{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_5\"><h4>Stories of Resilience (Submit  your climate resilience story of combating climate change) <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-0]\" value=\"Water Conservation\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Water Conservation<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-1]\" value=\"Good Farming Practices\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Good Farming Practices<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-2]\" value=\"Solar Energy\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Solar Energy<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-3]\" value=\"Afforestation\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Afforestation<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-4]\" value=\"Biodiversity Management\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Biodiversity Management<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-5]\" value=\"Mangrove Conservation\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Mangrove Conservation<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-6]\" value=\"Eco-efficiency\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Eco-efficiency<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-7]\" value=\"Fuel-free cooking\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Fuel-free cooking<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-8]\" value=\"Wildlife Conservation\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Wildlife Conservation<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-9]\" value=\"Disease\/Healthcare\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Disease\/Healthcare<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-10]\" value=\"Lake rejuvenation\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Lake rejuvenation<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-11]\" value=\"Women empowerment\/Climate Justice\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Women empowerment\/Climate Justice<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[5-BLANKHACK]\" value=\"\"  \/>\n<\/div><div class=\"report_row\" id=\"custom_field_row_1\"><h4>Gender<span class='required'> *<\/span> <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[1-0]\" value=\"Female\" id=\"custom_field_1\" \/><label for=\"custom_field[1]\" > Female<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[1-1]\" value=\"Male\" id=\"custom_field_1\" \/><label for=\"custom_field[1]\" > Male<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[1-2]\" value=\"Other\" id=\"custom_field_1\" \/><label for=\"custom_field[1]\" > Other<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[1-3]\" value=\"Not Specified\" id=\"custom_field_1\" \/><label for=\"custom_field[1]\" > Not Specified<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[1-BLANKHACK]\" value=\"\"  \/>\n<\/div><\/div>"}