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Registration | Webinar on Pulmonary and Respiratory Care
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Once your registration is finalized, please send an email to <a href="mailto:support@sciconx.com">support@sciconx.com</a> for any further clarification or assistance. </span> </div> <div class="col-xs-12 padding-0 currency-block"> <div class="col-xs-12 padding-0 currency-block"> <div class="col-xs-2 padding-left-0 choose-currency"> <span>Choose Currency</span> </div> <div class="col-xs-6"> <!-- --> <div class="col-xs-4 padding-left-0 choose-currency"> <div class="btn-label"> <input type="radio" value="EUR" name="currency_code" checked/> <label class="control-label">EUR (€)</label> </div> </div> <!-- --> <!-- --> <div class="col-xs-4 padding-left-0 choose-currency"> <div class="btn-label"> <input type="radio" value="USD" name="currency_code" /> <label class="control-label">USD ($)</label> </div> </div> <!-- --> <!-- --> <div class="col-xs-4 padding-left-0 choose-currency"> <div class="btn-label"> <input type="radio" value="GBP" name="currency_code" /> <label class="control-label">GBP (£)</label> </div> </div> <!-- --> </div> </div> <br/><br/> <div class="col-xs-12 padding-0 currency-block"> <div class="col-xs-12 padding-0 currency-block"> <div class="col-xs-2 padding-left-0 choose-currency"> <span>Payment Gateway</span> </div> <div class="col-xs-2 choose-currency"> <div class="btn-label2"> <input type="radio" value="razorpay" name="gateway" checked/> <img src="https://www.sciconx.com/assets/main/images/razorpay.png"/> </div> </div> <!-- <div class="col-xs-2"> <input type="radio" value="stripe" name="gateway"/> <img src="<?//=ASSETS_MAIN;?>images/stripe.png"/> </div> --> <!-- <div class="col-xs-2"> <input type="radio" value="paypal" name="gateway"/> <img src="https://www.sciconx.com/assets/conference/img/paypal.png"/> </div> <div class="col-xs-4 padding-0"> <a href="https://www.paypal.com/uk/webapps/mpp/paypal-safety-and-security" target="_blank" class="instructions blinking" title="Click here to know How Safe PayPal is to make your registration?">Click here to know How Safe PayPal is to make your registration?</a> </div> --> </div> </div> </div> <br/> <div class="table-responsive registration"> <table class="table table-bordered table-striped table-dark"> <thead> <tr> <th>Category</th> <th>Item Name</th> <th>Earlybird<br/> <span> Oct 31, 2024 </span> </th> <th>Normal<br/> <span> Nov 15, 2024 </span> </th> <th>Final<br/> <span> Dec 11, 2024 </span> </th> <th>Select</th> <th style="min-width:113px;">Qty</th> <th>Sub Total</th> </tr> </thead> <tbody id="product_list"> <tbody> </table> </div> </div> <div class="form-section-block billing first"> <div class="billing-container registratation shiping-50"> <h3 id="bill">Billing Information</h3> <div class="inside_color"> <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="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" name="billing_country" id="billing_country"> <option value=selected >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> <!-- <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="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="United Kingdom">United Kingdom</option> <option value="United States">United States</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="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-12 full-view"> <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> <h3 id="ship">Shipping Information</h3> <div class="billing-container registratation shiping-50"> <div class="row"> <div class="col-xs-12 no-padding"> <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" name="shipping_country" id="shipping_country"> <option value=selected >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> 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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="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-12"> <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> </div> <div class="col-xs-12 text-center"> <div class="form-group copy-btn agree"> <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.sciconx.com/terms" target="_blank">terms and conditions</a></span> <!-- <div class="error" id="terms_errors"></div> --> <div id="terms_errors"> <p class="alert alert-danger" role="alert" style="background:#f9b7b7"> <button type="button" class="close" data-dismiss="alert" aria-hidden="true">x</button> </p> </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 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">Please click on next to verify your details</p> </div> </div> <div class="form-section-block modified-content"> <!-- --> <div> <div class="_guidelines-container"> <h2>Welcome to the registration page for the Webinar on Pulmonary and Respiratory Care, hosted by "Sciconx Webinars".</h2> <h3>Pulmonary and Respiratory Webinar Details:</h3> <p>Date: December 11, 2024</p> <p>Theme: "Advances in Personalized Medicine for Respiratory Diseases"</p> <h2>Registration Guidelines</h2> <p>Thank you for your interest in registering for our event! To ensure a smooth registration process, please follow these guidelines:</p> <ul> <li><strong>Complete Registration Online:</strong> All registrations must be completed electronically through our secure online portal using Razorpay. You'll find the registration portal on this page.</li> <li><strong>Clarification or Assistance:</strong> After finalizing your registration, if you have any questions or require further assistance, kindly send an email to our support team at <a href="mailto:support@sciconx.com">support@sciconx.com</a>.</li> <li><strong>Registration Deadlines:</strong> Please note the different registration deadlines (Early Bird, Normal, and Final) based on the date mentioned. Registering earlier allows you to avail the Early Bird discount.</li> </ul> <h3>Registration Process:</h3> <ol> <li><strong>Registration Portal:</strong> Access the registration portal and proceed to fill out the online form.</li> <li><strong>Payment Gateway:</strong> Choose your preferred currency (EUR, USD, or GBP) from the available options.</li> <li><strong>Category Selection:</strong> Select the category that best suits you (Academic, Industry/Business, Student, etc.).</li> <li><strong>Registration Fee:</strong> Choose the registration type (Speaker, Delegate, Poster, etc.) and indicate the quantity (number of attendees) for each type. The corresponding fee will be automatically calculated based on your selection and the chosen registration deadline.</li> <li><strong>Optional Add-Ons:</strong> If interested, you can add optional add-ons like E-Poster, Accompanying person, or Accommodation (one night, two nights, or three nights).</li> <li><strong>Sponsor Registration:</strong> If applicable, select the Sponsor registration option and choose your sponsorship tier (Platinum, Gold, or Silver).</li> <li><strong>Billing & Shipping Information:</strong> <ul> <li>Complete all required fields marked with an asterisk (*).</li> <li>Ensure accurate entry of your billing information.</li> <li>If your shipping information matches the billing information, you can copy it directly.</li> </ul> </li> <li><strong>Terms & Conditions:</strong> Carefully review and agree to the Terms & Conditions before proceeding.</li> <li><strong>Verification:</strong> Once you've completed all sections, click "Next" to verify your details and submit your registration.</li> </ol> <div class="important-info"> <h3>Additional Information:</h3> <p>You'll receive a confirmation email upon successful registration.</p> <p>Please refer to the confirmation email for further instructions or contact <a href="mailto:support@sciconx.com">support@sciconx.com</a> if you have any questions.</p> </div> <div class="important-info"> <h3>Important Information</h3> <!-- <h4>Cancellation Policy:</h4> <p>Cancellations received 60 days or more before the webinar start date will be eligible for a full refund, minus a cancellation fee of 100 USD. No refunds will be issued for cancellations received after this date.</p> --> <h4>Substitutions:</h4> <p>If you are unable to attend, substitutions are welcome at any time. Please contact us at <a href="mailto:support@sciconx.com">support@sciconx.com</a> to arrange a substitution.</p> <h4>Group Registrations:</h4> <p>For group registrations or inquiries about group discounts, please contact us at <a href="mailto:support@sciconx.com">support@sciconx.com</a></p> </div> <div class="contact-info"> <h3>Contact Us</h3> <p>If you have any questions or need assistance with the registration process, please don't hesitate to contact us at <a href="mailto:support@sciconx.com">support@sciconx.com</a>. We're here to help!</p> </div> <p>Thank you for your interest in the <b>Webinar on Pulmonary and Respiratory Care</b>. We look forward to welcoming you to Paris for an inspiring and enriching experience.</p> </div> </div> </div> </form> </div> </div> </div> <!-- About Event Area End Here --> <script> var data = 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