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[contact-form-7 id="600" title="That Good Feet Feeling"]
<div role="form" class="wpcf7" id="wpcf7-f600-o2" lang="en-US" dir="ltr"> <div class="screen-reader-response"></div> <form action="/st-louis/coupon/#wpcf7-f600-o2" method="post" class="wpcf7-form" novalidate="novalidate"> <div style="display: none;"> <input type="hidden" name="_wpcf7" value="600" /> <input type="hidden" name="_wpcf7_version" value="5.1.6" /> <input type="hidden" name="_wpcf7_locale" value="en_US" /> <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f600-o2" /> <input type="hidden" name="_wpcf7_container_post" value="0" /> </div> <div class="good-feeling-form"> <h1>Which of the following activities would you like to do more of?</h1> <p> <span class="wpcf7-form-control-wrap which-activities"><span class="wpcf7-form-control wpcf7-checkbox"><span class="wpcf7-list-item first"><input type="checkbox" name="which-activities[]" value="Shopping" /><span class="wpcf7-list-item-label">Shopping</span></span><span class="wpcf7-list-item"><input type="checkbox" name="which-activities[]" value="Fitness" /><span class="wpcf7-list-item-label">Fitness</span></span><span class="wpcf7-list-item"><input type="checkbox" name="which-activities[]" value="Gardening" /><span class="wpcf7-list-item-label">Gardening</span></span><span class="wpcf7-list-item last"><input type="checkbox" name="which-activities[]" value="Vacationing" /><span class="wpcf7-list-item-label">Vacationing</span></span></span></span> </p> <p>Please submit info below and receive more info about getting the Good Feet feeling.</p> <div style="display:none"> <span class="wpcf7-form-control-wrap currenturl"><input type="text" name="currenturl" value="" size="40" class="wpcf7-form-control wpcf7-text" id="input-currenturl-gtdsc" aria-invalid="false" /></span> <span class="wpcf7-form-control-wrap reachlocalvalue"><input type="text" name="reachlocalvalue" value="" size="40" class="wpcf7-form-control wpcf7-text" id="input-reachlocalvalue-gtdsc" aria-invalid="false" /></span> <input type="hidden" id="hdnReachLocalField-gtdsc" name="cpsys_FormItem_cpsys_DefaultGroup_LeadSource" value="Direct" /> </div> <p> <span class="wpcf7-form-control-wrap your-name"><input type="text" name="your-name" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Name" /></span> <span class="wpcf7-form-control-wrap your-email"><input type="email" name="your-email" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" aria-required="true" aria-invalid="false" placeholder="Email" /></span> <span class="wpcf7-form-control-wrap your-phone"><input type="tel" name="your-phone" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" aria-required="true" aria-invalid="false" placeholder="Phone" /></span> <input type="submit" value="Sign Me Up" class="wpcf7-form-control wpcf7-submit om-trigger-conversion" /> </p> </div> <script> $(document).ready(function() { $('.good-feeling-form #input-currenturl-gtdsc').val(window.location.href); $('.good-feeling-form #input-reachlocalvalue-gtdsc').val( $('.good-feeling-form #hdnReachLocalField-gtdsc').val() ); }); </script><div class="wpcf7-response-output wpcf7-display-none"></div></form></div>