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Registration | World Forum on Obstetrics and Gynecology | Nexus Forums
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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="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="isle of man">isle of man</option> <option value="israel">israel</option> <option value="italy">italy</option> <option value="ivory coast">ivory coast</option> <option value="jamaica">jamaica</option> <option value="japan">japan</option> <option value="jersey">jersey</option> <option value="jordan">jordan</option> <option value="kazakhstan">kazakhstan</option> <option value="kenya">kenya</option> <option value="kiribati">kiribati</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="macao">macao</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="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="montenegro">montenegro</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="north korea">north korea</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="puerto rico">puerto rico</option> <option value="qatar">qatar</option> <option value="republic of the congo">republic of the congo</option> <option value="romania">romania</option> <option value="russia">russia</option> <option value="rwanda">rwanda</option> <option value="saint barthelemy">saint barthelemy</option> <option value="saint helena">saint helena</option> <option value="saint kitts and nevis">saint kitts and nevis</option> <option value="saint lucia">saint lucia</option> <option value="saint martin">saint martin</option> <option value="saint pierre and miquelon">saint pierre and miquelon</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="slovakia">slovakia</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="south georgia and the south sandwich islands">south georgia and the south sandwich islands</option> <option value="south korea">south korea</option> <option value="spain">spain</option> <option value="sri lanka">sri lanka</option> <option value="sudan">sudan</option> <option value="suriname">suriname</option> <option value="svalbard and jan mayen">svalbard and jan mayen</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="u.s. virgin islands">u.s. virgin 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">vatican</option> <option value="venezuela">venezuela</option> <option value="vietnam">vietnam</option> <option value="wallis and futuna">wallis and futuna</option> <option value="western sahara">western sahara</option> <option value="yemen">yemen</option> <option value="zambia">zambia</option> <option value="zimbabwe">zimbabwe</option> </select> </div> <div class="form-group col-md-6"> <input type="text" class="form-control brch-ctrl" name="org" placeholder="Company/University" required=""> </div> </div> <div class="form-row"> <div class="form-group col-md-6"> <textarea class="form-control brch-ctrl" rows="3" placeholder="Address" name="address" required=""></textarea> </div> <div class="form-group col-md-6" align="center"> <img src="https://nexusforums.net/stripe-secured.png" class="img-responsive" style="width: 240px;"> </div> </div> <div class="row"> <h3 style="padding-left: 20px">Select from various categories below</h3> <div class="table-responsive table-bordered movie-table col-md-12"> <table class="table movie-table"> <tbody> <tr> <th style="background-color: #f57c00;color: #FFF">Academic</th> <th style="background-color: #f57c00; color: #FFF">Early Bird Registration<br><i class="fa fa-calendar"></i> October 29, 2024</th> <th style="background-color: #f57c00; color: #FFF">Standard Registration<br><i class="fa fa-calendar"></i> November 22, 2024</th> <th style="background-color: #f57c00; color: #FFF">OnSpot Registration<br><i class="fa fa-calendar"></i> May 22, 2025</th> </tr> <tr> <td> <input type="checkbox" name="speaker" id="speaker" value="949" onclick="return speaker_reg()"> Speaker Registration </td> <td id="r1_749">$ 749</td> <td id="r1_849"> $ 849</td> <td id="r1_949">$ 949</td> </tr> <tr> <td><input type="checkbox" name="delegate" id="delegate" value="1099" onclick="return delegate_reg()"> Delegate Registration</td> <td id="r2_899"> $ 899 </td> <td id="r2_999"> $ 999 </td> <td id="r2_1099"> $ 1099 </td> </tr> <tr> <td><input type="checkbox" name="poster" id="poster" value="649" onclick="return poster_reg()"> Poster Registration</td> <td id="r3_449"> $ 449 </td> <td id="r3_549"> $ 549 </td> <td id="r3_649"> $ 649 </td> </tr> <tr> <td> <input type="checkbox" name="student1" id="student1" value="499" onclick="return student1_reg()"> Student </td> <td id="r4_299"> $ 299 </td> <td id="r4_399"> $ 399 </td> <td id="r4_499"> $ 499 </td> </tr> <!-- <tr>--> <tr> <th style="background-color: #f57c00;color: #FFF;text-align: center;font-size: 19px;" colspan="4">Add-On's</th> </tr> <tr> <td><input type="checkbox" name="addon" id="addon" value="249" onclick="return addon_reg()"> Accompanying Person</td> <td id="acc_person" colspan="3"> $ 249 </td> </tr> <tr> <th style="background-color: #f57c00;color: #FFF;text-align: center;font-size: 19px;" colspan="4"> Business</th> </tr> <tr> <td id="r5_4999"><input type="checkbox" name="platinum" id="platinum" value="4999" onclick="return platinum_reg()"> Platinum $ 4999</td> <td id="r6_3999"><input type="checkbox" name="diamond" id="diamond" value="3999" onclick="return diamond_reg()"> Diamond $ 3999</td> <td id="r7_2999"><input type="checkbox" name="gold" id="gold" value="2999" onclick="return gold_reg()"> Gold $ 2999</td> <td id="r8_1999"><input type="checkbox" name="exhibition" id="exhibition" value="1999" onclick="return exhibition_reg()"> Exhibition $ 1999</td> </tr> <tr> <th style="background-color: #f57c00;color: #FFF;text-align: center;font-size: 19px;" colspan="4"> Accommodation </th> </tr> <tr> <td colspan="4"> <table class="table movie-table"> <tbody><tr> <th class="text-center" colspan="2"> 2 Nights </th> <th class="text-center" colspan="2"> 3 Nights </th> <th class="text-center" colspan="2"> 4 Nights </th> <th class="text-center" colspan="2"> 5 Nights </th> </tr> <tr> <td>Single Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="400" onclick="return update_price()"> $ 400 </td> <td>Single Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="600" onclick="return update_price()"> $ 600 </td> <td>Single Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="800" onclick="return update_price()"> $ 800 </td> <td>Single Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="1000" onclick="return update_price()"> $ 1000 </td> </tr> <tr> <td>Double Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="460" onclick="return update_price()"> $ 460 </td> <td>Double Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="690" onclick="return update_price()"> $ 690 </td> <td>Double Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="920" onclick="return update_price()"> $ 920 </td> <td>Double Occupancy</td> <td> <input type="radio" name="accprice" id="accprice" value="1150" onclick="return update_price()"> $ 1150 </td> </tr> </tbody></table> </td> </tr> </tbody> </table> </div> </div> <div class="row"> <div class="col-md-6 text-right"><label><strong>TOTAL PRICE($) :</strong> </label></div> <div class="col-md-6"><label name="lblTotalPrice" id="lblTotalPrice">0</label><input type="hidden" name="price" id="price"><input type="hidden" name="reg_desc" id="reg_desc"><input type="hidden" name="addon_desc"><input type="hidden" name="offline1_desc"><input type="hidden" name="offline2_desc"><input type="hidden" name="acc_desc"> <input type="hidden" name="currency" value="USD"> </div> <!--<div class="col-md-4"> </div>--> </div> <div class="row"> <div class="col-md-3"> </div> <div style="padding: 20px;" class="col-md-6 text-center"><input type="checkbox" name="accept" required=""> I've read and accept the <a style="color: #f57c00;" href="terms-conditions" target="_blank">terms & conditions</a>.</div> <div class="col-md-3"> </div> <div class="col-md-3"> </div> <div align="center" class="col-md-6"> <table align="center" class=""> <tbody><tr> <td colspan="2" align="center" valign="top"></td> </tr> <tr> <td align="right" valign="top"> Validation code:</td> <td><img src="https://obstetrics.nexusforums.net/captcha.php?rand=1245567575" id="captchaimg"><br> <label for="message">Enter the code above here :</label> <br> <input id="captcha_code" name="captcha_code" 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