Club Member Form

.wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .wpv-collage { grid-column-gap: 15px;grid-row-gap: 15px; } .wpv-block-loop-item[data-toolset-views-view-template-block="64348500c59aae21ccb60f8e89f72acd"] { font-size: 13px;line-height: 0px; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .wpv-collage { grid-column-gap: 15px;grid-row-gap: 15px; } .wpv-block-loop-item[data-toolset-views-view-template-block="8e408263ea8776715f07b669a385b8d6"] { font-size: 13px;line-height: 1px; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .wpv-collage { grid-column-gap: 15px;grid-row-gap: 15px; } .wpv-block-loop-item[data-toolset-views-view-template-block="e0a7721f6209a17e11efd015c22c6808"] { font-size: 13px;line-height: 1px;margin-bottom: 0;padding-top: 0;padding-bottom: 0;border: 0px solid rgba( 140, 136, 136, 0.61 ); } .tb-field[data-toolset-blocks-field="b39ee8f69e895dcfea126ab2232f8f8f"] { text-align: left; } .tb-field[data-toolset-blocks-field="7d935ada78213c09d5473f37b293b4d7"] { text-align: left; } h4.tb-heading[data-toolset-blocks-heading="92305997c2862eb6e46877a136b467e6"]  { font-size: 24px;font-family: ABeeZee;font-weight: bold;text-shadow: 1px 1px 1px rgba( 0, 0, 0, 0.5 );color: rgba( 223, 29, 49, 1 );text-align: center; } h4.tb-heading[data-toolset-blocks-heading="92305997c2862eb6e46877a136b467e6"] a  { color: rgba( 223, 29, 49, 1 ); } @media only screen and (max-width: 781px) { .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 2) { grid-column: 2 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] > .tb-grid-column:nth-of-type(3n + 3) { grid-column: 3 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 0.3333fr) minmax(0, 0.3333fr) minmax(0, 0.3333fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; }  } @media only screen and (max-width: 599px) { .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"]  > .tb-grid-column:nth-of-type(1n+1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 1fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="489fe6c8d64e6d82fe873c5cfb5b36de"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"]  > .tb-grid-column:nth-of-type(1n+1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 1fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="43fa124292b0d5949eab6885f7e316ad"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"]  > .tb-grid-column:nth-of-type(1n+1) { grid-column: 1 } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .js-wpv-loop-wrapper > .tb-grid { grid-template-columns: minmax(0, 1fr);grid-auto-flow: row } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry { grid-template-columns: minmax(0, 1fr) minmax(0, 1fr) minmax(0, 1fr);grid-column-gap: 5px; } .wpv-view-output[data-toolset-views-view-editor="c805f47c5816686daddfa7f3f21c89e3"] .tb-masonry .tb-brick__content { padding: 0 0 5px 0; }  } 

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