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</div> <style> #app_disp_styles { color: white; font: 15px arial; font-weight: 500; padding: 5px 6px; margin: 10px; width: 124px; background: #0b0988; z-index: 101; border-radius: 6px; left: 0; border: 5px solid #fff; border-style: outset; } .a_icon_android { background: #00b4ff; text-align: center; display: inline-block; padding: 6px 5px; border-radius: 5px; margin-left: 32px; } #target a { text-decoration: none; margin: 0 3px; } .a_icon_android span .fa { font-size: 30px; color: #fff; } .a_icon_apple { background: #f6941d; } </style> <div class="inner-page-banner-area registration-banner"> <div class="container"> <div class="pagination-area"> <h1>Registration</h1> <div class="backrow cnt-head" style="color: #fff;"> <span class="con-location"> Nov 28-29, 2024  </span> <span class="con-location"> Dubai, UAE</span> </div> <i><span class="edition-title cnt-head">World Expo on </span></i> <h1 class="main_title1 cnt-head">Endocrinology, Diabetes and Health care disorders</h1> <ul> <li><a 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href="mailto:support@longdom.com">support[at]longdom[dot]com</a> </span> </div> <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 (&dollar;)<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> <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> <strong>"Update Soon"</strong> </span> </th> <th>Normal<br/> <span> <strong>"Update Soon"</strong> </span> </th> <th>Final<br/> <span> <strong>"Update Soon"</strong> </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 class="error" id="product_error"></div> </div> <div class="form-section-block billing first"> <h3 id="bill">Billing Information</h3> <div class="billing-container registratation"> <div class="row"> <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 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"> </div> </div> </form> </div> </div> </div>  <script> var data = 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settings: { slidesToShow: 3 } }, { breakpoint: 620, settings: { slidesToShow: 2 } }, { breakpoint: 460, settings: { slidesToShow: 2 } }] }); }); </script> <script> $(window).scroll(function() { var scrolledVal = $(document).scrollTop().valueOf(); if (scrolledVal > 180) { $('.logoscrollup').css('opacity', '0') } else { $('.logoscrollup').css('opacity', '1') } }); //13-05-2021 $(document).ready(function(){ $('#chosen_price, #billing_contact_no').bind('keyup', function(){ this.value = this.value.replace(/[^\d+]/g, ''); }); }); </script> <style type="text/css"> /* .whatsapp_contact { float:left !important; } */ .conf_unique_email1 { top: 420px !important; } .conf_unique_email2 { top: 460px !important; } .conf_unique_email3 { top: 500px !important; } .reach-us-email { font-size: 11px !important; padding: 5px 0px !important; } .social_contacts_div .action-box-content a { color: #c31045 !important; font-size: 14px !important; cursor:pointer !important; } .social_contacts_div .action-box-content a:hover { text-decoration: underline !important; color: blue !important; cursor:pointer !important; } #st-2.st-left { top: 300px !important; } /* .footer-area-top { padding:0px !important; } */ .footer-area-top:before { background: none !important; } .social_contacts_div { background:#104673 !important; padding: 25px 15px 15px !important; } .copyright_div { background-color: #000929; padding: 25px 0px 65px !important; } .social_contacts_div .action-box-content a:visited { text-decoration:underline !important; } /* kesava 23-06-2021*/ .add_to_calendar_container { width: 20px; height: 24px; display: inline-block; cursor:pointer; } .add_to_calendar_container.grid { height: 20px; margin-top: -10px; padding-top: 5px } .add_to_calendar_container .add_to_calendar_content { z-index: 100; display: none; top: 48px; width: 250px; position: absolute; background: #FFF; font-size: 14px; -webkit-box-shadow: 0 2px 20px #333; -moz-box-shadow: 0 2px 20px #333; box-shadow: 0 2px 20px #333 } .add_to_calendar_container .add_to_calendar_content span, .add_to_calendar_container .add_to_calendar_content a, .add_to_calendar_container .add_to_calendar_content .social-share-icons .more-social-icon-link, .social-share-icons .add_to_calendar_container .add_to_calendar_content .more-social-icon-link { float: left; width: 100% } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_header { background: #333; color: #FFF; text-transform: uppercase; padding: 10px 20px; margin-bottom: 5px; font-weight: bold; } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_description { padding: 10px 20px; font-size: 14px; text-transform: none; color: #000; } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_option { float: left; width: 100%; padding: 10px 20px; text-transform: none; font-size: 14px !important; top: auto !important; left: auto !important; position: static !important; margin: 0 !important; font-weight: normal !important } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_option img { margin-right: 20px; float: left; height: 30px; width: 30px; } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_option .add_to_calendar_text { width: auto; line-height: 30px; color:#b6bd00; } .conf_dates { color:#000; font-size:12px; } .add_to_calendar_container .add_to_calendar_content .add_to_calendar_option:hover { background: #f1f1f1 } /* 05-08-2021 */ span.add_to_calendar_text { font-size: 14px !important; } span.add_to_calendar_header { font-size: 14px !important; } /* kesava */ </style> <script type="text/javascript"> $(document).ready(function(){ $('.add_to_calendar').on("click", function(e) { var cal_content = $(this).attr('cal_content'); $('#'+cal_content).show(); e.stopPropagation(); }); $(document).click(function(){ $(".add_to_calendar_content").hide(); }); }); </script> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script> <script 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