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Become a Sponsor | Global Conferences on Healthcare Technologies | Pubic Health Meetings | Portugal
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text-decoration:none; background:url(images/arrow-link.png) no-repeat left; padding-left:20px; -webkit-transition: all .3s ease-in-out; -moz-transition: all .3s ease-in-out; -o-transition: all .3s ease-in-out; transition: all .3s ease-in-out;} .form a:hover{color:#ff6600; text-decoration:underline; background:url(images/arrow-hover.png) no-repeat left; padding-left:20px; margin-left:5px; -webkit-transition: all .3s ease-in-out; -moz-transition: all .3s ease-in-out; -o-transition: all .3s ease-in-out; transition: all .3s ease-in-out;} .abButtons{width:100px; height:30px; margin-left:70px; margin-top:20px;} .abHeading{text-align:center; padding:5px;} #jsonpResult h2{font-size:20px;} </style> <script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.3/jquery.min.js"></script> <div id="page-banner-area" class="page-banner-area" style="background-image:url(images/banner/banner1.jpg)"> <!-- Subpage title start --> <div class="page-banner-title"> <div class="text-center"> <h2>Become a Sponsor</h2> </div> </div><!-- Subpage title end --> </div><!-- Page Banner end --> <!--Banner Inner--> <!--[if lt IE 7]> <p class="browsehappy">We are Extreamly sorry, But the browser you are using is probably from when civilization started. Which is way behind to view this site properly. Please update to a modern browser, At least a real browser. </p> <![endif]--> <div class="cbx-container"> <!-- SITE CONTENT START HERE --> <div class="content"> <div class="introduction-block row-6 container"> <div class="clear"> <div class="col-11 no-float no-padding"> <br> <!-- <div class="about_banner"> <div class="main_title"><br>About Us<br><br></div> <div class="divider"></div> </div> --> <!-- Ends Header --> <!------------ Start Content ----------------> <h3>Become a Sponsor</h3><BR> <h4>Download the <a href="pdfs/SponsorShip_Healthcare_League_2020.pdf" target="_blank" title="Click here for Sponsorship Guide" style="color:#ff6600;">Sponsorship Guide</a></h4> <div><small><strong>Note:</strong> <span style="color:#ff0000;">All Fields are mandatory</span></small></div> <div class="mainForm"> <form action="/become_a_sponsor.php" method="post" name="form1" enctype="multipart/form-data" > <div class="abformTitle">Title</div> <div class="abformTitle"> <select class="abInput1" name="tittle"> <option value="Dr.">Dr.</option> <option value="Mr.">Mr.</option> <option value="Mrs.">Mrs.</option> <option value="Ms.">Ms.</option> </select> </div> <div style="clear:both;"></div> <div class="abformTitle">Name</div> <div class="abformTitle"> <input class="abInput" type="text" placeholder="Enter your name" name="name" required /> </div> <div style="clear:both;"></div> <div class="abformTitle">Email</div> <div class="abformTitle"> <input class="abInput" type="text" placeholder="Enter your Email" name="email" required /></div> <div style="clear:both;"></div> <div class="abformTitle">Organization</div> <div class="abformTitle"> <input class="abInput" type="text" placeholder="Organization/Institution" name="institution" /></div> <div style="clear:both;"></div> <div class="abformTitle">Telephone</div> <div class="abformTitle"> <input class="abInput" type="text" placeholder="Enter your phone number" name="phone" required /></div> <div style="clear:both;"></div> <div class="abformTitle">City</div> <div class="abformTitle"> <input class="abInput" type="text" placeholder="Enter your city name" name="city" /></div> <div style="clear:both;"></div> <div class="abformTitle">Country</div> <div class="abformTitle"> <select class="abInput1" name="country" data-country="US"> <option value="Select Any" selected="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="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="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 style="clear:both;"></div> <div class="abformTitle">Sponsorship Category</div> <div class="abformTitle"> <select class="abInput1" name="session" id="session" onChange="mySelect();"> <option selected>Select</option> <option value="Platinum">Platinum </option> <option value="Gold">Gold</option> <option value="Silver">Silver</option> <option value="Bronze">Bronze</option> <option value="Exhibitor">Exhibitor</option> <option value="Supporting">Supporting</option> <option value="Others">Others</option> </select> </div> <div style="clear:both;"></div> <div id="reg_spon"></div> <div style="clear:both;"></div> <div class="abformTitle">Amount</div> <div class="abformTitle"><input class="abInput" type="text" placeholder="Enter amount" id="amount" name="amount" /></div> <div style="clear:both;"></div> <div class="abformTitle">Upload Your Logo<br><small>[ .jpg, .gif, .png ]</small></div> <div class="abformTitle"> <input class="abInput" type="file" name="uploadfile" required /> </div> <div style="clear:both;"></div> <div style="margin-left:2px;"><input type="checkbox" name="discountregistration" id="discountregistration" /> Have a promo code </div> <div id="display_discountinput" style="display:none;"> <div id="afterdiscount" style="display:none;"></div> <div id="discountpercentage" style="display:none;"></div> <div id="discounttype_category" style="display:none;"></div> <div class="cl" style="margin:1px 1px 1px 0px; border-radius:0 0 10px 10px; padding: 5px 20px 20px 0px;"> <div class="abformTitle" style="font-size:16px; line-height:15px; font-weight:bold;">Enter Discount Code</div> <div class="abformTitle"><input type="text" name="discount_code" id="discount_code" value="" style="width:90%;" /></div><div class="discountcheck" style="background: #19546b none repeat scroll 0 0; color:#fff; cursor:pointer; float:left; margin-top:0.5%; padding:2px 12px">Apply</div> </div> </div> <div style="clear:both;"></div> <span id="jsonpResult"></span> <div class="abformTitle"><input name="submit" type="submit" onClick="validate();" value="Submit" class="abButtons" /></div> <div class="abformTitle"><input type="reset" value="Reset" class="abButtons" /></div> </form> </div> </div> </div> </div> <script type="text/javascript"> function mySelect() { var x = document.getElementById("session").value; if(x=='Registration Sponsorships') { document.getElementById("reg_spon").innerHTML = "<div class='abformTitle'>Registration Sponsorship Category</div><div class='abformTitle'><select class='abInput1' name='sub_cat' id='sub_cat' onchange='printValue(this.value);' /><option selected>Select</option><option value='Tote Bags'>Tote Bags</option><option value='Lanyards'>Lanyards</option> </select></div>"; } else { document.getElementById("reg_spon").innerHTML = ""; } } function printValue(amt) { if(amt=='Tote Bags') document.form1.amount.value=3000; if(amt=='Lanyards') document.form1.amount.value=2000; } </script> <script type="text/javascript"> $(document).ready(function(){ $('select[name=session]').change(function() { var amounttext = $(this).val(); if(amounttext == 'Platinum'){ $("#amount").val(10000); $('#amount').prop('readonly', true); } else if(amounttext == 'Gold'){ $("#amount").val(8000); $('#amount').prop('readonly', true); } else if(amounttext == 'Silver'){ $("#amount").val(7500); $('#amount').prop('readonly', true); } else if(amounttext == 'Bronze'){ $("#amount").val(5000); $('#amount').prop('readonly', true); } else if(amounttext == 'Exhibitor'){ $("#amount").val(3500); $('#amount').prop('readonly', true); } else if(amounttext == 'Supporting'){ $("#amount").val(2500); $('#amount').prop('readonly', true); } else if(amounttext == 'Others'){ $("#amount").val(''); $('#amount').prop('readonly', false); } }); $(".discountcheck").click(function(){ $("#result_show").hide(); var price = $("#amount").val(); var discount_code = $("#discount_code").val(); var afterdiscount = $("div#afterdiscount").text(); var ajaxurl = "sponsor_discount.php"; var dataString = 'amount='+ price + '&discount_code='+ discount_code; if(discount_code==''){ alert("Please Enter Discount Code"); } else if(afterdiscount!=''){ alert("Discount Code Already Applied"); } else { $.ajax({ url:ajaxurl, type:"POST", data:dataString, success:function(data){ $(data).filter('#result_show').appendTo('#jsonpResult'); $(data).filter('#finalresult_price').appendTo('#afterdiscount'); $(data).filter('#discounttype_percentage').appendTo('#discountpercentage'); var discountpersentage = $(data).filter('#discounttype_percentage').text(); var discountprice = $(data).filter('#discount_amount').text(); $("#discount_code").val(""); $("input[name=discount_code]").attr("value", ''); if(discountpersentage!=''){ $("#amount").removeAttr('value'); $("#amount").removeAttr('placeholder'); var amount = $(data).filter('#finalresult_price').text(); $('input[name=amount]').attr("placeholder", amount); $('input[name=amount]').attr("value", amount); $('input[name=discount_price]').attr("value", discountprice); $("#amount").val(amount); $("#amount").css({"background-color": "#009933", "color": "#fff"}); } $(".discountcheck").attr('disabled','disabled'); //$("#discountcheck").disabled(); return false; //$(data).find('#finalresult_price').appendTo($('#price').val('#finalresult_price')); } }); } }); $('#discountregistration').change(function(){ if(this.checked){ $('#display_discountinput').css("display", "block"); } else { $('#display_discountinput').css("display", "none"); } }); }); </script> </div></section> <style> .form-control { box-shadow: none; padding: 6px 12px; height: 34px; background: none; color: #333 !important; font-size: 12px; border-radius: 0; border: 0; border-radius: 0; color: #fff; border: 1px solid #dedede; border-bottom: 1px solid rgba(0, 0, 0, 0.15); } .form-control:focus { box-shadow: none; border-bottom: 1px solid #ff0763; } .form-control::-moz-placeholder { color: #999; opacity: 1; } .form-control:-ms-input-placeholder { color: #999; } .form-control::-webkit-input-placeholder { color: #999; } </style> <section id="ts-intro" class="ts-intro" style="padding-bottom: 30px;"> <div class="container"> <div class="row"> <div class="col-sm-4"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title text-center"><strong>Contact us</strong></h3> </div> <div class="panel-body"> <div class="row"> <!--<div class="col-xs-2"><p><img src="img/glyph/mic_25.gif"></p></div>--> <div class="col-xs-12"><strong><u>Organising Partner</u></strong></div> <div class="col-xs-12"><p style="line-height:16px;"><strong>GED Biomedical Innovations AB</strong><br> Per Albin Hanssons vag 41<br> Malmo- 20512, Sweden<br> Phone: +46 40 666 53 35<br></p> </div> <div class="col-xs-12"><strong><u>Administrative Office</u></strong></div> <div class="col-xs-12"><p style="line-height:16px;"><strong>Yuktan Technologies Pvt Ltd</strong><br> 1 Raffles Place, #44-01A<br> One Raffles Place, Singapore 048616<br> Phone: +65 9189 1271<br></p> <!--<span class="fa fa-paper-plane-o"></span> <a href="mailto:arnab.das@healthcareleague.com">arnab.das@healthcareleague.com</a></p>--> </div> </div> </div><!-- /.panel-body --> </div> </div> <div class="col-sm-8"> <div class="panel panel-default"> <div class="panel-heading"> <h3 class="panel-title text-center"><strong>Leave us message</strong></h3> </div> <div class="panel-body"> <div class="row"> <form class="form-horizontal" action="#" method="post" id="contactForm"> <div class="col-sm-6"> <div class="form-group"> <div class="col-sm-12"> <input type="text" class="form-control" placeholder="Enter full name" id="name" name="name"> </div> </div> <div class="form-group"> <div class="col-sm-12"> <select class="form-control" id="country" name="country" data-country="US"> <option value="Select Any" selected="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="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="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="form-group"> <div class="col-sm-12"> <input type="phone" class="form-control" placeholder="Enter phone number" id="phone" name="phone"> </div> </div> <div class="form-group"> <div class="col-sm-12"> <input type="email" class="form-control" placeholder="Enter email" name="email" id="email"> </div> </div> </div><!-- /.col-sm-6--> <!-- /.col-sm-6--> <div class="col-sm-6"> <textarea class="form-control" placeholder="Enter your message" id="message" name="message" style="height: 150px;margin: 10px 0;"></textarea> <input type="submit" value="Submit" class="btn btn-default"> </div> </form> <div id="msgSubmit" class="h3 text-center hidden">Submitted Successfully! 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