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class="help-block text-danger"></p> </div> </div> <div class="col-lg-1"></div> <div class="col-lg-5"> <div class="form-group"> <input type="text" class="form-control" id="name" placeholder="Name" name="name" required> <p class="help-block text-danger"></p> </div> </div> </div> <div class="row"> <div class="col-lg-5"> <div class="form-group"> <input type="email" class="form-control" id="email" placeholder="Email" name="email" required> <p class="help-block text-danger"></p> </div> </div> <div class="col-lg-1"></div> <div class="col-lg-5"> <div class="form-group"> <input type="text" class="form-control" id="phno" placeholder="Phone Number" name="phno" required> <p class="help-block text-danger"></p> </div> </div> </div> <div class="row"> <div class="col-lg-5"> <div class="form-group"> <input type="text" class="form-control" id="organization" placeholder="Organization" name="organization" required> <p class="help-block text-danger"></p> </div> </div> <div class="col-lg-1"></div> <div class="col-lg-5"> <div class="form-group"> <select name="country" id="country" class="form-control" required> <option value="" selected="selected">- Please choose a country -</option> <option id="af" value="AFGHANISTAN">AFGHANISTAN</option> <option id="ax" value="脜LAND ISLANDS">ALAND ISLANDS</option> <option id="al" value="ALBANIA">ALBANIA</option> <option id="dz" value="ALGERIA">ALGERIA</option> <option id="as" value="AMERICAN SAMOA">AMERICAN SAMOA</option> <option id="ad" value="ANDORRA">ANDORRA</option> <option id="ao" value="ANGOLA">ANGOLA</option> <option id="ai" value="ANGUILLA">ANGUILLA</option> <option id="aq" value="ANTARCTICA">ANTARCTICA</option> <option id="ag" value="ANTIGUA AND BARBUDA">ANTIGUA AND BARBUDA</option> <option id="ar" value="ARGENTINA">ARGENTINA</option> <option id="am" value="ARMENIA">ARMENIA</option> <option id="aw" value="ARUBA">ARUBA</option> <option id="au" value="AUSTRALIA">AUSTRALIA</option> <option id="at" value="AUSTRIA">AUSTRIA</option> <option id="az" value="AZERBAIJAN">AZERBAIJAN</option> <option id="bs" value="BAHAMAS">BAHAMAS</option> <option id="bh" value="BAHRAIN">BAHRAIN</option> <option id="bd" value="BANGLADESH">BANGLADESH</option> <option id="bb" value="BARBADOS">BARBADOS</option> <option id="by" value="BELARUS">BELARUS</option> <option id="be" value="BELGIUM">BELGIUM</option> <option id="bz" value="BELIZE">BELIZE</option> <option id="bj" value="BENIN">BENIN</option> <option id="bm" value="BERMUDA">BERMUDA</option> <option id="bt" value="BHUTAN">BHUTAN</option> <option id="bo" value="BOLIVIA">BOLIVIA</option> <option id="ba" value="BOSNIA AND HERZEGOVINA">BOSNIA AND HERZEGOVINA</option> <option id="bw" value="BOTSWANA">BOTSWANA</option> <option id="bv" value="BOUVET ISLAND">BOUVET ISLAND</option> <option id="br" value="BRAZIL">BRAZIL</option> <option id="io" value="BRITISH INDIAN OCEAN TERRITORY">BRITISH INDIAN OCEAN TERRITORY</option> <option id="bn" value="BRUNEI DARUSSALAM">BRUNEI DARUSSALAM</option> <option id="bg" value="BULGARIA">BULGARIA</option> <option id="bf" value="BURKINA FASO">BURKINA FASO</option> <option id="bi" value="BURUNDI">BURUNDI</option> <option id="kh" value="CAMBODIA">CAMBODIA</option> <option id="cm" value="CAMEROON">CAMEROON</option> <option id="ca" value="CANADA">CANADA</option> <option id="cv" value="CAPE VERDE">CAPE VERDE</option> <option id="ky" value="CAYMAN ISLANDS">CAYMAN ISLANDS</option> <option id="cf" value="CENTRAL AFRICAN REPUBLIC">CENTRAL AFRICAN REPUBLIC</option> <option id="td" value="CHAD">CHAD</option> <option id="cl" value="CHILE">CHILE</option> <option id="cn" value="CHINA">CHINA</option> <option id="cx" value="CHRISTMAS ISLAND">CHRISTMAS ISLAND</option> <option id="cc" value="COCOS (KEELING) ISLANDS">COCOS (KEELING) ISLANDS</option> <option id="co" value="COLOMBIA">COLOMBIA</option> <option id="km" value="COMOROS">COMOROS</option> <option id="cg" value="CONGO">CONGO</option> <option id="cd" value="CONGO, THE DEMOCRATIC REPUBLIC OF THE">CONGO, THE DEMOCRATIC REPUBLIC OF THE</option> <option id="ck" value="COOK ISLANDS">COOK ISLANDS</option> <option id="cr" value="COSTA RICA">COSTA RICA</option> <option id="ci" value="COTE D'IVOIRE">COTE D'IVOIRE</option> <option id="hr" value="CROATIA">CROATIA</option> <option id="cu" value="CUBA">CUBA</option> <option id="cy" value="CYPRUS">CYPRUS</option> <option id="cz" value="CZECH REPUBLIC">CZECH REPUBLIC</option> <option id="dk" value="DENMARK">DENMARK</option> <option id="dj" value="DJIBOUTI">DJIBOUTI</option> <option id="dm" value="DOMINICA">DOMINICA</option> <option id="do" value="DOMINICAN REPUBLIC">DOMINICAN REPUBLIC</option> <option id="tl" value="EAST TIMOR">EAST TIMOR</option> <option id="ec" value="ECUADOR">ECUADOR</option> <option id="eg" value="EGYPT">EGYPT</option> <option id="sv" value="EL SALVADOR">EL SALVADOR</option> <option id="gq" value="EQUATORIAL GUINEA">EQUATORIAL GUINEA</option> <option id="er" value="ERITREA">ERITREA</option> <option id="ee" value="ESTONIA">ESTONIA</option> <option id="et" value="ETHIOPIA">ETHIOPIA</option> <option id="fk" value="FALKLAND ISLANDS (MALVINAS)">FALKLAND ISLANDS (MALVINAS)</option> <option id="fo" value="FAROE ISLANDS">FAROE ISLANDS</option> <option id="fj" value="FIJI">FIJI</option> <option id="fi" value="FINLAND">FINLAND</option> <option id="fr" value="FRANCE">FRANCE</option> <option id="gf" value="FRENCH GUIANA">FRENCH GUIANA</option> <option id="pf" value="FRENCH POLYNESIA">FRENCH POLYNESIA</option> <option id="tf" value="FRENCH SOUTHERN TERRITORIES">FRENCH SOUTHERN TERRITORIES</option> <option id="ga" value="GABON">GABON</option> <option id="gm" value="GAMBIA">GAMBIA</option> <option id="ge" value="GEORGIA">GEORGIA</option> <option id="de" value="GERMANY">GERMANY</option> <option id="gh" value="GHANA">GHANA</option> <option id="gi" value="GIBRALTAR">GIBRALTAR</option> <option id="gr" value="GREECE">GREECE</option> <option id="gl" value="GREENLAND">GREENLAND</option> <option id="gd" value="GRENADA">GRENADA</option> <option id="gp" value="GUADELOUPE">GUADELOUPE</option> <option id="gu" value="GUAM">GUAM</option> <option id="gt" value="GUATEMALA">GUATEMALA</option> <option id="gg" value="GUERNSEY">GUERNSEY</option> <option id="gn" value="GUINEA">GUINEA</option> <option id="gw" value="GUINEA-BISSAU">GUINEA-BISSAU</option> <option id="gy" value="GUYANA">GUYANA</option> <option id="ht" value="HAITI">HAITI</option> <option id="hm" value="HEARD AND MC DONALD ISLANDS">HEARD AND MC DONALD ISLANDS</option> <option id="hn" value="HONDURAS">HONDURAS</option> <option id="hk" value="HONG KONG">HONG KONG</option> <option id="hu" value="HUNGARY">HUNGARY</option> <option id="is" value="ICELAND">ICELAND</option> <option id="in" value="INDIA">INDIA</option> <option id="id" value="INDONESIA">INDONESIA</option> <option id="ir" value="IRAN (ISLAMIC REPUBLIC OF)">IRAN (ISLAMIC REPUBLIC OF)</option> <option id="iq" value="IRAQ">IRAQ</option> <option id="ie" value="IRELAND">IRELAND</option> <option id="im" value="ISLE OF MAN">ISLE OF MAN</option> <option id="il" value="ISRAEL">ISRAEL</option> <option id="it" value="ITALY">ITALY</option> <option id="jm" value="JAMAICA">JAMAICA</option> <option id="jp" value="JAPAN">JAPAN</option> <option id="je" value="JERSEY">JERSEY</option> <option id="jo" value="JORDAN">JORDAN</option> <option id="kz" value="KAZAKHSTAN">KAZAKHSTAN</option> <option id="ke" value="KENYA">KENYA</option> <option id="ki" value="KIRIBATI">KIRIBATI</option> <option id="kp" value="KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF">KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF</option> <option id="kr" value="KOREA, REPUBLIC OF">KOREA, REPUBLIC OF</option> <option id="kw" value="KUWAIT">KUWAIT</option> <option id="kg" value="KYRGYZSTAN">KYRGYZSTAN</option> <option id="la" value="LAO PEOPLE'S DEMOCRATIC REPUBLIC">LAO PEOPLE'S DEMOCRATIC REPUBLIC</option> <option id="lv" value="LATVIA">LATVIA</option> <option id="lb" value="LEBANON">LEBANON</option> <option id="ls" value="LESOTHO">LESOTHO</option> <option id="lr" value="LIBERIA">LIBERIA</option> <option id="ly" value="LIBYAN ARAB JAMAHIRIYA">LIBYAN ARAB JAMAHIRIYA</option> <option id="li" value="LIECHTENSTEIN">LIECHTENSTEIN</option> <option id="lt" value="LITHUANIA">LITHUANIA</option> <option id="lu" value="LUXEMBOURG">LUXEMBOURG</option> <option id="mo" value="MACAU">MACAU</option> <option id="mk" value="MACEDONIA, THE FORMER YUGOSLAV REPUBLIC">MACEDONIA, THE FORMER YUGOSLAV REPUBLIC</option> <option id="mg" value="MADAGASCAR">MADAGASCAR</option> <option id="mw" value="MALAWI">MALAWI</option> <option id="my" value="MALAYSIA">MALAYSIA</option> <option id="mv" value="MALDIVES">MALDIVES</option> <option id="ml" value="MALI">MALI</option> <option id="mt" value="MALTA">MALTA</option> <option id="mh" value="MARSHALL ISLANDS">MARSHALL ISLANDS</option> <option id="mq" value="MARTINIQUE">MARTINIQUE</option> <option id="mr" value="MAURITANIA">MAURITANIA</option> <option id="mu" value="MAURITIUS">MAURITIUS</option> <option id="yt" value="MAYOTTE">MAYOTTE</option> <option id="mx" value="MEXICO">MEXICO</option> <option id="fm" value="MICRONESIA, FEDERATED STATES OF">MICRONESIA, FEDERATED STATES OF</option> <option id="md" value="MOLDOVA, REPUBLIC OF">MOLDOVA, REPUBLIC OF</option> <option id="mc" value="MONACO">MONACO</option> <option id="mn" value="MONGOLIA">MONGOLIA</option> <option id="me" value="MONTENEGRO">MONTENEGRO</option> <option id="ms" value="MONTSERRAT">MONTSERRAT</option> <option id="ma" value="MOROCCO">MOROCCO</option> <option id="mz" value="MOZAMBIQUE">MOZAMBIQUE</option> <option id="mm" value="MYANMAR">MYANMAR</option> <option id="na" value="NAMIBIA">NAMIBIA</option> <option id="nr" value="NAURU">NAURU</option> <option id="np" value="NEPAL">NEPAL</option> <option id="nl" value="NETHERLANDS">NETHERLANDS</option> <option id="an" value="NETHERLANDS ANTILLES">NETHERLANDS ANTILLES</option> <option id="nc" value="NEW CALEDONIA">NEW CALEDONIA</option> <option id="nz" value="NEW ZEALAND">NEW ZEALAND</option> <option id="ni" value="NICARAGUA">NICARAGUA</option> <option id="ne" value="NIGER">NIGER</option> <option id="ng" value="NIGERIA">NIGERIA</option> <option id="nu" value="NIUE">NIUE</option> <option id="nf" value="NORFOLK ISLAND">NORFOLK ISLAND</option> <option id="mp" value="NORTHERN MARIANA ISLANDS">NORTHERN MARIANA ISLANDS</option> <option id="no" value="NORWAY">NORWAY</option> <option id="om" value="OMAN">OMAN</option> <option id="pk" value="PAKISTAN">PAKISTAN</option> <option id="pw" value="PALAU">PALAU</option> <option id="ps" value="PALESTINIAN TERRITORY, OCCUPIED">PALESTINIAN TERRITORY, OCCUPIED</option> <option id="pa" value="PANAMA">PANAMA</option> <option id="pg" value="PAPUA NEW GUINEA">PAPUA NEW GUINEA</option> <option id="py" value="PARAGUAY">PARAGUAY</option> <option id="pe" value="PERU">PERU</option> <option id="ph" value="PHILIPPINES">PHILIPPINES</option> <option id="pn" value="PITCAIRN">PITCAIRN</option> <option id="pl" value="POLAND">POLAND</option> <option id="pt" value="PORTUGAL">PORTUGAL</option> <option id="pr" value="PUERTO RICO">PUERTO RICO</option> <option id="qa" value="QATAR">QATAR</option> <option id="re" value="REUNION">REUNION</option> <option id="ro" value="ROMANIA">ROMANIA</option> <option id="ru" value="RUSSIAN FEDERATION">RUSSIAN FEDERATION</option> <option id="rw" value="RWANDA">RWANDA</option> <option id="kn" value="SAINT KITTS AND NEVIS">SAINT KITTS AND NEVIS</option> <option id="lc" value="SAINT LUCIA">SAINT LUCIA</option> <option id="vc" value="SAINT VINCENT AND THE GRENADINES">SAINT VINCENT AND THE GRENADINES</option> <option id="ws" value="SAMOA">SAMOA</option> <option id="sm" value="SAN MARINO">SAN MARINO</option> <option id="st" value="SAO TOME AND PRINCIPE">SAO TOME AND PRINCIPE</option> <option id="sa" value="SAUDI ARABIA">SAUDI ARABIA</option> <option id="sn" value="SENEGAL">SENEGAL</option> <option id="rs" value="SERBIA">SERBIA</option> <option id="sc" value="SEYCHELLES">SEYCHELLES</option> <option id="sl" value="SIERRA LEONE">SIERRA LEONE</option> <option id="sg" value="SINGAPORE">SINGAPORE</option> <option id="sk" value="SLOVAKIA">SLOVAKIA</option> <option id="si" value="SLOVENIA">SLOVENIA</option> <option id="sb" value="SOLOMON ISLANDS">SOLOMON ISLANDS</option> <option id="so" value="SOMALIA">SOMALIA</option> <option id="za" value="SOUTH AFRICA">SOUTH AFRICA</option> <option id="gs" value="SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS">SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS</option> <option id="es" value="SPAIN">SPAIN</option> <option id="lk" value="SRI LANKA">SRI LANKA</option> <option id="sh" value="ST. 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