Error while running CustomForm

Hello Everyone,

I have created a CustomForm and when i am running that form via CustomForm Activity i am getting below error.Can anyone please help me in this.
Below is the attached CustomCode [HTMLPage1.html|attachment](upload://7ar6V5l8QjAVOK88Qr0DziVz6iy.html) (7.4 KB)

It looks like you’re trying to get the Checked property of something. There are no checkboxes on your page, though. Can you reattach your code, it’s not displaying correctly on your initial post.

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