[{"lid":"1570290149233","ls":"10","loff":"","li_type":"nm","li_title":"Your Full Name","li_ph":"e.g., John Smith","li_req":"y","li_inputinrow":"y","li_nm":"Name"},{"lid":"1731592950439","ls":"20","loff":"","li_type":"in","li_title":"Your Age","li_ph":"e.g., 23","li_req":"y","li_nm":"Your Age"},{"lid":"1531306243545","ls":"30","loff":"","li_type":"em","li_name":"email","li_title":"E-mail Address ","li_ph":"e.g., name@cryptonica.io ","li_req":"y","li_inputinrow":"y","li_nm":"email"},{"lid":"1570290207299","ls":"40","loff":"","li_type":"ph","li_title":"Phone Number","li_ph":"e.g. +1 (000) 000-0000","li_req":"y","li_masktype":"a","li_maskcountry":"US","li_nm":"Phone"},{"lid":"1731428644364","ls":"50","loff":"","li_type":"sb","li_title":"Country of Residence","li_req":"y","li_variants":"United States\nUnited Kingdom\nAfghanistan\nAlbania\nAlgeria\nAndorra\nAngola\nAntigua and Barbuda\nArgentina\nArmenia\nAustralia\nAustria\nAzerbaijan\nBahamas\nBahrain\nBangladesh\nBarbados\nBelarus\nBelgium\nBelize\nBenin\nBhutan\nBolivia\nBosnia and Herzegovina\nBotswana\nBrazil\nBrunei\nBulgaria\nBurkina Faso\nBurundi\nCabo Verde\nCambodia\nCameroon\nCanada\nCentral African Republic\nChad\nChile\nChina\nColombia\nComoros\nCongo, Democratic Republic of the\nCongo, Republic of the\nCosta Rica\nC\u00f4te dIvoire\nCroatia\nCuba\nCyprus\nCzech Republic\nDenmark\nDjibouti\nDominica\nDominican Republic\nEcuador\nEgypt\nEl Salvador\nEquatorial Guinea\nEritrea\nEstonia\nEswatini\nEthiopia\nFiji\nFinland\nFrance\nGabon\nGambia\nGeorgia\nGermany\nGhana\nGreece\nGrenada\nGuatemala\nGuinea\nGuinea-Bissau\nGuyana\nHaiti\nHonduras\nHungary\nIceland\nIndia\nIndonesia\nIran\nIraq\nIreland\nIsrael\nItaly\nJamaica\nJapan\nJordan\nKazakhstan\nKenya\nKiribati\nKorea, Republic of\nKorea, Democratic Peoples Republic of\nKuwait\nKyrgyzstan\nLaos\nLatvia\nLebanon\nLesotho\nLiberia\nLibya\nLiechtenstein\nLithuania\nLuxembourg\nMadagascar\nMalawi\nMalaysia\nMaldives\nMali\nMalta\nMarshall Islands\nMauritania\nMauritius\nMexico\nMicronesia\nMoldova\nMonaco\nMongolia\nMontenegro\nMorocco\nMozambique\nMyanmar (Burma)\nNamibia\nNauru\nNepal\nNetherlands\nNew Zealand\nNicaragua\nNiger\nNigeria\nNorth Macedonia\nNorway\nOman\nPakistan\nPalau\nPanama\nPapua New Guinea\nParaguay\nPeru\nPhilippines\nPoland\nPortugal\nQatar\nRomania\nRussia\nRwanda\nSaint Kitts and Nevis\nSaint Lucia\nSaint Vincent and the Grenadines\nSamoa\nSan Marino\nSao Tome and Principe\nSaudi Arabia\nSenegal\nSerbia\nSeychelles\nSierra Leone\nSingapore\nSlovakia\nSlovenia\nSolomon Islands\nSomalia\nSouth Africa\nSouth Sudan\nSpain\nSri Lanka\nSudan\nSuriname\nSweden\nSwitzerland\nSyria\nTaiwan\nTajikistan\nTanzania\nThailand\nTimor-Leste\nTogo\nTonga\nTrinidad and Tobago\nTunisia\nTurkey\nTurkmenistan\nTuvalu\nUganda\nUkraine\nUnited Arab Emirates\nUruguay\nUzbekistan\nVanuatu\nVatican City\nVenezuela\nVietnam\nYemen\nZambia\nZimbabwe","li_selfirstvar":"Choose variant from the list","li_nm":"Country of Residence"},{"lid":"1731428410479","ls":"60","loff":"","li_type":"rd","li_title":"Are you participating in the Cryptonica Liquidity Pool?","li_subtitle":"(If you are participating in multiple pools, check all that apply)","li_variants":"Pool A\nPool B\nPool C","li_radcb":"cb","li_radioposition":"1_3","li_nm":"Are you participating in the Cryptonica Liquidity Pool?"},{"lid":"1731428476643","ls":"70","loff":"","li_type":"rd","li_title":"Are you an ATM Hosting Partner?","li_variants":"Yes\nNo","li_radcb":"rb","li_radioposition":"1_2","li_nm":"Are you an ATM Hosting Partner?"},{"lid":"1731428610063","ls":"80","loff":"","li_type":"rd","li_title":"Do you use Cryptonica ATMs?","li_variants":"Yes\nNo","li_radcb":"rb","li_radioposition":"1_2","li_nm":"Do you use Cryptonica ATMs?"},{"lid":"1731428239644","ls":"90","loff":"","li_type":"rd","li_title":"Food Preference","li_subtitle":"(Check all that apply)","li_variants":"Vegetarian\nVegan\nGluten-Free\nSugar-Free\nDairy-Free\nHalal\nKosher\nNo Raw Food","li_isownvariant":"y","li_ownvariant":"Other","li_radcb":"cb","li_radioposition":"1_2","li_nm":"Food Preference"},{"lid":"1731588063353","ls":"100","loff":"","li_type":"rd","li_title":"Accessibility Needs","li_subtitle":"(Check all that apply)","li_variants":"Assisted-listening devices\nBraille materials\nService Animal Accommodations\nAccessible Parking\nWheelchair (I need one)\nWheelchair (I will bring one)","li_isownvariant":"y","li_ownvariant":"Other","li_radcb":"cb","li_radioposition":"1_2","li_nm":"Accessibility Needs"},{"lid":"1570301582012","ls":"110","loff":"","li_type":"ta","li_title":"Comments","li_subtitle":"Here you can provide any additional information regarding your food preferences, accessibility needs, or anything else not mentioned above.","li_rows":"5","li_nm":"Comments"},{"lid":"1731588207427","ls":"120","loff":"","li_type":"cb","li_req":"y","li_label":"By submitting this application, I confirm my consent to the processing and transfer of my personal data. I understand that my personal data may be processed for purposes related to the application, including, but not limited to, its registration, analysis, and review.","li_nm":"Checkbox"}]
Participation Form
