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neurology, neuropathy, Alzheimer disease, Neurology Conferences, Neuroscience Conference 2024, Brain Disorders Conference, Neurology Conference 2024, Neuroscience Conferences, Neurology Conferences 2024, Neuroscience Conferences, Brain Disorders Conference 2024, Brain Congress 2024, Neurology Events 2024, Neurology and Brain Disorders Congress, Neurology Congress 2024, Neurology Conferences 2024, Neuroscience Conference, Neuroscience Conference 2024, Neurology Congress 2024, Neurology Conference, Neurology Conference 2024, International Neurology Conferences 2024, Neurology Conferences, European Neurology Congress 2024, Neurology World Congress, Neurology 2024, Neurology Congress, International Neurology Conferences 2024, Neuroscience Conferences 2024, Brain Congress 2024, Brain Disorders Conference, Brain Injury Conference, Neuroscience Conference 2024, Brain Disorders 2024, Neurology Congresses 2024, International Neuroscience Conference 2024, Congress Neurology, Neurology 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class="pagination-area"> <h1>Registration</h1> <div class="backrow cnt-head" style="color: #fff;"> <span class="con-location"> Apr 18-19, 2024  </span> <span class="con-location"> Dubai, UAE</span> </div> <i><span class="edition-title cnt-head"></span></i> <h1 class="main_title1 cnt-head">4th International Conference on Neuroscience and Neurology</h1> <ul> <li><a href="https://www.longdom.com/neuroscience">Home</a> -</li> <li>Registration</li> </ul> </div> </div> </div>  <style> h1{ color:white; } #registartion .form-section-block{ background:white; } </style>  <div class="about-event-area2"> <div class="container"> <div class="row"> <form id="registartion" role="form" method="post" action="" class="form-horizontal" enctype="multipart/form-data"> <div> <div class="form-section-block"> <div class="step-container"> <i><img src="https://www.longdom.com/assets/conference/img/img-step1of2.png" alt="step one"/></i> </div> <div id="currencies" class="martop-50"> <div class="col-xs-12 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class="form-control" name="billing_title" id="billing_title"> <option value="0">Select Title</option> <option value="Prof">Prof</option> <option value="Assoc Prof Dr">Assoc Prof</option> <option value="Assist Prof Dr">Assist Prof</option> <option value="Dr">Dr</option> <option value="Mr">Mr</option> <option value="Ms">Ms</option> <option value="Mrs">Mrs</option> </select> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="fname" class="control-label">First Name <span class="red">*</span></label> <input type="text" class="form-control" name="billing_fname" id="billing_fname" value="" placeholder="Your First Name" size="40"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label notrequired">Last Name</label> <input type="text" class="form-control" name="billing_lname" id="billing_lname" value="" placeholder="Your Last Name"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="country" class="control-label">Country <span class="red">*</span></label> <select class="form-control country_name" name="billing_country" id="billing_country"> <option value= "" >Select Country</option> <option value='United States' >United States</option> <option value='United Kingdom' >United Kingdom</option> <option value='Afghanistan' >Afghanistan</option> <option value='Albania' >Albania</option> <option value='Algeria' >Algeria</option> <option value='American Samoa' >American Samoa</option> <option value='Andorra' >Andorra</option> <option value='Angola' >Angola</option> <option value='Anguilla' >Anguilla</option> <option value='Antarctica' >Antarctica</option> <option value='Antigua and Barbuda' >Antigua and Barbuda</option> <option value='Argentina' >Argentina</option> <option value='Armenia' >Armenia</option> <option value='Aruba' >Aruba</option> <option value='Australia' >Australia</option> <option value='Austria' >Austria</option> <option value='Azerbaijan' >Azerbaijan</option> <option value='Bahamas' >Bahamas</option> <option value='Bahrain' >Bahrain</option> <option value='Bangladesh' >Bangladesh</option> <option value='Barbados' >Barbados</option> <option value='Belarus' >Belarus</option> <option value='Belgium' >Belgium</option> <option value='Belize' >Belize</option> <option value='Benin' >Benin</option> <option value='Bermuda' >Bermuda</option> <option value='Bhutan' >Bhutan</option> <option value='Bolivia' >Bolivia</option> <option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option> <option value='Botswana' >Botswana</option> <option value='Bouvet Island' >Bouvet Island</option> <option value='Brazil' >Brazil</option> <option value='British Indian Ocean Territory' >British Indian Ocean Territory</option> <option value='Brunei Darussalam' >Brunei Darussalam</option> <option value='Bulgaria' >Bulgaria</option> <option value='Burkina Faso' >Burkina Faso</option> <option value='Burundi' >Burundi</option> <option value='Cambodia' >Cambodia</option> <option value='Cameroon' >Cameroon</option> <option value='Canada' >Canada</option> <option value='Canadian Nunavut Territory' >Canadian Nunavut Territory</option> <option value='Cape Verde' >Cape Verde</option> <option value='Cayman Islands' >Cayman Islands</option> <option value='Central African Republic' >Central African Republic</option> <option value='Chad' >Chad</option> <option value='Chile' >Chile</option> <option value='China' >China</option> <option value='Christmas Island' >Christmas Island</option> <option value='Cocos (Keeling Islands)' >Cocos (Keeling Islands)</option> <option value='Colombia' >Colombia</option> <option value='Comoros' >Comoros</option> <option value='Congo' >Congo</option> <option value='Cook Islands' >Cook Islands</option> <option value='Costa Rica' >Costa Rica</option> <option value='Cote D"Ivoire (Ivory Coast)' >Cote D"Ivoire (Ivory Coast)</option> <option value='Croatia (Hrvatska)' >Croatia (Hrvatska)</option> <option value='Cuba' >Cuba</option> <option value='Cyprus' >Cyprus</option> <option value='Czech Republic' >Czech Republic</option> <option value='Denmark' >Denmark</option> <option value='Djibouti' >Djibouti</option> <option value='Dominica' >Dominica</option> <option value='Dominican Republic' >Dominican Republic</option> <option value='East Timor' >East Timor</option> <option value='Ecuador' >Ecuador</option> <option value='Egypt' >Egypt</option> <option value='El Salvador' >El Salvador</option> <option value='Equatorial Guinea' >Equatorial Guinea</option> <option value='Eritrea' >Eritrea</option> <option value='Estonia' >Estonia</option> <option value='Ethiopia' >Ethiopia</option> <option value='Falkland Islands (Malvinas)' >Falkland Islands (Malvinas)</option> <option value='Faroe Islands' >Faroe Islands</option> <option value='Fiji' >Fiji</option> <option value='Finland' >Finland</option> <option value='France' >France</option> <option value='France, Metropolitan' >France, Metropolitan</option> <option value='French Guiana' >French Guiana</option> <option value='French Polynesia' >French Polynesia</option> <option value='French Southern Territories' >French Southern Territories</option> <option value='Gabon' >Gabon</option> <option value='Gambia' >Gambia</option> <option value='Georgia' >Georgia</option> <option value='Germany' >Germany</option> <option value='Ghana' >Ghana</option> <option value='Gibraltar' >Gibraltar</option> <option value='Greece' >Greece</option> <option value='Greenland' >Greenland</option> <option value='Grenada' >Grenada</option> <option value='Guadeloupe' >Guadeloupe</option> <option value='Guam' >Guam</option> <option value='Guatemala' >Guatemala</option> <option value='Guinea' >Guinea</option> <option value='Guinea-Bissau' >Guinea-Bissau</option> <option value='Guyana' >Guyana</option> <option value='Haiti' >Haiti</option> <option value='Heard and McDonald Islands' >Heard and McDonald Islands</option> <option value='Honduras' >Honduras</option> <option value='Hong Kong' >Hong Kong</option> <option value='Hungary' >Hungary</option> <option value='Iceland' >Iceland</option> <option value='India' >India</option> <option value='Indonesia' >Indonesia</option> <option value='Iran' >Iran</option> <option value='Iraq' >Iraq</option> <option value='Ireland' >Ireland</option> <option value='Israel' >Israel</option> <option value='Italy' >Italy</option> <option value='Jamaica' >Jamaica</option> <option value='Japan' >Japan</option> <option value='Jordan' >Jordan</option> <option value='Kazakhstan' >Kazakhstan</option> <option value='Kenya' >Kenya</option> <option value='Kiribati' >Kiribati</option> <option value='Korea (North)' >Korea (North)</option> <option value='Korea (South)' >Korea (South)</option> <option value='Kuwait' >Kuwait</option> <option value='Kyrgyzstan' >Kyrgyzstan</option> <option value='Laos' >Laos</option> <option value='Latvia' >Latvia</option> <option value='Lebanon' >Lebanon</option> <option value='Lesotho' >Lesotho</option> <option value='Liberia' >Liberia</option> <option value='Libya' >Libya</option> <option value='Liechtenstein' >Liechtenstein</option> <option value='Lithuania' >Lithuania</option> <option value='Luxembourg' >Luxembourg</option> <option value='Macau' >Macau</option> <option value='Macedonia' >Macedonia</option> <option value='Madagascar' >Madagascar</option> <option value='Malawi' >Malawi</option> <option value='Malaysia' >Malaysia</option> <option value='Maldives' >Maldives</option> <option value='Mali' >Mali</option> <option value='Malta' >Malta</option> <option value='Marshall Islands' >Marshall Islands</option> <option value='Martinique' >Martinique</option> <option value='Mauritania' >Mauritania</option> <option value='Mauritius' >Mauritius</option> <option value='Mayotte' >Mayotte</option> <option value='Mexico' >Mexico</option> <option value='Micronesia' >Micronesia</option> <option value='Moldova' >Moldova</option> <option value='Monaco' >Monaco</option> <option value='Mongolia' >Mongolia</option> <option value='Montserrat' >Montserrat</option> <option value='Morocco' >Morocco</option> <option value='Mozambique' >Mozambique</option> <option value='Myanmar' >Myanmar</option> <option value='Namibia' >Namibia</option> <option value='Nauru' >Nauru</option> <option value='Nepal' >Nepal</option> <option value='Netherlands' >Netherlands</option> <option value='Netherlands Antilles' >Netherlands Antilles</option> <option value='New Caledonia' >New Caledonia</option> <option value='New Zealand' >New Zealand</option> <option value='Nicaragua' >Nicaragua</option> <option value='Niger' >Niger</option> <option value='Nigeria' >Nigeria</option> <option value='Niue' >Niue</option> <option value='Norfolk Island' >Norfolk Island</option> <option value='Northern Mariana Islands' >Northern Mariana Islands</option> <option value='Norway' >Norway</option> <option value='Oman' >Oman</option> <option value='Pakistan' >Pakistan</option> <option value='Palau' >Palau</option> <option value='Palestine' >Palestine</option> <option value='Panama' >Panama</option> <option value='Papua New Guinea' >Papua New Guinea</option> <option value='Paraguay' >Paraguay</option> <option value='Peru' >Peru</option> <option value='Philippines' >Philippines</option> <option value='Pitcairn' >Pitcairn</option> <option value='Poland' >Poland</option> <option value='Portugal' >Portugal</option> <option value='Qatar' >Qatar</option> <option value='Reunion' >Reunion</option> <option value='Romania' >Romania</option> <option value='Russian Federation' >Russian Federation</option> <option value='Rwanda' >Rwanda</option> <option value='S. Georgia and S. Sandwich Isls.' >S. Georgia and S. Sandwich Isls.</option> <option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option> <option value='Saint Lucia' >Saint Lucia</option> <option value='Saint Vincent and The Grenadines' >Saint Vincent and The Grenadines</option> <option value='Samoa' >Samoa</option> <option value='San Marino' >San Marino</option> <option value='Sao Tome and Principe' >Sao Tome and Principe</option> <option value='Saudi Arabia' >Saudi Arabia</option> <option value='Senegal' >Senegal</option> <option value='Serbia' >Serbia</option> <option value='Seychelles' >Seychelles</option> <option value='Sierra Leone' >Sierra Leone</option> <option value='Singapore' >Singapore</option> <option value='Slovak Republic' >Slovak Republic</option> <option value='Slovenia' >Slovenia</option> <option value='Solomon Islands' >Solomon Islands</option> <option value='Somalia' >Somalia</option> <option value='South Africa' >South Africa</option> <option value='Spain' >Spain</option> <option value='Sri Lanka' >Sri Lanka</option> <option value='St. Helena' >St. Helena</option> <option value='St. Pierre and Miquelon' >St. Pierre and Miquelon</option> <option value='Sudan' >Sudan</option> <option value='Suriname' >Suriname</option> <option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands</option> <option value='Swaziland' >Swaziland</option> <option value='Sweden' >Sweden</option> <option value='Switzerland' >Switzerland</option> <option value='Syria' >Syria</option> <option value='Taiwan' >Taiwan</option> <option value='Tajikistan' >Tajikistan</option> <option value='Tanzania' >Tanzania</option> <option value='Thailand' >Thailand</option> <option value='Togo' >Togo</option> <option value='Tokelau' >Tokelau</option> <option value='Tonga' >Tonga</option> <option value='Trinidad and Tobago' >Trinidad and Tobago</option> <option value='Tunisia' >Tunisia</option> <option value='Turkey' >Turkey</option> <option value='Turkmenistan' >Turkmenistan</option> <option value='Turks and Caicos Islands' >Turks and Caicos Islands</option> <option value='Tuvalu' >Tuvalu</option> <option value='US Minor Outlying Islands' >US Minor Outlying Islands</option> <option value='Uganda' >Uganda</option> <option value='Ukraine' >Ukraine</option> <option value='United Arab Emirates' >United Arab Emirates</option> <option value='Uruguay' >Uruguay</option> <option value='Uzbekistan' >Uzbekistan</option> <option value='Vanuatu' >Vanuatu</option> <option value='Vatican City State (Holy See)' >Vatican City State (Holy See)</option> <option value='Venezuela' >Venezuela</option> <option value='Viet Nam' >Viet Nam</option> <option value='Virgin Islands (British)' >Virgin Islands (British)</option> <option value='Wallis and Futuna Islands' >Wallis and Futuna Islands</option> <option value='Western Sahara' >Western Sahara</option> <option value='Yemen' >Yemen</option> <option value='Yugoslavia' >Yugoslavia</option> <option value='Zaire' >Zaire</option> <option value='Zambia' >Zambia</option> <option value='Zimbabwe' >Zimbabwe</option>  </select> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label ">City</label> <input type="text" class="form-control" name="billing_city" id="billing_city" value="" placeholder="City"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label ">State</label> <input type="text" class="form-control" name="billing_state" id="billing_state" value="" placeholder="State"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="email" class="control-label">Email <span class="red">*</span></label> <input type="email" class="form-control" name="billing_email" id="billing_email" value="" placeholder="Your email"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="phno" class="control-label">Mobile No <span class="red">*</span></label> <input type="tel" class="form-control" id="billing_contact_no" name="billing_contact_no" value="" placeholder="Mobile Number"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="address" class="control-label">Postal Address</label> <textarea rows="3" class="form-control" id="billing_address" name="billing_address"></textarea> <div class="error"></div> </div> </div> </div> </div> </div> <div class="form-section-block billing"> <h3 id="ship">Shipping Information</h3> <div class="billing-container registratation"> <div class="row"> <div class="col-xs-12"> <div class="form-group copy-btn"> <div class="checkbox1"><i><input type="checkbox" class="copy-address" value="68" id="copy_billing"></i></div> <span>Copy from Billing Address</span> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="title" class="control-label">Title <span class="red">*</span></label> <select class="form-control" name="shipping_title" id="shipping_title"> <option value="">Select Title</option> <option value="Prof">Prof</option> <option value="Assoc Prof Dr">Assoc Prof</option> <option value="Assist Prof Dr">Assist Prof</option> <option value="Dr">Dr</option> <option value="Mr">Mr</option> <option value="Ms">Ms</option> <option value="Mrs">Mrs</option> </select> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="fname" class="control-label">First Name <span class="red">*</span></label> <input type="text" class="form-control" name="shipping_fname" id="shipping_fname" value="" placeholder="Your First Name" size="40"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label notrequired">Last Name</label> <input type="text" class="form-control" name="shipping_lname" id="shipping_lname" value="" placeholder="Your Last Name"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="country" class="control-label">Country <span class="red">*</span></label> <select class="form-control country_name" name="shipping_country" id="shipping_country"> <option value= "" >Select Country</option> <option value='United States' >United States</option> <option value='United Kingdom' >United Kingdom</option> <option value='Afghanistan' >Afghanistan</option> <option value='Albania' >Albania</option> <option value='Algeria' >Algeria</option> <option value='American Samoa' >American Samoa</option> <option value='Andorra' >Andorra</option> <option value='Angola' >Angola</option> <option value='Anguilla' >Anguilla</option> <option value='Antarctica' >Antarctica</option> <option value='Antigua and Barbuda' >Antigua and Barbuda</option> <option value='Argentina' >Argentina</option> <option value='Armenia' >Armenia</option> <option value='Aruba' >Aruba</option> <option value='Australia' >Australia</option> <option value='Austria' >Austria</option> <option value='Azerbaijan' >Azerbaijan</option> <option value='Bahamas' >Bahamas</option> <option value='Bahrain' >Bahrain</option> <option value='Bangladesh' >Bangladesh</option> <option value='Barbados' >Barbados</option> <option value='Belarus' >Belarus</option> <option value='Belgium' >Belgium</option> <option value='Belize' >Belize</option> <option value='Benin' >Benin</option> <option value='Bermuda' >Bermuda</option> <option value='Bhutan' >Bhutan</option> <option value='Bolivia' >Bolivia</option> <option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option> <option value='Botswana' >Botswana</option> <option value='Bouvet Island' >Bouvet Island</option> <option value='Brazil' >Brazil</option> <option value='British Indian Ocean Territory' >British Indian Ocean Territory</option> <option value='Brunei Darussalam' >Brunei Darussalam</option> <option value='Bulgaria' >Bulgaria</option> <option value='Burkina Faso' >Burkina Faso</option> <option value='Burundi' >Burundi</option> <option value='Cambodia' >Cambodia</option> <option value='Cameroon' >Cameroon</option> <option value='Canada' >Canada</option> <option value='Canadian Nunavut Territory' >Canadian Nunavut Territory</option> <option value='Cape Verde' >Cape Verde</option> <option value='Cayman Islands' >Cayman Islands</option> <option value='Central African Republic' >Central African Republic</option> <option value='Chad' >Chad</option> <option value='Chile' >Chile</option> <option value='China' >China</option> <option value='Christmas Island' >Christmas Island</option> <option value='Cocos (Keeling Islands)' >Cocos (Keeling Islands)</option> <option value='Colombia' >Colombia</option> <option value='Comoros' >Comoros</option> <option value='Congo' >Congo</option> <option value='Cook Islands' >Cook Islands</option> <option value='Costa Rica' >Costa Rica</option> <option value='Cote D"Ivoire (Ivory Coast)' >Cote D"Ivoire (Ivory Coast)</option> <option value='Croatia (Hrvatska)' >Croatia (Hrvatska)</option> <option value='Cuba' >Cuba</option> <option value='Cyprus' >Cyprus</option> <option value='Czech Republic' >Czech Republic</option> <option value='Denmark' >Denmark</option> <option value='Djibouti' >Djibouti</option> <option value='Dominica' >Dominica</option> <option value='Dominican Republic' >Dominican Republic</option> <option value='East Timor' >East Timor</option> <option value='Ecuador' >Ecuador</option> <option value='Egypt' >Egypt</option> <option value='El Salvador' >El Salvador</option> <option value='Equatorial Guinea' >Equatorial Guinea</option> <option value='Eritrea' >Eritrea</option> <option value='Estonia' >Estonia</option> <option value='Ethiopia' >Ethiopia</option> <option value='Falkland Islands (Malvinas)' >Falkland Islands (Malvinas)</option> <option value='Faroe Islands' >Faroe Islands</option> <option value='Fiji' >Fiji</option> <option value='Finland' >Finland</option> <option value='France' >France</option> <option value='France, Metropolitan' >France, Metropolitan</option> <option value='French Guiana' >French Guiana</option> <option value='French Polynesia' >French Polynesia</option> <option value='French Southern Territories' >French Southern Territories</option> <option value='Gabon' >Gabon</option> <option value='Gambia' >Gambia</option> <option value='Georgia' >Georgia</option> <option value='Germany' >Germany</option> <option value='Ghana' >Ghana</option> <option value='Gibraltar' >Gibraltar</option> <option value='Greece' >Greece</option> <option value='Greenland' >Greenland</option> <option value='Grenada' >Grenada</option> <option value='Guadeloupe' >Guadeloupe</option> <option value='Guam' >Guam</option> <option value='Guatemala' >Guatemala</option> <option value='Guinea' >Guinea</option> <option value='Guinea-Bissau' >Guinea-Bissau</option> <option value='Guyana' >Guyana</option> <option value='Haiti' >Haiti</option> <option value='Heard and McDonald Islands' >Heard and McDonald Islands</option> <option value='Honduras' >Honduras</option> <option value='Hong Kong' >Hong Kong</option> <option value='Hungary' >Hungary</option> <option value='Iceland' >Iceland</option> <option value='India' >India</option> <option value='Indonesia' >Indonesia</option> <option value='Iran' >Iran</option> <option value='Iraq' >Iraq</option> <option value='Ireland' >Ireland</option> <option value='Israel' >Israel</option> <option value='Italy' >Italy</option> <option value='Jamaica' >Jamaica</option> <option value='Japan' >Japan</option> <option value='Jordan' >Jordan</option> <option value='Kazakhstan' >Kazakhstan</option> <option value='Kenya' >Kenya</option> <option value='Kiribati' >Kiribati</option> <option value='Korea (North)' >Korea (North)</option> <option value='Korea (South)' >Korea (South)</option> <option value='Kuwait' >Kuwait</option> <option value='Kyrgyzstan' >Kyrgyzstan</option> <option value='Laos' >Laos</option> <option value='Latvia' >Latvia</option> <option value='Lebanon' >Lebanon</option> <option value='Lesotho' >Lesotho</option> <option value='Liberia' >Liberia</option> <option value='Libya' >Libya</option> <option value='Liechtenstein' >Liechtenstein</option> <option value='Lithuania' >Lithuania</option> <option value='Luxembourg' >Luxembourg</option> <option value='Macau' >Macau</option> <option value='Macedonia' >Macedonia</option> <option value='Madagascar' >Madagascar</option> <option value='Malawi' >Malawi</option> <option value='Malaysia' >Malaysia</option> <option value='Maldives' >Maldives</option> <option value='Mali' >Mali</option> <option value='Malta' >Malta</option> <option value='Marshall Islands' >Marshall Islands</option> <option value='Martinique' >Martinique</option> <option value='Mauritania' >Mauritania</option> <option value='Mauritius' >Mauritius</option> <option value='Mayotte' >Mayotte</option> <option value='Mexico' >Mexico</option> <option value='Micronesia' >Micronesia</option> <option value='Moldova' >Moldova</option> <option value='Monaco' >Monaco</option> <option value='Mongolia' >Mongolia</option> <option value='Montserrat' >Montserrat</option> <option value='Morocco' >Morocco</option> <option value='Mozambique' >Mozambique</option> <option value='Myanmar' >Myanmar</option> <option value='Namibia' >Namibia</option> <option value='Nauru' >Nauru</option> <option value='Nepal' >Nepal</option> <option value='Netherlands' >Netherlands</option> <option value='Netherlands Antilles' >Netherlands Antilles</option> <option value='New Caledonia' >New Caledonia</option> <option value='New Zealand' >New Zealand</option> <option value='Nicaragua' >Nicaragua</option> <option value='Niger' >Niger</option> <option value='Nigeria' >Nigeria</option> <option value='Niue' >Niue</option> <option value='Norfolk Island' >Norfolk Island</option> <option value='Northern Mariana Islands' >Northern Mariana Islands</option> <option value='Norway' >Norway</option> <option value='Oman' >Oman</option> <option value='Pakistan' >Pakistan</option> <option value='Palau' >Palau</option> <option value='Palestine' >Palestine</option> <option value='Panama' >Panama</option> <option value='Papua New Guinea' >Papua New Guinea</option> <option value='Paraguay' >Paraguay</option> <option value='Peru' >Peru</option> <option value='Philippines' >Philippines</option> <option value='Pitcairn' >Pitcairn</option> <option value='Poland' >Poland</option> <option value='Portugal' >Portugal</option> <option value='Qatar' >Qatar</option> <option value='Reunion' >Reunion</option> <option value='Romania' >Romania</option> <option value='Russian Federation' >Russian Federation</option> <option value='Rwanda' >Rwanda</option> <option value='S. Georgia and S. Sandwich Isls.' >S. Georgia and S. Sandwich Isls.</option> <option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option> <option value='Saint Lucia' >Saint Lucia</option> <option value='Saint Vincent and The Grenadines' >Saint Vincent and The Grenadines</option> <option value='Samoa' >Samoa</option> <option value='San Marino' >San Marino</option> <option value='Sao Tome and Principe' >Sao Tome and Principe</option> <option value='Saudi Arabia' >Saudi Arabia</option> <option value='Senegal' >Senegal</option> <option value='Serbia' >Serbia</option> <option value='Seychelles' >Seychelles</option> <option value='Sierra Leone' >Sierra Leone</option> <option value='Singapore' >Singapore</option> <option value='Slovak Republic' >Slovak Republic</option> <option value='Slovenia' >Slovenia</option> <option value='Solomon Islands' >Solomon Islands</option> <option value='Somalia' >Somalia</option> <option value='South Africa' >South Africa</option> <option value='Spain' >Spain</option> <option value='Sri Lanka' >Sri Lanka</option> <option value='St. Helena' >St. Helena</option> <option value='St. Pierre and Miquelon' >St. Pierre and Miquelon</option> <option value='Sudan' >Sudan</option> <option value='Suriname' >Suriname</option> <option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands</option> <option value='Swaziland' >Swaziland</option> <option value='Sweden' >Sweden</option> <option value='Switzerland' >Switzerland</option> <option value='Syria' >Syria</option> <option value='Taiwan' >Taiwan</option> <option value='Tajikistan' >Tajikistan</option> <option value='Tanzania' >Tanzania</option> <option value='Thailand' >Thailand</option> <option value='Togo' >Togo</option> <option value='Tokelau' >Tokelau</option> <option value='Tonga' >Tonga</option> <option value='Trinidad and Tobago' >Trinidad and Tobago</option> <option value='Tunisia' >Tunisia</option> <option value='Turkey' >Turkey</option> <option value='Turkmenistan' >Turkmenistan</option> <option value='Turks and Caicos Islands' >Turks and Caicos Islands</option> <option value='Tuvalu' >Tuvalu</option> <option value='US Minor Outlying Islands' >US Minor Outlying Islands</option> <option value='Uganda' >Uganda</option> <option value='Ukraine' >Ukraine</option> <option value='United Arab Emirates' >United Arab Emirates</option> <option value='Uruguay' >Uruguay</option> <option value='Uzbekistan' >Uzbekistan</option> <option value='Vanuatu' >Vanuatu</option> <option value='Vatican City State (Holy See)' >Vatican City State (Holy See)</option> <option value='Venezuela' >Venezuela</option> <option value='Viet Nam' >Viet Nam</option> <option value='Virgin Islands (British)' >Virgin Islands (British)</option> <option value='Wallis and Futuna Islands' >Wallis and Futuna Islands</option> <option value='Western Sahara' >Western Sahara</option> <option value='Yemen' >Yemen</option> <option value='Yugoslavia' >Yugoslavia</option> <option value='Zaire' >Zaire</option> <option value='Zambia' >Zambia</option> <option value='Zimbabwe' >Zimbabwe</option>  </select> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label ">City</label> <input type="text" class="form-control" name="shipping_city" id="shipping_city" value="" placeholder="City"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="lname" class="control-label ">State</label> <input type="text" class="form-control" name="shipping_state" id="shipping_state" value="" placeholder="State"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="email" class="control-label">Email <span class="red">*</span></label> <input type="email" name="shipping_email" class="form-control" id="shipping_email" value="" placeholder="Your email"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="phno" class="control-label">Mobile No <span class="red">*</span></label> <input type="tel" class="form-control" id="shipping_contact_no" name="shipping_contact_no" value="" placeholder="Mobile Number"> <div class="error"></div> </div> </div> <div class="col-xs-4"> <div class="form-group"> <label for="address" class="control-label">Postal Address</label> <textarea rows="3" class="form-control" id="shipping_address" name="shipping_address"></textarea> <div class="error"></div> </div> </div> <div class="col-xs-12 text-center"> <div class="form-group copy-btn"> <div class="checkbox1"><i><input type="checkbox" class="copy-address" id="terms" name="terms"></i></div> <span>I have read and agree to the <a href="https://www.longdom.com/terms-and-conditions" target="_blank">terms and conditions</a></span> <div class="error" id="terms_errors"></div> </div> </div> </div> </div> <div class="btn-submit-registraion col-xs-12"> <input type="hidden" name="cart" id="cart" value="" /> <input type="hidden" name="amount" id="amount" value="" /> <input type="hidden" name="currency_symbol" id="currency_symbol" value="" /> <input type="hidden" id="stripe" value="" name="gateway_stripe" /> <input type="hidden" id = "ccavenue" value="" name="gateway_ccavenue" /> <input type="hidden" id = "razorpay" value="razorpay" name="razorpay" /> <input type="hidden" name="currency_symbol" id="currency_symbol" value="" /> <input class="btn btn-primary btn-large" type="button" value="Next >>" name="submit_registration" id="submit_registration" title="Please click on next to verify your details" />  <p class="blinking" style="color:#865000;">Please click on next to verify your details</p> </div> </div> <div class="form-section-block"> <p style="text-align:justify"><span style="color:#000000"><strong><span style="font-size:14px"><span style="font-family:Georgia,serif">Registration Privileges (For Presenters):</span></span></strong></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-size:14px"><span style="font-family:Georgia,serif">1. 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