Our Team

Our tight-knit team works together to serve child abuse victims and families, and to equip our community to prevent abuse.
Children's Advocacy Center of Smith County Staff Members

The CACSC Team

Leadership

Terri Smith

Operations

Teri Tanner

Jane Coker

Alex

  • Client Assistance Coordinator

Alejandra

  • Client Assistance and Intake Coordinator

Development

Deanna Sims

Emily Taylor, BA

Jennifer Clark

Client Services

Jennifer, MA

Sonya

Alma

Abby, LMSW

Yesenia

Morgan, LMSW

Lisbet, BSW

Macy, BSW

Devin

Medical Services

Meghan, MSN, APRN, FNP-C, CFN, CA-SANE, CP-SANE

Emily, BSN, RN, CA-CP SANE

Lisa, BSN, MSN, FNP-C

Clinical Services

Amber, MA, LPC-S

  • Clinical Director, EMDR Trained, TF-CBT Certified
  • Email Amber

Natali, PhD, LMFT Associate

Kelly, MA, LPC

Melinda, MA, LPC-A, NCC

Michael, LMSW

Alison, MA, LPC

Education Services

Darlene Marshall, M.Ed

Lenore, MS, LPC, CAMS-II

  • Trauma Informed Schools Therapist, EMDR Trained, Registered COS-P Facilitator
  • Email Lenore

LaKenya

Rachel

Ramsey

[class^="wpforms-"]
[class^="wpforms-"]
[gravityforms id="10" title="false" description="false"]
<script type="text/javascript">var gform;gform||(document.addEventListener("gform_main_scripts_loaded",function(){gform.scriptsLoaded=!0}),window.addEventListener("DOMContentLoaded",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener("DOMContentLoaded",o):document.addEventListener("gform_main_scripts_loaded",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook("action",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook("filter",o,n,r,t)},doAction:function(o){gform.doHook("action",o,arguments)},applyFilters:function(o){return gform.doHook("filter",o,arguments)},removeAction:function(o,n){gform.removeHook("action",o,n)},removeFilter:function(o,n,r){gform.removeHook("filter",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+"_"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){"function"!=typeof(t=o.callable)&&(t=window[t]),"action"==n?t.apply(null,r):r[0]=t.apply(null,r)})),"filter"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});</script> <div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_10' ><form method='post' enctype='multipart/form-data' id='gform_10' action='/about/team/' > <div class='gform_body gform-body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_10_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_10_2"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_10_2'> <span id='input_10_2_3_container' class='name_first' > <input type='text' name='input_2.3' id='input_10_2_3' value='' aria-required='true' placeholder='First &amp; Last Name' /> <label for='input_10_2_3' class='hidden_sub_label screen-reader-text'>First</label> </span> </div></fieldset><div id="field_10_3" class="gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_3"><label class='gfield_label' for='input_10_3' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_10_3' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></div><div id="field_10_4" class="gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_4"><label class='gfield_label' for='input_10_4' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_10_4' type='text' value='' class='large' placeholder='Phone' aria-invalid="false" /></div></div><div id="field_10_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_1"><label class='gfield_label' for='input_10_1' >Your Message<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_10_1' class='textarea small' placeholder='Let me know how I can help!' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_10_5" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_5"><label class='gfield_label' for='input_10_5' >Email</label><div class='ginput_container'><input name='input_5' id='input_10_5' type='text' value='' /></div><div class='gfield_description' id='gfield_description_10_5'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Send' onclick='if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; jQuery("#gform_10").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='10' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_10' value='WyJbXSIsIjE5NzYxYzdiYjU0ODg0M2YxMjgwOTY2NmM4OTJmMTg0Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js" value="233"/><script>document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
[class^="wpforms-"]
[class^="wpforms-"]
[gravityforms id="11" title="true" description="false"]
<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_11' > <div class='gform_heading'> <h2 class="gform_title">Contact Terri</h2> </div><form method='post' enctype='multipart/form-data' id='gform_11' action='/about/team/' > <div class='gform_body gform-body'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_11_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_11_2"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_11_2'> <span id='input_11_2_3_container' class='name_first' > <input type='text' name='input_2.3' id='input_11_2_3' value='' aria-required='true' placeholder='First &amp; Last Name' /> <label for='input_11_2_3' class='hidden_sub_label screen-reader-text'>First</label> </span> </div></fieldset><div id="field_11_3" class="gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_11_3"><label class='gfield_label' for='input_11_3' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_11_3' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></div><div id="field_11_4" class="gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_11_4"><label class='gfield_label' for='input_11_4' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_11_4' type='text' value='' class='large' placeholder='Phone' aria-invalid="false" /></div></div><div id="field_11_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_11_1"><label class='gfield_label' for='input_11_1' >Your Message<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_11_1' class='textarea small' placeholder='Let me know how I can help!' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_11_5" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_11_5"><label class='gfield_label' for='input_11_5' >Comments</label><div class='ginput_container'><input name='input_5' id='input_11_5' type='text' value='' /></div><div class='gfield_description' id='gfield_description_11_5'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_11' class='gform_button button' value='Send' onclick='if(window["gf_submitting_11"]){return false;} window["gf_submitting_11"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_11"]){return false;} window["gf_submitting_11"]=true; jQuery("#gform_11").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='11' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_11' value='WyJbXSIsIjE5NzYxYzdiYjU0ODg0M2YxMjgwOTY2NmM4OTJmMTg0Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_11' id='gform_target_page_number_11' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_11' id='gform_source_page_number_11' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_2" name="ak_js" value="193"/><script>document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
[gravityforms id="10" title="false" description="false"]
<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_10' ><form method='post' enctype='multipart/form-data' id='gform_10' action='/about/team/' > <div class='gform_body gform-body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_10_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_10_2"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_10_2'> <span id='input_10_2_3_container' class='name_first' > <input type='text' name='input_2.3' id='input_10_2_3' value='' aria-required='true' placeholder='First &amp; Last Name' /> <label for='input_10_2_3' class='hidden_sub_label screen-reader-text'>First</label> </span> </div></fieldset><div id="field_10_3" class="gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_3"><label class='gfield_label' for='input_10_3' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_10_3' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></div><div id="field_10_4" class="gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_4"><label class='gfield_label' for='input_10_4' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_10_4' type='text' value='' class='large' placeholder='Phone' aria-invalid="false" /></div></div><div id="field_10_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_1"><label class='gfield_label' for='input_10_1' >Your Message<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_10_1' class='textarea small' placeholder='Let me know how I can help!' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_10_5" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_10_5"><label class='gfield_label' for='input_10_5' >Name</label><div class='ginput_container'><input name='input_5' id='input_10_5' type='text' value='' /></div><div class='gfield_description' id='gfield_description_10_5'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Send' onclick='if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_10"]){return false;} window["gf_submitting_10"]=true; jQuery("#gform_10").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='10' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_10' value='WyJbXSIsIjE5NzYxYzdiYjU0ODg0M2YxMjgwOTY2NmM4OTJmMTg0Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_3" name="ak_js" value="181"/><script>document.getElementById( "ak_js_3" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
[gravityforms id="6" title="false" description="false"]
<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_6' ><form method='post' enctype='multipart/form-data' id='gform_6' action='/about/team/' > <div class='gform_body gform-body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_6_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_6_2"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_6_2'> <span id='input_6_2_3_container' class='name_first' > <input type='text' name='input_2.3' id='input_6_2_3' value='' aria-required='true' placeholder='First &amp; Last Name' /> <label for='input_6_2_3' class='hidden_sub_label screen-reader-text'>First</label> </span> </div></fieldset><div id="field_6_3" class="gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_6_3"><label class='gfield_label' for='input_6_3' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_6_3' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></div><div id="field_6_4" class="gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_6_4"><label class='gfield_label' for='input_6_4' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_6_4' type='text' value='' class='large' placeholder='Phone' aria-invalid="false" /></div></div><div id="field_6_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_6_1"><label class='gfield_label' for='input_6_1' >Your Message<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_6_1' class='textarea small' placeholder='Let me know how I can help!' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_6_5" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_6_5"><label class='gfield_label' for='input_6_5' >Comments</label><div class='ginput_container'><input name='input_5' id='input_6_5' type='text' value='' /></div><div class='gfield_description' id='gfield_description_6_5'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_6' class='gform_button button' value='Send' onclick='if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} window["gf_submitting_6"]=true; jQuery("#gform_6").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='6' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_6' value='WyJbXSIsIjE5NzYxYzdiYjU0ODg0M2YxMjgwOTY2NmM4OTJmMTg0Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_6' id='gform_target_page_number_6' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_6' id='gform_source_page_number_6' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_4" name="ak_js" value="73"/><script>document.getElementById( "ak_js_4" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>
[class^="wpforms-"]
[class^="wpforms-"]
[gravityforms id="4" title="false" description="false"]
<div class='gf_browser_unknown gform_wrapper gravity-theme' id='gform_wrapper_4' ><form method='post' enctype='multipart/form-data' id='gform_4' action='/about/team/' > <div class='gform_body gform-body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below'><fieldset id="field_4_2" class="gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible" data-js-reload="field_4_2"><legend class='gfield_label gfield_label_before_complex' >Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name' id='input_4_2'> <span id='input_4_2_3_container' class='name_first' > <input type='text' name='input_2.3' id='input_4_2_3' value='' aria-required='true' placeholder='First &amp; Last Name' /> <label for='input_4_2_3' class='hidden_sub_label screen-reader-text'>First</label> </span> </div></fieldset><div id="field_4_3" class="gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_4_3"><label class='gfield_label' for='input_4_3' >Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_email'> <input name='input_3' id='input_4_3' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" /> </div></div><div id="field_4_4" class="gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_4_4"><label class='gfield_label' for='input_4_4' >Phone</label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_4_4' type='text' value='' class='large' placeholder='Phone' aria-invalid="false" /></div></div><div id="field_4_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_4_1"><label class='gfield_label' for='input_4_1' >Your Message<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_4_1' class='textarea small' placeholder='Let me know how I can help!' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_4_5" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" data-js-reload="field_4_5"><label class='gfield_label' for='input_4_5' >Name</label><div class='ginput_container'><input name='input_5' id='input_4_5' type='text' value='' /></div><div class='gfield_description' id='gfield_description_4_5'>This field is for validation purposes and should be left unchanged.</div></div></div></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_4' class='gform_button button' value='Send' onclick='if(window["gf_submitting_4"]){return false;} window["gf_submitting_4"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_4"]){return false;} window["gf_submitting_4"]=true; jQuery("#gform_4").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='4' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_4' value='WyJbXSIsIjE5NzYxYzdiYjU0ODg0M2YxMjgwOTY2NmM4OTJmMTg0Il0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_4' id='gform_target_page_number_4' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_4' id='gform_source_page_number_4' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> <p style="display: none !important;"><label>&#916;<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_5" name="ak_js" value="197"/><script>document.getElementById( "ak_js_5" ).setAttribute( "value", ( new Date() ).getTime() );</script></p></form> </div>