform-field-34_287_2" value="2" /><label for="quform_34_287_5c905b_2" class="quform-option-label quform-option-label-34_287_2"><span class="quform-option-text">2</span></label></div><div class="quform-option"><input type="radio" name="quform_34_287" id="quform_34_287_5c905b_3" class="quform-field quform-field-radio quform-field-34_287 quform-field-34_287_3" value="3" /><label for="quform_34_287_5c905b_3" class="quform-option-label quform-option-label-34_287_3"><span class="quform-option-text">3</span></label></div><div class="quform-option"><input type="radio" name="quform_34_287" id="quform_34_287_5c905b_4" class="quform-field quform-field-radio quform-field-34_287 quform-field-34_287_4" value="4" /><label for="quform_34_287_5c905b_4" class="quform-option-label quform-option-label-34_287_4"><span class="quform-option-text">4</span></label></div><div class="quform-option"><input type="radio" name="quform_34_287" id="quform_34_287_5c905b_5" class="quform-field quform-field-radio quform-field-34_287 quform-field-34_287_5" value="5" /><label for="quform_34_287_5c905b_5" class="quform-option-label quform-option-label-34_287_5"><span class="quform-option-text">5</span></label></div></div></div></div></div></div><div class="quform-element quform-element-radio quform-element-34_286 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_286"><label  class="quform-label-text">How likely are you to recommend Beyond Chai to others?<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-radio quform-inner-34_286 quform-field-size-medium"><p class="quform-description quform-description-above">On a scale of 1-5, please rate your experiences with us with 1 being Poor and 5 being Excellent.</p><div class="quform-input quform-input-radio quform-input-34_286 quform-cf"><div class="quform-options quform-cf quform-options-inline"><div class="quform-option"><input type="radio" name="quform_34_286" id="quform_34_286_5c905b_1" class="quform-field quform-field-radio quform-field-34_286 quform-field-34_286_1" value="1" /><label for="quform_34_286_5c905b_1" class="quform-option-label quform-option-label-34_286_1"><span class="quform-option-text">1</span></label></div><div class="quform-option"><input type="radio" name="quform_34_286" id="quform_34_286_5c905b_2" class="quform-field quform-field-radio quform-field-34_286 quform-field-34_286_2" value="2" /><label for="quform_34_286_5c905b_2" class="quform-option-label quform-option-label-34_286_2"><span class="quform-option-text">2</span></label></div><div class="quform-option"><input type="radio" name="quform_34_286" id="quform_34_286_5c905b_3" class="quform-field quform-field-radio quform-field-34_286 quform-field-34_286_3" value="3" /><label for="quform_34_286_5c905b_3" class="quform-option-label quform-option-label-34_286_3"><span class="quform-option-text">3</span></label></div><div class="quform-option"><input type="radio" name="quform_34_286" id="quform_34_286_5c905b_4" class="quform-field quform-field-radio quform-field-34_286 quform-field-34_286_4" value="4" /><label for="quform_34_286_5c905b_4" class="quform-option-label quform-option-label-34_286_4"><span class="quform-option-text">4</span></label></div><div class="quform-option"><input type="radio" name="quform_34_286" id="quform_34_286_5c905b_5" class="quform-field quform-field-radio quform-field-34_286 quform-field-34_286_5" value="5" /><label for="quform_34_286_5c905b_5" class="quform-option-label quform-option-label-34_286_5"><span class="quform-option-text">5</span></label></div></div></div></div></div></div><div class="quform-element quform-element-textarea quform-element-34_291 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_291"><label  class="quform-label-text" for="quform_34_291_5c905b">Do you have any positive feedback and/or suggestions on how we can improve our service (Matchmaking, Website, etc.)?<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-textarea quform-inner-34_291 quform-field-size-medium"><div class="quform-input quform-input-textarea quform-input-34_291 quform-cf"><textarea id="quform_34_291_5c905b" name="quform_34_291" class="quform-field quform-field-textarea quform-field-34_291"></textarea></div></div></div></div><div class="quform-element quform-element-textarea quform-element-34_293 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_293"><label  class="quform-label-text" for="quform_34_293_5c905b">Why are you leaving this service? <span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-textarea quform-inner-34_293 quform-field-size-medium"><div class="quform-input quform-input-textarea quform-input-34_293 quform-cf"><textarea id="quform_34_293_5c905b" name="quform_34_293" class="quform-field quform-field-textarea quform-field-34_293"></textarea></div></div></div></div><input type="hidden" name="quform_34_295" class="quform-field quform-field-hidden quform-field-34_295" data-default="Membership Cancellation Request" value="Membership Cancellation Request" /><div class="quform-element quform-element-row quform-element-row-34_260 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape"><div class="quform-element quform-element-column quform-element-34_261"><div class="quform-element quform-element-submit quform-element-34_2 quform-cf quform-button-style-blue-3d quform-button-size-medium quform-button-width-medium"><div class="quform-button-submit quform-button-submit-default quform-button-submit-34_2" data-animation="one"><button name="quform_submit" type="submit" class="quform-submit" value="submit"><span class="quform-button-text quform-button-submit-text">Cancel My Subscription</span></button></div><div class="quform-loading quform-loading-position-left quform-loading-type-spinner-1"><div class="quform-loading-inner"><div class="quform-loading-spinner"><div class="quform-loading-spinner-inner"></div></div></div></div></div></div><div class="quform-element quform-element-column quform-element-34_262"></div></div></div></div></div><div class="quform-element quform-element-group quform-element-34_273 quform-cf quform-group-style-plain"><div class="quform-spacer"><div class="quform-child-elements"><div class="quform-element quform-element-html quform-element-34_283 quform-cf"><div class="quform-spacer"><h2 class="quform-page-title" style="margin-bottom: 0px;">On Hold</h2>
Placing your membership On Hold costs 20% of your membership fee per month. Being "On Hold" allows you to retain your Matchmaker if you decide to return to our service.</div></div><div class="quform-element quform-element-name quform-element-34_274 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_274"><label  class="quform-label-text" id="quform_34_274_5c905b_label">Name<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-name quform-inner-34_274 quform-field-size-medium"><div class="quform-input quform-input-name quform-input-34_274 quform-cf"><div class="quform-element-row quform-element-row-size-fixed quform-2-columns"><div class="quform-element-column"><div class="quform-element quform-element-text quform-element-34_274_2 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-inner quform-inner-text quform-inner-34_274_2 quform-field-size-medium"><div class="quform-input quform-input-text quform-input-34_274_2 quform-cf"><input type="text" id="quform_34_274_2_5c905b" value="" name="quform_34_274[2]" class="quform-field quform-field-text quform-field-34_274_2" aria-labelledby="quform_34_274_5c905b_label quform_34_274_2_5c905b_sub_label" /></div><label id="quform_34_274_2_5c905b_sub_label" class="quform-sub-label">First</label></div></div></div></div><div class="quform-element-column"><div class="quform-element quform-element-text quform-element-34_274_4 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-inner quform-inner-text quform-inner-34_274_4 quform-field-size-medium"><div class="quform-input quform-input-text quform-input-34_274_4 quform-cf"><input type="text" id="quform_34_274_4_5c905b" value="" name="quform_34_274[4]" class="quform-field quform-field-text quform-field-34_274_4" aria-labelledby="quform_34_274_5c905b_label quform_34_274_4_5c905b_sub_label" /></div><label id="quform_34_274_4_5c905b_sub_label" class="quform-sub-label">Last</label></div></div></div></div></div></div></div></div></div><div class="quform-element quform-element-email quform-element-34_275 quform-cf quform-labels-inside quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_275"><label  class="quform-label-text" for="quform_34_275_5c905b">Email address<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-email quform-inner-34_275 quform-field-size-medium"><div class="quform-input quform-input-email quform-input-34_275 quform-cf"><input type="email" id="quform_34_275_5c905b" name="quform_34_275" value="" class="quform-field quform-field-email quform-field-34_275" /></div></div></div></div><div class="quform-element quform-element-select quform-element-34_296 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_296"><label  class="quform-label-text" for="quform_34_296_5c905b">Please select your package<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-select quform-inner-34_296 quform-field-size-medium"><div class="quform-input quform-input-select quform-input-34_296 quform-cf"><select id="quform_34_296_5c905b" name="quform_34_296" class="quform-field quform-field-select quform-field-34_296"><option value="" selected="selected" selected="selected"">Please select</option><option value="Basic Package" ">Basic Package</option><option value="Professional Package" ">Professional Package</option><option value="Premier Package" ">Premier Package</option><option value="Companionship Package" ">Companionship Package</option></select></div></div></div></div><div class="quform-element quform-element-select quform-element-34_276 quform-cf quform-element-required"><div class="quform-spacer"><div class="quform-label quform-label-34_276"><label  class="quform-label-text" for="quform_34_276_5c905b">Matchmaker<span class="quform-required">*</span> </label></div><div class="quform-inner quform-inner-select quform-inner-34_276 quform-field-size-medium"><div class="quform-input quform-input-select quform-input-34_276 quform-cf"><select id="quform_34_276_5c905b" name="quform_34_276" class="quform-field quform-field-select quform-field-34_276"><option value="" selected="selected" ">Please select</option><option value="Alisa" ">Alisa</option><option value="Aasia" ">Aasia</option><option value="Juwairiyyah" ">Juwairiyyah</option><option value="Kamila" ">Kamila</option><option value="Khadija" ">Khadija</option><option value="Rumana" ">Rumana</option><option value="Saman" ">Saman</option><option value="Sharifa" ">Sharifa</option><option value="Samiya" ">Samiya</option><option value="Shorouk" ">Shorouk</option></select></div></div></div></div><div class="quform-element quform-element-row quform-element-row-34_278 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape"><div class="quform-element quform-element-column quform-element-34_279"><div class="quform-element quform-element-submit quform-element-34_280 quform-cf quform-button-style-blue-3d quform-button-size-medium quform-button-width-medium"><div class="quform-button-submit quform-button-submit-default quform-button-submit-34_280" data-animation="one"><button name="quform_submit" type="submit" class="quform-submit" value="submit"><span class="quform-button-text quform-button-submit-text">Place My Subscription On Hold</span></button></div><div class="quform-loading quform-loading-position-left quform-loading-type-spinner-1"><div class="quform-loading-inner"><div class="quform-loading-spinner"><div class="quform-loading-spinner-inner"></div></div></div></div></div></div><div class="quform-element quform-element-column quform-element-34_281"></div></div></div></div></div><div class="quform-element-tree"><label for="quform_34_0_5c905b">This field should be left blank</label><input type="text" id="quform_34_0_5c905b" name="quform_34_0" class="quform-field quform-field-tree quform-field-34_0" tabindex="-1" autocomplete="off" /></div></div></div></div></div></form></div></div>
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