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class='gfield-choice-input' name='input_4.2' type='checkbox'  value='\u06cc\u0627\u0632\u062f\u0647\u0645'  id='choice_3_4_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_4_2' id='label_3_4_2' class='gform-field-label gform-field-label--type-inline'>\u06cc\u0627\u0632\u062f\u0647\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_4_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.3' type='checkbox'  value='\u062f\u0648\u0627\u0632\u062f\u0647\u0645'  id='choice_3_4_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_4_3' id='label_3_4_3' class='gform-field-label gform-field-label--type-inline'>\u062f\u0648\u0627\u0632\u062f\u0647\u0645<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0631\u0634\u062a\u0647 \u062e\u0648\u062f \u0631\u0627 \u0627\u0646\u062a\u062e\u0627\u0628 \u06a9\u0646\u06cc\u062f.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(\u0636\u0631\u0648\u0631\u06cc)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_5'><div class='gchoice gchoice_3_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='\u0634\u0628\u06a9\u0647 \u0648 \u0646\u0631\u0645 \u0627\u0641\u0632\u0627\u0631'  id='choice_3_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_1' id='label_3_5_1' class='gform-field-label gform-field-label--type-inline'>\u0634\u0628\u06a9\u0647 \u0648 \u0646\u0631\u0645 \u0627\u0641\u0632\u0627\u0631<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='\u0645\u0639\u0645\u0627\u0631\u06cc'  id='choice_3_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_2' id='label_3_5_2' class='gform-field-label gform-field-label--type-inline'>\u0645\u0639\u0645\u0627\u0631\u06cc<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='\u0639\u0644\u0648\u0645 \u0627\u0646\u0633\u0627\u0646\u06cc'  id='choice_3_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_3' id='label_3_5_3' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0648\u0645 \u0627\u0646\u0633\u0627\u0646\u06cc<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='\u0639\u0644\u0648\u0645 \u062a\u062c\u0631\u0628\u06cc'  id='choice_3_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_4' id='label_3_5_4' class='gform-field-label gform-field-label--type-inline'>\u0639\u0644\u0648\u0645 \u062a\u062c\u0631\u0628\u06cc<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='\u0631\u06cc\u0627\u0636\u06cc \u0641\u06cc\u0632\u06cc\u06a9'  id='choice_3_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_5' id='label_3_5_5' class='gform-field-label gform-field-label--type-inline'>\u0631\u06cc\u0627\u0636\u06cc \u0641\u06cc\u0632\u06cc\u06a9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_3_6\" ><legend class='gfield_label gform-field-label 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