{"id":7210,"date":"2026-08-20T12:59:58","date_gmt":"2026-08-20T16:59:58","guid":{"rendered":"https:\/\/curesz.org\/?page_id=7210"},"modified":"2026-08-20T13:00:54","modified_gmt":"2026-08-20T17:00:54","slug":"sign-up","status":"publish","type":"page","link":"https:\/\/curesz.org\/he\/vitucci-memorial-lecture-2026\/sign-up\/","title":{"rendered":"2026 Vitucci Memorial Lecture Sign Up"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1352px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return 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 gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_12' style='display:none'><div id='gf_12' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/he\/wp-json\/wp\/v2\/pages\/7210#gf_12' data-formid='12' novalidate><div id=\"payments-sdk__contingency-lightbox\"><\/div>\n        <div id='gf_progressbar_wrapper_12' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u05e9\u05dc\u05d1 <span class='gf_step_current_page'>1<\/span> \u05de\u05ea\u05d5\u05da <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_12_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_above description_above validation_above'><div id=\"field_12_16\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_16'><span class='gform-field-label__text'>Company<\/span><\/label><div class='gfield_description' id='gfield_description_12_16'>\u05e9\u05d3\u05d4 \u05d6\u05d4 \u05de\u05d9\u05d5\u05e2\u05d3 \u05dc\u05de\u05d8\u05e8\u05d5\u05ea \u05d0\u05d9\u05de\u05d5\u05ea \u05d5\u05d9\u05e9 \u05dc\u05d4\u05e9\u05d0\u05d9\u05e8 \u05d0\u05d5\u05ea\u05d5 \u05dc\u05dc\u05d0 \u05e9\u05d9\u05e0\u05d5\u05d9.<\/div><div class='ginput_container'><input name='input_16' id='input_12_16' type='text' value='' autocomplete='new-password'\/><\/div><\/div><fieldset id=\"field_12_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u05d7\u05d5\u05d1\u05d4)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_1'>\n                            \n                            <span id='input_12_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_12_1_3' class='gform-field-label gform-field-label--type-sub '>\u05e8\u05d0\u05e9\u05d5\u05df<\/label>\n                                                    <input type='text' name='input_1.3' id='input_12_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_12_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_12_1_6' class='gform-field-label gform-field-label--type-sub '>\u05d0\u05d7\u05e8\u05d5\u05df<\/label>\n                                                            <input type='text' name='input_1.6' id='input_12_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_12_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u05d7\u05d5\u05d1\u05d4)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_12_2_container'>\n                                <span id='input_12_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_12_2' class='gform-field-label gform-field-label--type-sub '>\u05d4\u05d6\u05df \u05d0\u05d9\u05de\u05d9\u05d9\u05dc<\/label>\n                                    <input class='' type='email' name='input_2' id='input_12_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_12_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_12_2_2' class='gform-field-label gform-field-label--type-sub '>\u05d0\u05d9\u05de\u05d5\u05ea \u05d0\u05d9\u05de\u05d9\u05d9\u05dc<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_12_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_12_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_12'><span class='gform-field-label__text'>State<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_12_12' class='large gfield_select'     aria-invalid=\"false\" ><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_12_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_13'><span class='gform-field-label__text'>Role<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_12_13' class='large gfield_select'     aria-invalid=\"false\" ><option value='Care Partner' >Care Partner<\/option><option value='Person With Lived Experience' >Person With Lived Experience<\/option><option value='Clinician' >Clinician<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><fieldset id=\"field_12_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>CME Credit<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_7'><div class='gchoice gchoice_12_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Please check if you would like CME credit.'  id='choice_12_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_7_1' id='label_12_7_1' class='gform-field-label gform-field-label--type-inline'>Please check if you would like CME credit.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Newsletter Sign Up<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_15'>\n\t\t\t<div class='gchoice gchoice_12_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes' checked='checked' id='choice_12_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_15_0' id='label_12_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_12_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_15_1' id='label_12_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_3\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_12_3 gfield_product_12_3 gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Donation Amount<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u05d7\u05d5\u05d1\u05d4)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_3'>\n\t\t\t<div class='gchoice gchoice_12_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='25|25' checked='checked' id='choice_12_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_0' id='label_12_3_0' class='gform-field-label gform-field-label--type-inline'>25 USD (minimum for CME)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='50|50'  id='choice_12_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_1' id='label_12_3_1' class='gform-field-label gform-field-label--type-inline'>50 USD<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='100|100'  id='choice_12_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_2' id='label_12_3_2' class='gform-field-label gform-field-label--type-inline'>100 USD (will be acknowledged as silver sponsor)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='250|250'  id='choice_12_3_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_3' id='label_12_3_3' class='gform-field-label gform-field-label--type-inline'>250 USD (will be acknowledged as gold sponsor)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='1000|0'  id='choice_12_3_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_4' id='label_12_3_4' class='gform-field-label gform-field-label--type-inline'>1000 USD (will be acknowledged as platinum sponsor and mailed signed copy of Awakenings)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Other amount|0'  id='choice_12_3_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_5' id='label_12_3_5' class='gform-field-label gform-field-label--type-inline'>Other amount (don't want to donate? Enter 0 below)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_4\" class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_12_4 gfield_product_12_4 gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_4'><span class='gform-field-label__text'>Other Amount<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u05d7\u05d5\u05d1\u05d4)<\/span><\/span><\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_4' id='input_12_4' type='text' value='' class='medium ginput_amount'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_12_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Continue to Payment<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_2' class='gform_fields top_label form_sublabel_above description_above validation_above'><div id=\"field_12_10\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><h2>Payment Info<\/h2><\/div><fieldset id=\"field_12_6\" class=\"gfield gfield--type-paypal gfield--input-type-paypal gfield--width-full 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