events.precision-globe.com
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urlscan Pro
108.167.172.162
Public Scan
URL:
https://events.precision-globe.com/register/47
Submission: On August 22 via manual from IN — Scanned from DE
Submission: On August 22 via manual from IN — Scanned from DE
Form analysis
2 forms found in the DOMPOST https://events.precision-globe.com/welcome/registrationSubmition
<form method="POST" action="https://events.precision-globe.com/welcome/registrationSubmition" enctype="multipart/form-data" id="registrationForm" class="has-validation-callback" siq_id="autopick_9370">
<div class="row">
<div class="form-group col-md-6">
<label for="title">Title <span class="text-danger">*</span></label>
<select id="title" name="title" data-validation="required" class="form-control form_select">
<option value=""> Title</option>
<option value="Mrs.">Mrs.</option>
<option value="Mr.">Mr.</option>
<option value="Ms.">Ms.</option>
<option value="Miss.">Miss.</option>
<option value="Dr.">Dr.</option>
</select>
</div>
</div>
<div class="row">
<div class="form-group col-md-6">
<label for="fname">First Name <span class="text-danger">*</span></label>
<input type="text" class="form-control form_elements" data-validation="required" name="fname" id="fname" placeholder="First Name*">
</div>
<div class="form-group col-md-6">
<label for="lname">Last Name <span class="text-danger">*</span></label>
<input type="text" class="form-control form_elements" data-validation="required" id="surname" name="lname" placeholder="Last Name*">
</div>
<div class="form-group col-md-6">
<label for="email">Corporate Email<span class="text-danger">*</span></label>
<input type="email" class="form-control form_elements" data-validation="email" id="email" name="email" placeholder="Corporate Email*">
<small id="emailHelp" class="form-text text-muted">Please use your corporate/business email address. Personal addresses (e.g. gmail, hotmail, yahoo) will result in your registration being refused</small>
</div>
<div class="form-group col-md-6">
<label for="office_number">Office Number <span class="text-danger">*</span></label>
<input type="text" class="form-control form_elements" data-validation="required" name="office_number" id="number" placeholder="Office*">
</div>
<!-- 3 -->
<div class="form-group col-md-6">
<label for="mobile">Mobile Number <span class="text-danger">*</span></label>
<div class="iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
<ul class="iti__country-list iti__hide" id="iti-0__country-listbox" role="listbox" aria-label="List of countries">
<li class="iti__country iti__preferred iti__active" tabindex="-1" id="iti-0__item-us-preferred" role="option" data-dial-code="1" data-country-code="us" aria-selected="true">
<div class="iti__flag-box">
<div class="iti__flag iti__us"></div>
</div><span class="iti__country-name">United States</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__preferred" tabindex="-1" id="iti-0__item-gb-preferred" role="option" data-dial-code="44" data-country-code="gb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gb"></div>
</div><span class="iti__country-name">United Kingdom</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__divider" role="separator" aria-disabled="true"></li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-af" role="option" data-dial-code="93" data-country-code="af" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__af"></div>
</div><span class="iti__country-name">Afghanistan (افغانستان)</span><span class="iti__dial-code">+93</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-al" role="option" data-dial-code="355" data-country-code="al" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__al"></div>
</div><span class="iti__country-name">Albania (Shqipëri)</span><span class="iti__dial-code">+355</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-dz" role="option" data-dial-code="213" data-country-code="dz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dz"></div>
</div><span class="iti__country-name">Algeria (الجزائر)</span><span class="iti__dial-code">+213</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-as" role="option" data-dial-code="1" data-country-code="as" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__as"></div>
</div><span class="iti__country-name">American Samoa</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ad" role="option" data-dial-code="376" data-country-code="ad" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ad"></div>
</div><span class="iti__country-name">Andorra</span><span class="iti__dial-code">+376</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ao" role="option" data-dial-code="244" data-country-code="ao" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ao"></div>
</div><span class="iti__country-name">Angola</span><span class="iti__dial-code">+244</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ai" role="option" data-dial-code="1" data-country-code="ai" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ai"></div>
</div><span class="iti__country-name">Anguilla</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ag" role="option" data-dial-code="1" data-country-code="ag" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ag"></div>
</div><span class="iti__country-name">Antigua and Barbuda</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ar" role="option" data-dial-code="54" data-country-code="ar" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ar"></div>
</div><span class="iti__country-name">Argentina</span><span class="iti__dial-code">+54</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-am" role="option" data-dial-code="374" data-country-code="am" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__am"></div>
</div><span class="iti__country-name">Armenia (Հայաստան)</span><span class="iti__dial-code">+374</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-aw" role="option" data-dial-code="297" data-country-code="aw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__aw"></div>
</div><span class="iti__country-name">Aruba</span><span class="iti__dial-code">+297</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ac" role="option" data-dial-code="247" data-country-code="ac" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ac"></div>
</div><span class="iti__country-name">Ascension Island</span><span class="iti__dial-code">+247</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-au" role="option" data-dial-code="61" data-country-code="au" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__au"></div>
</div><span class="iti__country-name">Australia</span><span class="iti__dial-code">+61</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-at" role="option" data-dial-code="43" data-country-code="at" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__at"></div>
</div><span class="iti__country-name">Austria (Österreich)</span><span class="iti__dial-code">+43</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-az" role="option" data-dial-code="994" data-country-code="az" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__az"></div>
</div><span class="iti__country-name">Azerbaijan (Azərbaycan)</span><span class="iti__dial-code">+994</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bs" role="option" data-dial-code="1" data-country-code="bs" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bs"></div>
</div><span class="iti__country-name">Bahamas</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bh" role="option" data-dial-code="973" data-country-code="bh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bh"></div>
</div><span class="iti__country-name">Bahrain (البحرين)</span><span class="iti__dial-code">+973</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bd" role="option" data-dial-code="880" data-country-code="bd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bd"></div>
</div><span class="iti__country-name">Bangladesh (বাংলাদেশ)</span><span class="iti__dial-code">+880</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bb" role="option" data-dial-code="1" data-country-code="bb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bb"></div>
</div><span class="iti__country-name">Barbados</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-by" role="option" data-dial-code="375" data-country-code="by" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__by"></div>
</div><span class="iti__country-name">Belarus (Беларусь)</span><span class="iti__dial-code">+375</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-be" role="option" data-dial-code="32" data-country-code="be" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__be"></div>
</div><span class="iti__country-name">Belgium (België)</span><span class="iti__dial-code">+32</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bz" role="option" data-dial-code="501" data-country-code="bz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bz"></div>
</div><span class="iti__country-name">Belize</span><span class="iti__dial-code">+501</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bj" role="option" data-dial-code="229" data-country-code="bj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bj"></div>
</div><span class="iti__country-name">Benin (Bénin)</span><span class="iti__dial-code">+229</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bm" role="option" data-dial-code="1" data-country-code="bm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bm"></div>
</div><span class="iti__country-name">Bermuda</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bt" role="option" data-dial-code="975" data-country-code="bt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bt"></div>
</div><span class="iti__country-name">Bhutan (འབྲུག)</span><span class="iti__dial-code">+975</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bo" role="option" data-dial-code="591" data-country-code="bo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bo"></div>
</div><span class="iti__country-name">Bolivia</span><span class="iti__dial-code">+591</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ba" role="option" data-dial-code="387" data-country-code="ba" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ba"></div>
</div><span class="iti__country-name">Bosnia and Herzegovina (Босна и Херцеговина)</span><span class="iti__dial-code">+387</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bw" role="option" data-dial-code="267" data-country-code="bw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bw"></div>
</div><span class="iti__country-name">Botswana</span><span class="iti__dial-code">+267</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-br" role="option" data-dial-code="55" data-country-code="br" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__br"></div>
</div><span class="iti__country-name">Brazil (Brasil)</span><span class="iti__dial-code">+55</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-io" role="option" data-dial-code="246" data-country-code="io" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__io"></div>
</div><span class="iti__country-name">British Indian Ocean Territory</span><span class="iti__dial-code">+246</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-vg" role="option" data-dial-code="1" data-country-code="vg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vg"></div>
</div><span class="iti__country-name">British Virgin Islands</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bn" role="option" data-dial-code="673" data-country-code="bn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bn"></div>
</div><span class="iti__country-name">Brunei</span><span class="iti__dial-code">+673</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bg" role="option" data-dial-code="359" data-country-code="bg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bg"></div>
</div><span class="iti__country-name">Bulgaria (България)</span><span class="iti__dial-code">+359</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bf" role="option" data-dial-code="226" data-country-code="bf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bf"></div>
</div><span class="iti__country-name">Burkina Faso</span><span class="iti__dial-code">+226</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bi" role="option" data-dial-code="257" data-country-code="bi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bi"></div>
</div><span class="iti__country-name">Burundi (Uburundi)</span><span class="iti__dial-code">+257</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kh" role="option" data-dial-code="855" data-country-code="kh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kh"></div>
</div><span class="iti__country-name">Cambodia (កម្ពុជា)</span><span class="iti__dial-code">+855</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cm" role="option" data-dial-code="237" data-country-code="cm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cm"></div>
</div><span class="iti__country-name">Cameroon (Cameroun)</span><span class="iti__dial-code">+237</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ca" role="option" data-dial-code="1" data-country-code="ca" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ca"></div>
</div><span class="iti__country-name">Canada</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cv" role="option" data-dial-code="238" data-country-code="cv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cv"></div>
</div><span class="iti__country-name">Cape Verde (Kabu Verdi)</span><span class="iti__dial-code">+238</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bq" role="option" data-dial-code="599" data-country-code="bq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bq"></div>
</div><span class="iti__country-name">Caribbean Netherlands</span><span class="iti__dial-code">+599</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ky" role="option" data-dial-code="1" data-country-code="ky" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ky"></div>
</div><span class="iti__country-name">Cayman Islands</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cf" role="option" data-dial-code="236" data-country-code="cf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cf"></div>
</div><span class="iti__country-name">Central African Republic (République centrafricaine)</span><span class="iti__dial-code">+236</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-td" role="option" data-dial-code="235" data-country-code="td" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__td"></div>
</div><span class="iti__country-name">Chad (Tchad)</span><span class="iti__dial-code">+235</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cl" role="option" data-dial-code="56" data-country-code="cl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cl"></div>
</div><span class="iti__country-name">Chile</span><span class="iti__dial-code">+56</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cn" role="option" data-dial-code="86" data-country-code="cn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cn"></div>
</div><span class="iti__country-name">China (中国)</span><span class="iti__dial-code">+86</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cx" role="option" data-dial-code="61" data-country-code="cx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cx"></div>
</div><span class="iti__country-name">Christmas Island</span><span class="iti__dial-code">+61</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cc" role="option" data-dial-code="61" data-country-code="cc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cc"></div>
</div><span class="iti__country-name">Cocos (Keeling) Islands</span><span class="iti__dial-code">+61</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-co" role="option" data-dial-code="57" data-country-code="co" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__co"></div>
</div><span class="iti__country-name">Colombia</span><span class="iti__dial-code">+57</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-km" role="option" data-dial-code="269" data-country-code="km" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__km"></div>
</div><span class="iti__country-name">Comoros (جزر القمر)</span><span class="iti__dial-code">+269</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cd" role="option" data-dial-code="243" data-country-code="cd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cd"></div>
</div><span class="iti__country-name">Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)</span><span class="iti__dial-code">+243</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cg" role="option" data-dial-code="242" data-country-code="cg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cg"></div>
</div><span class="iti__country-name">Congo (Republic) (Congo-Brazzaville)</span><span class="iti__dial-code">+242</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ck" role="option" data-dial-code="682" data-country-code="ck" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ck"></div>
</div><span class="iti__country-name">Cook Islands</span><span class="iti__dial-code">+682</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cr" role="option" data-dial-code="506" data-country-code="cr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cr"></div>
</div><span class="iti__country-name">Costa Rica</span><span class="iti__dial-code">+506</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ci" role="option" data-dial-code="225" data-country-code="ci" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ci"></div>
</div><span class="iti__country-name">Côte d’Ivoire</span><span class="iti__dial-code">+225</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-hr" role="option" data-dial-code="385" data-country-code="hr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hr"></div>
</div><span class="iti__country-name">Croatia (Hrvatska)</span><span class="iti__dial-code">+385</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cu" role="option" data-dial-code="53" data-country-code="cu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cu"></div>
</div><span class="iti__country-name">Cuba</span><span class="iti__dial-code">+53</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cw" role="option" data-dial-code="599" data-country-code="cw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cw"></div>
</div><span class="iti__country-name">Curaçao</span><span class="iti__dial-code">+599</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cy" role="option" data-dial-code="357" data-country-code="cy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cy"></div>
</div><span class="iti__country-name">Cyprus (Κύπρος)</span><span class="iti__dial-code">+357</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-cz" role="option" data-dial-code="420" data-country-code="cz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cz"></div>
</div><span class="iti__country-name">Czech Republic (Česká republika)</span><span class="iti__dial-code">+420</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-dk" role="option" data-dial-code="45" data-country-code="dk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dk"></div>
</div><span class="iti__country-name">Denmark (Danmark)</span><span class="iti__dial-code">+45</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-dj" role="option" data-dial-code="253" data-country-code="dj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dj"></div>
</div><span class="iti__country-name">Djibouti</span><span class="iti__dial-code">+253</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-dm" role="option" data-dial-code="1" data-country-code="dm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dm"></div>
</div><span class="iti__country-name">Dominica</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-do" role="option" data-dial-code="1" data-country-code="do" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__do"></div>
</div><span class="iti__country-name">Dominican Republic (República Dominicana)</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ec" role="option" data-dial-code="593" data-country-code="ec" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ec"></div>
</div><span class="iti__country-name">Ecuador</span><span class="iti__dial-code">+593</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-eg" role="option" data-dial-code="20" data-country-code="eg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__eg"></div>
</div><span class="iti__country-name">Egypt (مصر)</span><span class="iti__dial-code">+20</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sv" role="option" data-dial-code="503" data-country-code="sv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sv"></div>
</div><span class="iti__country-name">El Salvador</span><span class="iti__dial-code">+503</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gq" role="option" data-dial-code="240" data-country-code="gq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gq"></div>
</div><span class="iti__country-name">Equatorial Guinea (Guinea Ecuatorial)</span><span class="iti__dial-code">+240</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-er" role="option" data-dial-code="291" data-country-code="er" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__er"></div>
</div><span class="iti__country-name">Eritrea</span><span class="iti__dial-code">+291</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ee" role="option" data-dial-code="372" data-country-code="ee" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ee"></div>
</div><span class="iti__country-name">Estonia (Eesti)</span><span class="iti__dial-code">+372</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sz" role="option" data-dial-code="268" data-country-code="sz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sz"></div>
</div><span class="iti__country-name">Eswatini</span><span class="iti__dial-code">+268</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-et" role="option" data-dial-code="251" data-country-code="et" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__et"></div>
</div><span class="iti__country-name">Ethiopia</span><span class="iti__dial-code">+251</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fk" role="option" data-dial-code="500" data-country-code="fk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fk"></div>
</div><span class="iti__country-name">Falkland Islands (Islas Malvinas)</span><span class="iti__dial-code">+500</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fo" role="option" data-dial-code="298" data-country-code="fo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fo"></div>
</div><span class="iti__country-name">Faroe Islands (Føroyar)</span><span class="iti__dial-code">+298</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fj" role="option" data-dial-code="679" data-country-code="fj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fj"></div>
</div><span class="iti__country-name">Fiji</span><span class="iti__dial-code">+679</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fi" role="option" data-dial-code="358" data-country-code="fi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fi"></div>
</div><span class="iti__country-name">Finland (Suomi)</span><span class="iti__dial-code">+358</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fr" role="option" data-dial-code="33" data-country-code="fr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fr"></div>
</div><span class="iti__country-name">France</span><span class="iti__dial-code">+33</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gf" role="option" data-dial-code="594" data-country-code="gf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gf"></div>
</div><span class="iti__country-name">French Guiana (Guyane française)</span><span class="iti__dial-code">+594</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pf" role="option" data-dial-code="689" data-country-code="pf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pf"></div>
</div><span class="iti__country-name">French Polynesia (Polynésie française)</span><span class="iti__dial-code">+689</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ga" role="option" data-dial-code="241" data-country-code="ga" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ga"></div>
</div><span class="iti__country-name">Gabon</span><span class="iti__dial-code">+241</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gm" role="option" data-dial-code="220" data-country-code="gm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gm"></div>
</div><span class="iti__country-name">Gambia</span><span class="iti__dial-code">+220</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ge" role="option" data-dial-code="995" data-country-code="ge" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ge"></div>
</div><span class="iti__country-name">Georgia (საქართველო)</span><span class="iti__dial-code">+995</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-de" role="option" data-dial-code="49" data-country-code="de" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__de"></div>
</div><span class="iti__country-name">Germany (Deutschland)</span><span class="iti__dial-code">+49</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gh" role="option" data-dial-code="233" data-country-code="gh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gh"></div>
</div><span class="iti__country-name">Ghana (Gaana)</span><span class="iti__dial-code">+233</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gi" role="option" data-dial-code="350" data-country-code="gi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gi"></div>
</div><span class="iti__country-name">Gibraltar</span><span class="iti__dial-code">+350</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gr" role="option" data-dial-code="30" data-country-code="gr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gr"></div>
</div><span class="iti__country-name">Greece (Ελλάδα)</span><span class="iti__dial-code">+30</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gl" role="option" data-dial-code="299" data-country-code="gl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gl"></div>
</div><span class="iti__country-name">Greenland (Kalaallit Nunaat)</span><span class="iti__dial-code">+299</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gd" role="option" data-dial-code="1" data-country-code="gd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gd"></div>
</div><span class="iti__country-name">Grenada</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gp" role="option" data-dial-code="590" data-country-code="gp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gp"></div>
</div><span class="iti__country-name">Guadeloupe</span><span class="iti__dial-code">+590</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gu" role="option" data-dial-code="1" data-country-code="gu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gu"></div>
</div><span class="iti__country-name">Guam</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gt" role="option" data-dial-code="502" data-country-code="gt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gt"></div>
</div><span class="iti__country-name">Guatemala</span><span class="iti__dial-code">+502</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gg" role="option" data-dial-code="44" data-country-code="gg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gg"></div>
</div><span class="iti__country-name">Guernsey</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gn" role="option" data-dial-code="224" data-country-code="gn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gn"></div>
</div><span class="iti__country-name">Guinea (Guinée)</span><span class="iti__dial-code">+224</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gw" role="option" data-dial-code="245" data-country-code="gw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gw"></div>
</div><span class="iti__country-name">Guinea-Bissau (Guiné Bissau)</span><span class="iti__dial-code">+245</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gy" role="option" data-dial-code="592" data-country-code="gy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gy"></div>
</div><span class="iti__country-name">Guyana</span><span class="iti__dial-code">+592</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ht" role="option" data-dial-code="509" data-country-code="ht" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ht"></div>
</div><span class="iti__country-name">Haiti</span><span class="iti__dial-code">+509</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-hn" role="option" data-dial-code="504" data-country-code="hn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hn"></div>
</div><span class="iti__country-name">Honduras</span><span class="iti__dial-code">+504</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-hk" role="option" data-dial-code="852" data-country-code="hk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hk"></div>
</div><span class="iti__country-name">Hong Kong (香港)</span><span class="iti__dial-code">+852</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-hu" role="option" data-dial-code="36" data-country-code="hu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hu"></div>
</div><span class="iti__country-name">Hungary (Magyarország)</span><span class="iti__dial-code">+36</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-is" role="option" data-dial-code="354" data-country-code="is" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__is"></div>
</div><span class="iti__country-name">Iceland (Ísland)</span><span class="iti__dial-code">+354</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-in" role="option" data-dial-code="91" data-country-code="in" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__in"></div>
</div><span class="iti__country-name">India (भारत)</span><span class="iti__dial-code">+91</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-id" role="option" data-dial-code="62" data-country-code="id" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__id"></div>
</div><span class="iti__country-name">Indonesia</span><span class="iti__dial-code">+62</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ir" role="option" data-dial-code="98" data-country-code="ir" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ir"></div>
</div><span class="iti__country-name">Iran (ایران)</span><span class="iti__dial-code">+98</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-iq" role="option" data-dial-code="964" data-country-code="iq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__iq"></div>
</div><span class="iti__country-name">Iraq (العراق)</span><span class="iti__dial-code">+964</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ie" role="option" data-dial-code="353" data-country-code="ie" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ie"></div>
</div><span class="iti__country-name">Ireland</span><span class="iti__dial-code">+353</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-im" role="option" data-dial-code="44" data-country-code="im" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__im"></div>
</div><span class="iti__country-name">Isle of Man</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-il" role="option" data-dial-code="972" data-country-code="il" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__il"></div>
</div><span class="iti__country-name">Israel (ישראל)</span><span class="iti__dial-code">+972</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-it" role="option" data-dial-code="39" data-country-code="it" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__it"></div>
</div><span class="iti__country-name">Italy (Italia)</span><span class="iti__dial-code">+39</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-jm" role="option" data-dial-code="1" data-country-code="jm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jm"></div>
</div><span class="iti__country-name">Jamaica</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-jp" role="option" data-dial-code="81" data-country-code="jp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jp"></div>
</div><span class="iti__country-name">Japan (日本)</span><span class="iti__dial-code">+81</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-je" role="option" data-dial-code="44" data-country-code="je" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__je"></div>
</div><span class="iti__country-name">Jersey</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-jo" role="option" data-dial-code="962" data-country-code="jo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jo"></div>
</div><span class="iti__country-name">Jordan (الأردن)</span><span class="iti__dial-code">+962</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kz" role="option" data-dial-code="7" data-country-code="kz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kz"></div>
</div><span class="iti__country-name">Kazakhstan (Казахстан)</span><span class="iti__dial-code">+7</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ke" role="option" data-dial-code="254" data-country-code="ke" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ke"></div>
</div><span class="iti__country-name">Kenya</span><span class="iti__dial-code">+254</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ki" role="option" data-dial-code="686" data-country-code="ki" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ki"></div>
</div><span class="iti__country-name">Kiribati</span><span class="iti__dial-code">+686</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-xk" role="option" data-dial-code="383" data-country-code="xk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__xk"></div>
</div><span class="iti__country-name">Kosovo</span><span class="iti__dial-code">+383</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kw" role="option" data-dial-code="965" data-country-code="kw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kw"></div>
</div><span class="iti__country-name">Kuwait (الكويت)</span><span class="iti__dial-code">+965</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kg" role="option" data-dial-code="996" data-country-code="kg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kg"></div>
</div><span class="iti__country-name">Kyrgyzstan (Кыргызстан)</span><span class="iti__dial-code">+996</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-la" role="option" data-dial-code="856" data-country-code="la" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__la"></div>
</div><span class="iti__country-name">Laos (ລາວ)</span><span class="iti__dial-code">+856</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lv" role="option" data-dial-code="371" data-country-code="lv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lv"></div>
</div><span class="iti__country-name">Latvia (Latvija)</span><span class="iti__dial-code">+371</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lb" role="option" data-dial-code="961" data-country-code="lb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lb"></div>
</div><span class="iti__country-name">Lebanon (لبنان)</span><span class="iti__dial-code">+961</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ls" role="option" data-dial-code="266" data-country-code="ls" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ls"></div>
</div><span class="iti__country-name">Lesotho</span><span class="iti__dial-code">+266</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lr" role="option" data-dial-code="231" data-country-code="lr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lr"></div>
</div><span class="iti__country-name">Liberia</span><span class="iti__dial-code">+231</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ly" role="option" data-dial-code="218" data-country-code="ly" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ly"></div>
</div><span class="iti__country-name">Libya (ليبيا)</span><span class="iti__dial-code">+218</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-li" role="option" data-dial-code="423" data-country-code="li" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__li"></div>
</div><span class="iti__country-name">Liechtenstein</span><span class="iti__dial-code">+423</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lt" role="option" data-dial-code="370" data-country-code="lt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lt"></div>
</div><span class="iti__country-name">Lithuania (Lietuva)</span><span class="iti__dial-code">+370</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lu" role="option" data-dial-code="352" data-country-code="lu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lu"></div>
</div><span class="iti__country-name">Luxembourg</span><span class="iti__dial-code">+352</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mo" role="option" data-dial-code="853" data-country-code="mo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mo"></div>
</div><span class="iti__country-name">Macau (澳門)</span><span class="iti__dial-code">+853</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mk" role="option" data-dial-code="389" data-country-code="mk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mk"></div>
</div><span class="iti__country-name">North Macedonia (Македонија)</span><span class="iti__dial-code">+389</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mg" role="option" data-dial-code="261" data-country-code="mg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mg"></div>
</div><span class="iti__country-name">Madagascar (Madagasikara)</span><span class="iti__dial-code">+261</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mw" role="option" data-dial-code="265" data-country-code="mw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mw"></div>
</div><span class="iti__country-name">Malawi</span><span class="iti__dial-code">+265</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-my" role="option" data-dial-code="60" data-country-code="my" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__my"></div>
</div><span class="iti__country-name">Malaysia</span><span class="iti__dial-code">+60</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mv" role="option" data-dial-code="960" data-country-code="mv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mv"></div>
</div><span class="iti__country-name">Maldives</span><span class="iti__dial-code">+960</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ml" role="option" data-dial-code="223" data-country-code="ml" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ml"></div>
</div><span class="iti__country-name">Mali</span><span class="iti__dial-code">+223</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mt" role="option" data-dial-code="356" data-country-code="mt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mt"></div>
</div><span class="iti__country-name">Malta</span><span class="iti__dial-code">+356</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mh" role="option" data-dial-code="692" data-country-code="mh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mh"></div>
</div><span class="iti__country-name">Marshall Islands</span><span class="iti__dial-code">+692</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mq" role="option" data-dial-code="596" data-country-code="mq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mq"></div>
</div><span class="iti__country-name">Martinique</span><span class="iti__dial-code">+596</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mr" role="option" data-dial-code="222" data-country-code="mr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mr"></div>
</div><span class="iti__country-name">Mauritania (موريتانيا)</span><span class="iti__dial-code">+222</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mu" role="option" data-dial-code="230" data-country-code="mu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mu"></div>
</div><span class="iti__country-name">Mauritius (Moris)</span><span class="iti__dial-code">+230</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-yt" role="option" data-dial-code="262" data-country-code="yt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__yt"></div>
</div><span class="iti__country-name">Mayotte</span><span class="iti__dial-code">+262</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mx" role="option" data-dial-code="52" data-country-code="mx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mx"></div>
</div><span class="iti__country-name">Mexico (México)</span><span class="iti__dial-code">+52</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-fm" role="option" data-dial-code="691" data-country-code="fm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fm"></div>
</div><span class="iti__country-name">Micronesia</span><span class="iti__dial-code">+691</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-md" role="option" data-dial-code="373" data-country-code="md" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__md"></div>
</div><span class="iti__country-name">Moldova (Republica Moldova)</span><span class="iti__dial-code">+373</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mc" role="option" data-dial-code="377" data-country-code="mc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mc"></div>
</div><span class="iti__country-name">Monaco</span><span class="iti__dial-code">+377</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mn" role="option" data-dial-code="976" data-country-code="mn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mn"></div>
</div><span class="iti__country-name">Mongolia (Монгол)</span><span class="iti__dial-code">+976</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-me" role="option" data-dial-code="382" data-country-code="me" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__me"></div>
</div><span class="iti__country-name">Montenegro (Crna Gora)</span><span class="iti__dial-code">+382</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ms" role="option" data-dial-code="1" data-country-code="ms" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ms"></div>
</div><span class="iti__country-name">Montserrat</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ma" role="option" data-dial-code="212" data-country-code="ma" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ma"></div>
</div><span class="iti__country-name">Morocco (المغرب)</span><span class="iti__dial-code">+212</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mz" role="option" data-dial-code="258" data-country-code="mz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mz"></div>
</div><span class="iti__country-name">Mozambique (Moçambique)</span><span class="iti__dial-code">+258</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mm" role="option" data-dial-code="95" data-country-code="mm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mm"></div>
</div><span class="iti__country-name">Myanmar (Burma) (မြန်မာ)</span><span class="iti__dial-code">+95</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-na" role="option" data-dial-code="264" data-country-code="na" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__na"></div>
</div><span class="iti__country-name">Namibia (Namibië)</span><span class="iti__dial-code">+264</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nr" role="option" data-dial-code="674" data-country-code="nr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nr"></div>
</div><span class="iti__country-name">Nauru</span><span class="iti__dial-code">+674</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-np" role="option" data-dial-code="977" data-country-code="np" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__np"></div>
</div><span class="iti__country-name">Nepal (नेपाल)</span><span class="iti__dial-code">+977</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nl" role="option" data-dial-code="31" data-country-code="nl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nl"></div>
</div><span class="iti__country-name">Netherlands (Nederland)</span><span class="iti__dial-code">+31</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nc" role="option" data-dial-code="687" data-country-code="nc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nc"></div>
</div><span class="iti__country-name">New Caledonia (Nouvelle-Calédonie)</span><span class="iti__dial-code">+687</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nz" role="option" data-dial-code="64" data-country-code="nz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nz"></div>
</div><span class="iti__country-name">New Zealand</span><span class="iti__dial-code">+64</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ni" role="option" data-dial-code="505" data-country-code="ni" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ni"></div>
</div><span class="iti__country-name">Nicaragua</span><span class="iti__dial-code">+505</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ne" role="option" data-dial-code="227" data-country-code="ne" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ne"></div>
</div><span class="iti__country-name">Niger (Nijar)</span><span class="iti__dial-code">+227</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ng" role="option" data-dial-code="234" data-country-code="ng" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ng"></div>
</div><span class="iti__country-name">Nigeria</span><span class="iti__dial-code">+234</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nu" role="option" data-dial-code="683" data-country-code="nu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nu"></div>
</div><span class="iti__country-name">Niue</span><span class="iti__dial-code">+683</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-nf" role="option" data-dial-code="672" data-country-code="nf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nf"></div>
</div><span class="iti__country-name">Norfolk Island</span><span class="iti__dial-code">+672</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kp" role="option" data-dial-code="850" data-country-code="kp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kp"></div>
</div><span class="iti__country-name">North Korea (조선 민주주의 인민 공화국)</span><span class="iti__dial-code">+850</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mp" role="option" data-dial-code="1" data-country-code="mp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mp"></div>
</div><span class="iti__country-name">Northern Mariana Islands</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-no" role="option" data-dial-code="47" data-country-code="no" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__no"></div>
</div><span class="iti__country-name">Norway (Norge)</span><span class="iti__dial-code">+47</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-om" role="option" data-dial-code="968" data-country-code="om" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__om"></div>
</div><span class="iti__country-name">Oman (عُمان)</span><span class="iti__dial-code">+968</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pk" role="option" data-dial-code="92" data-country-code="pk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pk"></div>
</div><span class="iti__country-name">Pakistan (پاکستان)</span><span class="iti__dial-code">+92</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pw" role="option" data-dial-code="680" data-country-code="pw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pw"></div>
</div><span class="iti__country-name">Palau</span><span class="iti__dial-code">+680</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ps" role="option" data-dial-code="970" data-country-code="ps" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ps"></div>
</div><span class="iti__country-name">Palestine (فلسطين)</span><span class="iti__dial-code">+970</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pa" role="option" data-dial-code="507" data-country-code="pa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pa"></div>
</div><span class="iti__country-name">Panama (Panamá)</span><span class="iti__dial-code">+507</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pg" role="option" data-dial-code="675" data-country-code="pg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pg"></div>
</div><span class="iti__country-name">Papua New Guinea</span><span class="iti__dial-code">+675</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-py" role="option" data-dial-code="595" data-country-code="py" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__py"></div>
</div><span class="iti__country-name">Paraguay</span><span class="iti__dial-code">+595</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pe" role="option" data-dial-code="51" data-country-code="pe" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pe"></div>
</div><span class="iti__country-name">Peru (Perú)</span><span class="iti__dial-code">+51</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ph" role="option" data-dial-code="63" data-country-code="ph" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ph"></div>
</div><span class="iti__country-name">Philippines</span><span class="iti__dial-code">+63</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pl" role="option" data-dial-code="48" data-country-code="pl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pl"></div>
</div><span class="iti__country-name">Poland (Polska)</span><span class="iti__dial-code">+48</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pt" role="option" data-dial-code="351" data-country-code="pt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pt"></div>
</div><span class="iti__country-name">Portugal</span><span class="iti__dial-code">+351</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pr" role="option" data-dial-code="1" data-country-code="pr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pr"></div>
</div><span class="iti__country-name">Puerto Rico</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-qa" role="option" data-dial-code="974" data-country-code="qa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__qa"></div>
</div><span class="iti__country-name">Qatar (قطر)</span><span class="iti__dial-code">+974</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-re" role="option" data-dial-code="262" data-country-code="re" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__re"></div>
</div><span class="iti__country-name">Réunion (La Réunion)</span><span class="iti__dial-code">+262</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ro" role="option" data-dial-code="40" data-country-code="ro" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ro"></div>
</div><span class="iti__country-name">Romania (România)</span><span class="iti__dial-code">+40</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ru" role="option" data-dial-code="7" data-country-code="ru" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ru"></div>
</div><span class="iti__country-name">Russia (Россия)</span><span class="iti__dial-code">+7</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-rw" role="option" data-dial-code="250" data-country-code="rw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__rw"></div>
</div><span class="iti__country-name">Rwanda</span><span class="iti__dial-code">+250</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-bl" role="option" data-dial-code="590" data-country-code="bl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bl"></div>
</div><span class="iti__country-name">Saint Barthélemy</span><span class="iti__dial-code">+590</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sh" role="option" data-dial-code="290" data-country-code="sh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sh"></div>
</div><span class="iti__country-name">Saint Helena</span><span class="iti__dial-code">+290</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kn" role="option" data-dial-code="1" data-country-code="kn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kn"></div>
</div><span class="iti__country-name">Saint Kitts and Nevis</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lc" role="option" data-dial-code="1" data-country-code="lc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lc"></div>
</div><span class="iti__country-name">Saint Lucia</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-mf" role="option" data-dial-code="590" data-country-code="mf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mf"></div>
</div><span class="iti__country-name">Saint Martin (Saint-Martin (partie française))</span><span class="iti__dial-code">+590</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-pm" role="option" data-dial-code="508" data-country-code="pm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pm"></div>
</div><span class="iti__country-name">Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)</span><span class="iti__dial-code">+508</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-vc" role="option" data-dial-code="1" data-country-code="vc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vc"></div>
</div><span class="iti__country-name">Saint Vincent and the Grenadines</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ws" role="option" data-dial-code="685" data-country-code="ws" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ws"></div>
</div><span class="iti__country-name">Samoa</span><span class="iti__dial-code">+685</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sm" role="option" data-dial-code="378" data-country-code="sm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sm"></div>
</div><span class="iti__country-name">San Marino</span><span class="iti__dial-code">+378</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-st" role="option" data-dial-code="239" data-country-code="st" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__st"></div>
</div><span class="iti__country-name">São Tomé and Príncipe (São Tomé e Príncipe)</span><span class="iti__dial-code">+239</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sa" role="option" data-dial-code="966" data-country-code="sa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sa"></div>
</div><span class="iti__country-name">Saudi Arabia (المملكة العربية السعودية)</span><span class="iti__dial-code">+966</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sn" role="option" data-dial-code="221" data-country-code="sn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sn"></div>
</div><span class="iti__country-name">Senegal (Sénégal)</span><span class="iti__dial-code">+221</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-rs" role="option" data-dial-code="381" data-country-code="rs" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__rs"></div>
</div><span class="iti__country-name">Serbia (Србија)</span><span class="iti__dial-code">+381</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sc" role="option" data-dial-code="248" data-country-code="sc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sc"></div>
</div><span class="iti__country-name">Seychelles</span><span class="iti__dial-code">+248</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sl" role="option" data-dial-code="232" data-country-code="sl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sl"></div>
</div><span class="iti__country-name">Sierra Leone</span><span class="iti__dial-code">+232</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sg" role="option" data-dial-code="65" data-country-code="sg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sg"></div>
</div><span class="iti__country-name">Singapore</span><span class="iti__dial-code">+65</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sx" role="option" data-dial-code="1" data-country-code="sx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sx"></div>
</div><span class="iti__country-name">Sint Maarten</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sk" role="option" data-dial-code="421" data-country-code="sk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sk"></div>
</div><span class="iti__country-name">Slovakia (Slovensko)</span><span class="iti__dial-code">+421</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-si" role="option" data-dial-code="386" data-country-code="si" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__si"></div>
</div><span class="iti__country-name">Slovenia (Slovenija)</span><span class="iti__dial-code">+386</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sb" role="option" data-dial-code="677" data-country-code="sb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sb"></div>
</div><span class="iti__country-name">Solomon Islands</span><span class="iti__dial-code">+677</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-so" role="option" data-dial-code="252" data-country-code="so" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__so"></div>
</div><span class="iti__country-name">Somalia (Soomaaliya)</span><span class="iti__dial-code">+252</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-za" role="option" data-dial-code="27" data-country-code="za" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__za"></div>
</div><span class="iti__country-name">South Africa</span><span class="iti__dial-code">+27</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-kr" role="option" data-dial-code="82" data-country-code="kr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kr"></div>
</div><span class="iti__country-name">South Korea (대한민국)</span><span class="iti__dial-code">+82</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ss" role="option" data-dial-code="211" data-country-code="ss" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ss"></div>
</div><span class="iti__country-name">South Sudan (جنوب السودان)</span><span class="iti__dial-code">+211</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-es" role="option" data-dial-code="34" data-country-code="es" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__es"></div>
</div><span class="iti__country-name">Spain (España)</span><span class="iti__dial-code">+34</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-lk" role="option" data-dial-code="94" data-country-code="lk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lk"></div>
</div><span class="iti__country-name">Sri Lanka (ශ්රී ලංකාව)</span><span class="iti__dial-code">+94</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sd" role="option" data-dial-code="249" data-country-code="sd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sd"></div>
</div><span class="iti__country-name">Sudan (السودان)</span><span class="iti__dial-code">+249</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sr" role="option" data-dial-code="597" data-country-code="sr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sr"></div>
</div><span class="iti__country-name">Suriname</span><span class="iti__dial-code">+597</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sj" role="option" data-dial-code="47" data-country-code="sj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sj"></div>
</div><span class="iti__country-name">Svalbard and Jan Mayen</span><span class="iti__dial-code">+47</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-se" role="option" data-dial-code="46" data-country-code="se" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__se"></div>
</div><span class="iti__country-name">Sweden (Sverige)</span><span class="iti__dial-code">+46</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ch" role="option" data-dial-code="41" data-country-code="ch" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ch"></div>
</div><span class="iti__country-name">Switzerland (Schweiz)</span><span class="iti__dial-code">+41</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-sy" role="option" data-dial-code="963" data-country-code="sy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sy"></div>
</div><span class="iti__country-name">Syria (سوريا)</span><span class="iti__dial-code">+963</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tw" role="option" data-dial-code="886" data-country-code="tw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tw"></div>
</div><span class="iti__country-name">Taiwan (台灣)</span><span class="iti__dial-code">+886</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tj" role="option" data-dial-code="992" data-country-code="tj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tj"></div>
</div><span class="iti__country-name">Tajikistan</span><span class="iti__dial-code">+992</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tz" role="option" data-dial-code="255" data-country-code="tz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tz"></div>
</div><span class="iti__country-name">Tanzania</span><span class="iti__dial-code">+255</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-th" role="option" data-dial-code="66" data-country-code="th" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__th"></div>
</div><span class="iti__country-name">Thailand (ไทย)</span><span class="iti__dial-code">+66</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tl" role="option" data-dial-code="670" data-country-code="tl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tl"></div>
</div><span class="iti__country-name">Timor-Leste</span><span class="iti__dial-code">+670</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tg" role="option" data-dial-code="228" data-country-code="tg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tg"></div>
</div><span class="iti__country-name">Togo</span><span class="iti__dial-code">+228</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tk" role="option" data-dial-code="690" data-country-code="tk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tk"></div>
</div><span class="iti__country-name">Tokelau</span><span class="iti__dial-code">+690</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-to" role="option" data-dial-code="676" data-country-code="to" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__to"></div>
</div><span class="iti__country-name">Tonga</span><span class="iti__dial-code">+676</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tt" role="option" data-dial-code="1" data-country-code="tt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tt"></div>
</div><span class="iti__country-name">Trinidad and Tobago</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tn" role="option" data-dial-code="216" data-country-code="tn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tn"></div>
</div><span class="iti__country-name">Tunisia (تونس)</span><span class="iti__dial-code">+216</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tr" role="option" data-dial-code="90" data-country-code="tr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tr"></div>
</div><span class="iti__country-name">Turkey (Türkiye)</span><span class="iti__dial-code">+90</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tm" role="option" data-dial-code="993" data-country-code="tm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tm"></div>
</div><span class="iti__country-name">Turkmenistan</span><span class="iti__dial-code">+993</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tc" role="option" data-dial-code="1" data-country-code="tc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tc"></div>
</div><span class="iti__country-name">Turks and Caicos Islands</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-tv" role="option" data-dial-code="688" data-country-code="tv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tv"></div>
</div><span class="iti__country-name">Tuvalu</span><span class="iti__dial-code">+688</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-vi" role="option" data-dial-code="1" data-country-code="vi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vi"></div>
</div><span class="iti__country-name">U.S. Virgin Islands</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ug" role="option" data-dial-code="256" data-country-code="ug" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ug"></div>
</div><span class="iti__country-name">Uganda</span><span class="iti__dial-code">+256</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ua" role="option" data-dial-code="380" data-country-code="ua" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ua"></div>
</div><span class="iti__country-name">Ukraine (Україна)</span><span class="iti__dial-code">+380</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ae" role="option" data-dial-code="971" data-country-code="ae" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ae"></div>
</div><span class="iti__country-name">United Arab Emirates (الإمارات العربية المتحدة)</span><span class="iti__dial-code">+971</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-gb" role="option" data-dial-code="44" data-country-code="gb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gb"></div>
</div><span class="iti__country-name">United Kingdom</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-us" role="option" data-dial-code="1" data-country-code="us" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__us"></div>
</div><span class="iti__country-name">United States</span><span class="iti__dial-code">+1</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-uy" role="option" data-dial-code="598" data-country-code="uy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__uy"></div>
</div><span class="iti__country-name">Uruguay</span><span class="iti__dial-code">+598</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-uz" role="option" data-dial-code="998" data-country-code="uz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__uz"></div>
</div><span class="iti__country-name">Uzbekistan (Oʻzbekiston)</span><span class="iti__dial-code">+998</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-vu" role="option" data-dial-code="678" data-country-code="vu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vu"></div>
</div><span class="iti__country-name">Vanuatu</span><span class="iti__dial-code">+678</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-va" role="option" data-dial-code="39" data-country-code="va" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__va"></div>
</div><span class="iti__country-name">Vatican City (Città del Vaticano)</span><span class="iti__dial-code">+39</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ve" role="option" data-dial-code="58" data-country-code="ve" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ve"></div>
</div><span class="iti__country-name">Venezuela</span><span class="iti__dial-code">+58</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-vn" role="option" data-dial-code="84" data-country-code="vn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vn"></div>
</div><span class="iti__country-name">Vietnam (Việt Nam)</span><span class="iti__dial-code">+84</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-wf" role="option" data-dial-code="681" data-country-code="wf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__wf"></div>
</div><span class="iti__country-name">Wallis and Futuna (Wallis-et-Futuna)</span><span class="iti__dial-code">+681</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-eh" role="option" data-dial-code="212" data-country-code="eh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__eh"></div>
</div><span class="iti__country-name">Western Sahara (الصحراء الغربية)</span><span class="iti__dial-code">+212</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ye" role="option" data-dial-code="967" data-country-code="ye" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ye"></div>
</div><span class="iti__country-name">Yemen (اليمن)</span><span class="iti__dial-code">+967</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-zm" role="option" data-dial-code="260" data-country-code="zm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__zm"></div>
</div><span class="iti__country-name">Zambia</span><span class="iti__dial-code">+260</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-zw" role="option" data-dial-code="263" data-country-code="zw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__zw"></div>
</div><span class="iti__country-name">Zimbabwe</span><span class="iti__dial-code">+263</span>
</li>
<li class="iti__country iti__standard" tabindex="-1" id="iti-0__item-ax" role="option" data-dial-code="358" data-country-code="ax" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ax"></div>
</div><span class="iti__country-name">Åland Islands</span><span class="iti__dial-code">+358</span>
</li>
</ul>
</div><input type="tel" class="form-control form_elements" data-validation="required" name="mobile" id="mobile" placeholder="Mobile*" autocomplete="off" data-intl-tel-input-id="0"><input type="hidden" name="mobile">
</div>
</div>
<div class="form-group col-md-6">
<label for="company">Company </label>
<input type="text" class="form-control form_elements" name="company" id="company" placeholder="Company*">
</div>
<!-- 4 -->
<div class="form-group col-md-6">
<label for="job_title">Job Title <span class="text-danger">*</span></label>
<input type="text" class="form-control form_elements" data-validation="required" name="job_title" id="job_title" placeholder="Job Title*">
</div>
<div class="form-group col-md-6">
<label for="state">State <span class="text-danger">*</span></label>
<input type="text" class="form-control form_elements" data-validation="required" name="state" id="state" placeholder="State*">
</div>
<div class="form-group col-md-6">
<label for="country">Select Country <span class="text-danger">*</span></label>
<select id="country" class="form-control form_select text-capitalize" name="country" data-validation="required">
<option value=""> Select Country</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="Antigua & Barbuda">Antigua & 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="Bonaire">Bonaire</option>
<option value="Bosnia & Herzegovina">Bosnia & Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Ter">British Indian Ocean Ter</option>
<option value="Brunei">Brunei</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="Canary Islands">Canary Islands</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="Channel Islands">Channel Islands</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Island">Cocos Island</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">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</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">Falkland Islands</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="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Ter">French Southern Ter</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="Great Britain">Great Britain</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="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Hawaii">Hawaii</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="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="Midway Islands">Midway Islands</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="Nambia">Nambia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherland Antilles">Netherland Antilles</option>
<option value="Netherlands (Holland, Europe)">Netherlands (Holland, Europe)</option>
<option value="Nevis">Nevis</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="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau Island">Palau Island</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 Island">Pitcairn Island</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 Montenegro">Republic of Montenegro</option>
<option value="Republic of Serbia">Republic of Serbia</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="Saipan">Saipan</option>
<option value="Samoa">Samoa</option>
<option value="Samoa American">Samoa American</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & 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="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="St Barthelemy">St Barthelemy</option>
<option value="St Eustatius">St Eustatius</option>
<option value="St Helena">St Helena</option>
<option value="St Kitts-Nevis">St Kitts-Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="St Maarten">St Maarten</option>
<option value="St Pierre & Miquelon">St Pierre & Miquelon</option>
<option value="St Vincent & Grenadines">St Vincent & Grenadines</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Tahiti">Tahiti</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 & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks & Caicos Is">Turks & Caicos Is</option>
<option value="Tuvalu">Tuvalu</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 of America">United States of America</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City State">Vatican City State</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands (Brit)">Virgin Islands (Brit)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wake Island">Wake Island</option>
<option value="Wallis & Futana IS">Wallis & Futana IS</option>
<option value="Yemen">Yemen</option>
<option value="Zaire">Zaire</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
<div class="form-group col-md-6">
<label for="budget">Budget <span class="text-danger">*</span></label>
<select id="budget" class="form-control form_select" name="budget" data-validation="required">
<option value=""> Budget Responsibility</option>
<option value="USD 100,000 – USD 1,000,000">USD 100,000 – USD 1,000,000</option>
<option value="USD 1,000,000 – USD 10,000,000">USD 1,000,000 – USD 10,000,000</option>
<option value="USD 10,000,000 – USD 50,000,000">USD 10,000,000 – USD 50,000,000</option>
<option value="USD 50,000,000 +">USD 50,000,000 +</option>
</select>
</div>
<div class="form-group col-md-6">
<label for="pointOfContact">Point Of Contact (If Any)</label>
<input type="text" class="form-control form_elements" id="pointOfContact" name="point_of_contact" placeholder="Point Of Contact (If Any)">
</div>
<div class="col-md-6 mt-4"></div>
<div class="col-md-6 mt-4">
<div class="form-group">
<div class="form-check p-0">
<input type="checkbox" class="form-radio" name="is_speaker" id="isspeaker">
<label for="isspeaker">I am interested in speaking at the Summit</label>
</div>
</div>
</div>
<div class="col-md-6 mt-4">
<div class="form-group">
<div class="form-check p-0">
<input type="checkbox" class="form-radio" name="joining__panel_discussion" id="joining__panel_discussion">
<label for="joining__panel_discussion">I am interested in becoming a Panelist.</label>
</div>
</div>
</div>
</div>
<!-- 2 -->
<div class="row">
<div class="col-12">
<h2>What are your key priorities for the next 6 to 18 months?</h2>
</div>
<div class="form-group col-md-4">
<label for="keyPriority1">Key Priorty</label>
<input type="text" class="form-control form_elements" id="keyPriority1" name="key_priority1" placeholder="Key Priorty">
</div>
<div class="form-group col-md-4">
<label for="keyPriority2">Key Priorty</label>
<input type="text" class="form-control form_elements" id="keyPriority2" name="key_priority2" placeholder="Key Priorty">
</div>
<div class="form-group col-md-4">
<label for="keyPriority3">Key Priorty</label>
<input type="text" class="form-control form_elements" id="keyPriority3" name="key_priority3" placeholder="Key Priorty">
</div>
</div>
<!-- 3 -->
<div class="row">
<div class="col-12">
<h2>Which other colleagues and decision makers should also be invited from any Medical Devices, Pharma or Biotech Companies?</h2>
</div>
<div class="form-group col-md-4">
<label for="oc_name1">Name</label>
<input type="text" class="form-control form_elements" name="oc_name1" id="oc_name1" placeholder="Name">
</div>
<div class="form-group col-md-4">
<label for="oc_email1">Email</label>
<input type="text" class="form-control form_elements" name="oc_email1" id="oc_email1" placeholder="Email">
</div>
<div class="form-group col-md-4">
<label for="oc_jobtitle1">Job Title</label>
<input type="text" class="form-control form_elements" name="oc_jobtitle1" id="oc_jobtitle1" placeholder="Job Title">
</div>
<div class="form-group col-md-4">
<label for="oc_name2">Name</label>
<input type="text" class="form-control form_elements" name="oc_name2" id="oc_name2" placeholder="Name">
</div>
<div class="form-group col-md-4">
<label for="oc_email2">Email</label>
<input type="text" class="form-control form_elements" name="oc_email2" id="oc_email2" placeholder="Email">
</div>
<div class="form-group col-md-4">
<label for="oc_jobtitle2">Job Title</label>
<input type="text" class="form-control form_elements" name="oc_jobtitle2" id="oc_jobtitle2" placeholder="Job Title">
</div>
<div class="form-group col-md-4">
<label for="oc_name3">Name</label>
<input type="text" class="form-control form_elements" name="oc_name3" id="oc_name3" placeholder="Name">
</div>
<div class="form-group col-md-4">
<label for="oc_email3">Email</label>
<input type="text" class="form-control form_elements" name="oc_email3" id="oc_email3" placeholder="Email">
</div>
<div class="form-group col-md-4">
<label for="oc_jobtitle3">Job Title</label>
<input type="text" class="form-control form_elements" name="oc_jobtitle3" id="oc_jobtitle3" placeholder="Job Title">
</div>
</div>
<!-- 4 -->
<div class="row">
<div class="col-12">
<h2>What are your industry sectors?*</h2>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="Hospital and Healthcare" id="industry0" class="form-radio">
<label for="industry0" class="text-capitalize">Hospital and Healthcare</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="Pharmaceutical" id="industry1" class="form-radio">
<label for="industry1" class="text-capitalize">Pharmaceutical</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="Biotechnology" id="industry2" class="form-radio">
<label for="industry2" class="text-capitalize">Biotechnology</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="Medical Devices" id="industry3" class="form-radio">
<label for="industry3" class="text-capitalize">Medical Devices</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="IVD" id="industry4" class="form-radio">
<label for="industry4" class="text-capitalize">IVD</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="industry_sector[]" value="Other" id="industryother" class="form-radio industry-group">
<label for="industryother">Other? Please Specify</label>
</div>
<div class="form-group col-md-6">
<!-- For Radio -->
<!-- <input type="text" class="form-control form_elements" style="display: none" name="industry_sector_input" id="industryOthers"> -->
<input type="text" class="form-control form_elements" style="display: none" id="industryOthers">
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<h2> When is your next Medical Device Project due to start?</h2>
</div>
<div class="col-md-12">
<select id="next_due_to_start" class="form-control form_select" name="next_due_to_start" data-validation="required">
<option value=""> Please Select</option>
<option value="In less than 6 months">In less than 6 months</option>
<option value="6-12 months">6-12 months</option>
<option value="12+ Months">12+ Months</option>
</select>
</div>
</div>
<!-- 5 -->
<div class="row">
<div class="col-12">
<h2>What is your role in purchasing decision for your company?</h2>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="purchasing_role[]" value="Decision Maker" id="radiorole1" class="form-radio role-group">
<label for="radiorole1">Decision Maker</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="purchasing_role[]" value="Recommended" id="radiorole2" class="form-radio role-group">
<label for="radiorole2">Recommended</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="purchasing_role[]" value="Influence" id="radiorole3" class="form-radio role-group">
<label for="radiorole3">Influence</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="purchasing_role[]" value="Other" id="roleother" class="form-radio role-group">
<label for="roleother">Other</label>
</div>
<div class="form-group col-md-6">
<!-- For Radio -->
<!-- <input type="text" class="form-control form_elements" style="display: none" name="purchasing_role_input" id="roleothers"> -->
<input type="text" class="form-control form_elements" name="purchasing_role_input" style="display: none" id="roleothers">
</div>
</div>
</div>
<!-- 6 -->
<div class="row">
<div class="col-12">
<h2>Scope of responsibility?</h2>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="Departmental" id="scoperes1" class="form-radio scope-group">
<label for="scoperes1">Departmental</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="Regional" id="scoperes2" class="form-radio scope-group">
<label for="scoperes2">Regional</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="European" id="scoperes3" class="form-radio scope-group">
<label for="scoperes3">European</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="International" id="scoperes4" class="form-radio scope-group">
<label for="scoperes4">International</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="National" id="scoperes5" class="form-radio scope-group">
<label for="scoperes5">National</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="responsibility_scope[]" value="Other" id="scoperes_other" class="form-radio scope-group">
<label for="scoperes_other">Other? Please Specify</label>
</div>
<div class="form-group col-md-6">
<!-- <input type="text" class="form-control form_elements" style="display: none" name="responsibility_scope_input" id="scoperes_others"> -->
<input type="text" class="form-control form_elements" style="display: none" id="scoperes_others">
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<div class="form-group">
<h2>What is your company’s therapeutic focus?</h2>
<input type="text" class="form-control form_elements" name="therapeutic_focus" placeholder="What is your company’s therapeutic focus?">
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<div class="form-group">
<h2>How many devices does your company R&D portfolio have? <span class="text-danger">*</span></h2>
<input type="number" data-validation="required" class="form-control form_elements" name="medical_devices" placeholder="How many devices does your company R&D portfolio have?">
</div>
</div>
</div>
<!-- 7 -->
<div class="row">
<div class="col-12">
<h2>What products and services are you planning to purchase in the next 6-18 months?*</h2>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Clinical Trial Design" id="product0" class="form-radio">
<label for="product0" class="text-capitalize">Clinical Trial Design</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Biocompatibility Tests" id="product1" class="form-radio">
<label for="product1" class="text-capitalize">Biocompatibility Tests</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Project Management" id="product2" class="form-radio">
<label for="product2" class="text-capitalize">Project Management</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Prototype Development" id="product3" class="form-radio">
<label for="product3" class="text-capitalize">Prototype Development</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Licensing And Registration" id="product4" class="form-radio">
<label for="product4" class="text-capitalize">Licensing And Registration</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Sterilize & Packaging" id="product5" class="form-radio">
<label for="product5" class="text-capitalize">Sterilize & Packaging</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Performance Evaluations" id="product6" class="form-radio">
<label for="product6" class="text-capitalize">Performance Evaluations</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Chemical Characterization" id="product7" class="form-radio">
<label for="product7" class="text-capitalize">Chemical Characterization</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Medical Device Testing" id="product8" class="form-radio">
<label for="product8" class="text-capitalize">Medical Device Testing</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Pre-Clinical Testing" id="product9" class="form-radio">
<label for="product9" class="text-capitalize">Pre-Clinical Testing</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Sterility Assurance and Microbiology Tests" id="product10" class="form-radio">
<label for="product10" class="text-capitalize">Sterility Assurance and Microbiology Tests</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Toxicological Risk Assessment (TRA)" id="product11" class="form-radio">
<label for="product11" class="text-capitalize">Toxicological Risk Assessment (TRA)</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Analytical Chemistry" id="product12" class="form-radio">
<label for="product12" class="text-capitalize">Analytical Chemistry</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Accelerated Aging Testing" id="product13" class="form-radio">
<label for="product13" class="text-capitalize">Accelerated Aging Testing</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Medical Imaging Software" id="product14" class="form-radio">
<label for="product14" class="text-capitalize">Medical Imaging Software</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Safety Reporting" id="product15" class="form-radio">
<label for="product15" class="text-capitalize">Safety Reporting</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Regulatory Requirements" id="product16" class="form-radio">
<label for="product16" class="text-capitalize">Regulatory Requirements</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Clinical Testing" id="product17" class="form-radio">
<label for="product17" class="text-capitalize">Clinical Testing</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Clinical Monitoring" id="product18" class="form-radio">
<label for="product18" class="text-capitalize">Clinical Monitoring</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Feasibility Assessment" id="product19" class="form-radio">
<label for="product19" class="text-capitalize">Feasibility Assessment</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Global Medical Safety" id="product20" class="form-radio">
<label for="product20" class="text-capitalize">Global Medical Safety</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Clinical Development" id="product21" class="form-radio">
<label for="product21" class="text-capitalize">Clinical Development</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Design & Development" id="product22" class="form-radio">
<label for="product22" class="text-capitalize">Design & Development</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Medical Translation & Localization" id="product23" class="form-radio">
<label for="product23" class="text-capitalize">Medical Translation & Localization</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Medical Device Engineering" id="product24" class="form-radio">
<label for="product24" class="text-capitalize">Medical Device Engineering</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Post-Market Surveillance" id="product25" class="form-radio">
<label for="product25" class="text-capitalize">Post-Market Surveillance</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Regulatory Affairs" id="product26" class="form-radio">
<label for="product26" class="text-capitalize">Regulatory Affairs</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Device Design" id="product27" class="form-radio">
<label for="product27" class="text-capitalize">Device Design</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Quality Assurance" id="product28" class="form-radio">
<label for="product28" class="text-capitalize">Quality Assurance</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Medical Writing & Reporting" id="product29" class="form-radio">
<label for="product29" class="text-capitalize">Medical Writing & Reporting</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="CE-Marking" id="product30" class="form-radio">
<label for="product30" class="text-capitalize">CE-Marking</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Research and Development" id="product31" class="form-radio">
<label for="product31" class="text-capitalize">Research and Development</label>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<input type="checkbox" name="products_services[]" value="Other" id="prod_serv_other" class="form-radio prod-serv-group">
<label for="prod_serv_other">Other? Please Specify</label>
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<input type="text" class="form-control form_elements" style="display: none" id="prod_serv_others">
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</div>
</div>
<div class="row">
<div class="col-12">
<h2>What are the top three solution providers you would like to see at this event?</h2>
</div>
<div class="col-md-12">
<textarea class="form-control" id="three_solution_providers" name="three_solution_providers" rows="3" placeholder="What are the top three solution providers you would like to see at this event?"></textarea>
</div>
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<div class="col-12">
<h2>How Did you Hear about us?</h2>
</div>
<div class="col-md-12">
<select id="how_hear_about_us" class="form-control form_select" name="how_hear_about_us">
<option value=""> How Did you Hear about us?</option>
<option value="Social Media">Social Media</option>
<option value="Google">Google</option>
<option value="From a Colleague">From a Colleague</option>
<option value="From a Precision Global Member">From a Precision Global Member</option>
<option value="Other">Other Please let us know</option>
</select>
</div>
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<input type="text" class="form-control form_elements" style="display: none" id="hear_about_us_other" name="how_hear_about_us_other">
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<div class="col-12">
<h2>What is your company size?</h2>
</div>
<div class="col-md-12">
<select id="company_size" class="form-control form_select" name="company_size">
<option value=""> Please Select</option>
<option value="1-50 Employees">1-50 Employees</option>
<option value="51 - 200 Employees">51 - 200 Employees</option>
<option value="201 - 1000 Employees">201 - 1000 Employees</option>
<option value="1001+ Employees">1001+ Employees</option>
</select>
</div>
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<div class="col-md-12">
<div class="form-group">
<label for="comments">Feel free to share your personal bio</label>
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<div class="form-group">
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<p class="dropify-error">Ooops, something wrong appended.</p>
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<span class="help-block">600x450 recommended</span>
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<div class="col-12">
<h2><!--Participation Fee:--></h2>
</div>
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<div class="form-group">
<input type="radio" name="participation_fee" value="VIP Complementary Pass" id="p_fee2" class="form-radio">
<label for="p_fee2">VIP Complementary Pass</label>
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<div class="col-md-6">
<div class="form-group">
<label for="signature">Your Electronic Signature</label>
<input type="text" class="form-control form_elements" id="signature" name="signature" placeholder="Your Electronic Signature">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="signature">Date</label>
<input type="text" disabled="" class="form-control form_elements" id="date" name="date" value="2023-08-22" placeholder="Your Signature">
</div>
</div>
<div class="col-md-12">
<div class="form-group">
<label for="comments">Any Comments?</label>
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<p class="text-capitalize" style="font-size: 11px"> Please read these instructions first The following questionnaire is needed to register your position at the event. Kindly provide as much information as possible as this will help in shaping
the agenda and matching your needs with supplier's services. You can also pre-select the sessions and decision makers you want to meet through the details we will share prior the event. Your Complimentary Delegate Package includes:
Selection of keynote presentations, conference sessions and group discussions Copy of the conference brochure, including member details and speaker documents 1-to-1 networking meetings with peers and solution providers (Optional) Forum
Operations Manager dedicated to pre-event, on-site and post-event support Profiling and invitation of solution providers which best fit your requirements </p>
<p class="text-capitalize" style="font-size: 11px"> GDPR: By Using this website, you agree to the Precision Evolution Global <a href="https://precision-globe.com/privacy-policy/" target="_blank">Privacy Policy</a> and Statement. </p>
<h5 style="font-size: 11px"> Scope of Agreement</h5>
<!-- <ul>
<li>We will provide you with a planned schedule prior to the Event. Please note that this schedule may be altered where necessary by us.</li>
<li>We reserve the right to determine the theme, scope and content of seminars and presentations to be held during the Event and to vary the programme and/
<br> Or its contents as deemed necessary.
</li>
<li>Should the event be cancelled or the location be changed for reasons or circumstances beyond our control we reserve the right to reschedule the Event,
<br> Including changing the location, and/ or withdrawing delegate’s attendance upon written notice to you. Your Attendance is withdrawn by us you will receive a full refund of your registration fee.
</li>
</ul> -->
<p class="text-capitalize" style="font-size: 11px"> These are the conditions of the contract between you, the Client ("You'' and "your") and Precision Evolution Global Inc. (" Precision Globe.", "PEG",” we” "us" and "our") Governing your use
of our services, including event attendance as set out in your Booking form. This agreement constitutes the entire agreement between Precision Evolution Global and you. All prior agreements understandings and negotiations and
representations (save for fraudulent misrepresentation) whether oral or in writing are cancelled in their entirety. The terms of any other electronic communications will not form part of this agreement. </p>
<h5 style="font-size: 11px"> Your Complimentary Delegate Package includes:</h5>
<!-- <ul>
<li>Only named or pre-agreed delegates may attend the Event. Non-appearance of any of the Delegates will not affect your obligation to pay in accordance
<br>
With the terms set out below (5). No persons other than those officially registered or agreed with us may attend any part of the Event.
</li>
<li>
Delegates must adhere to the deadlines set out by the Operations Manager. Deadlines will be communicated once we have received your delegate
<br>
Contract confirmation. This includes returning your catalogue entry form, delegate photograph and you’re prioritized Meeting request choices.
</li>
<li>
Delegates must attend all prescheduled Event meetings and the seminar programme.
<br>
-Delegates are responsible for their own insurance (including, but not limited to, travel insurance, personal effects and personal insurance), vaccinations
<br>
And visas (where applicable).
</li>
</ul> -->
<p>
<!-- <i class="fas fa-check icon"></i> -->
</p>
<ul>
<li>We will provide you with a planned schedule prior to the Event. Please note that this schedule may be altered where necessary by us.</li>
<li>We reserve the right to determine the theme, scope and content of seminars and presentations to be held during the Event and to vary the programme and/Or its contents as deemed necessary.</li>
<li>Should the event be cancelled or the location be changed for reasons or circumstances beyond our control we reserve the right to reschedule the Event,ncluding changing the location, and/ or withdrawing the delegate's attendance upon
written notice to you.</li>
</ul>
<p></p>
<h5 style="font-size: 11px">Dalegates</h5>
<!-- <ul>
<li>
-Delegates are responsible for their own flight, transfer arrangements and accommodation and the costs associated with them. </li>
</ul> -->
<p>
<!-- <i class="fas fa-check icon"></i> -->
</p>
<ul>
<li>Only named or pre-agreed delegates may attend the Event. Non-appearance of any of the Delegates will not affect your obligation to pay in accordance.<br>With the terms set out below (5). No persons other than those officially registered
or agreed with us may attend any part of the Event.</li>
<li>Delegates must adhere to the deadlines set out by the Operations Manager. Deadlines will be communicated once we have received your delegate.<br>Contract confirmation. This includes returning your catalogue entry form, delegate
photograph and you’re prioritized Meeting request choices.</li>
<li>Delegates must attend all prescheduled Event meetings and the seminar programme.</li>
</ul>
<p></p>
<h5 style="font-size: 11px">Cancellation</h5>
<!-- <ul>
<li>
The total fees specified on the Agreement are subject to an additional service charge of 3.0% ("Service Charge") applied to cover administration costs,
<br>
And are exclusive of YAT and any other applicable sales tax which shall be payable in addition.
<br>
-Payment must be received in full within 5 days from the date of this agreement.
<br>
-The applicable VAT rate will be charged in addition to the Total Cost.
</li>
<li>
Contracts received within 28 days of the start of the event must be paid by return.
</li>
</ul> -->
<p>
<!-- <i class="fas fa-check icon"></i> -->
</p>
<ul>
<li>All cancellations must be received in writing and agreed by us</li>
</ul>
<p></p>
<!-- <h5 style="font-size: 11px">Cancellation</h5> -->
<!-- <ul>
<li>
-Cancellations received more than twelve weeks prior to the Event commencement date will be entitled to a full refund of the registration fee paid.
</li>
<li>
lf you cancel your registration less than twelve weeks before the Event commencement date you will incur a charge of £450 (less any registration fee, as
<br>
Specified on this registration form, that you may have already paid which will not be refunded).
</li>
<li>
Cancellation fees can be avoided by providing replacement delegates from your organisation. You will be liable for any additional cost incurred as a
<br>
Result of supplying replacement delegates. We reserve the right to refuse replacement delegates.
<br>
-All cancellations must be received in writing and agreed by us, and full cancellation fees must be paid within 14 days.
</li>
</ul> -->
<h5 style="font-size: 11px">General</h5>
<!-- <ul>
<li>
You the delegate, your executive/s or your agents may not transferor assign any of the rights or obligations of this Agreement (in whole or part) without
<br>
Our prior consent. Any attempt to resell, assign or transfer rights without our consent will entitle us to cancel the
<br>
Contract without liability to you.
</li>
<li>
Grant of Licence: 1 f your booking includes the Knowledge Pack, you warrant that you will only use the CD-ROM included in the Knowledge Pack for
<br>
Your business purposes and shall not, without our prior written consent, make available, copy, reproduce, transmit,
<br>
Disseminate, sell, licence, distribute, publish, broadcast or otherwise circulate the Knowledge Pack (or any part of it) to any other person other than in
<br>
Accordance with these terms and conditions.
</li>
<li>
Precision Evolution Global is subject to the Data Protection, Our primary goal in collecting personal information from you is to give you an enjoyable
<br>
Customized experience whilst allowing us to provide services and features that most likely meet
<br>
Your needs. We collect certain personal information from you, which you give to us when using our Sites and/or registering or subscribing for our products
<br>
And services. We also collect certain personal data from other group companies to whom you have given
<br>
Information through their website. If you do not want us to continue using this information please notify us at <b>info@precision-globe.com</b>
<br>
Please email <b>info@precision-globe.com</b> for a copy of the Precision Globe Privacy Policy.
</li>
<li>
This agreement is governed by and will be construed in accordance with Canadian law and each party irrevocably agrees that the courts of US & Canada will have the non-exclusive jurisdiction to deal with any disputes arising out of or in connection with this agreement.
</li>
<li>
The working language of the Event is English. Delegates requiring an interpretation service must make their own arrangements.
</li>
</ul> -->
<ul>
<li>You the delegate, your executive/s or your agents may not transferor assign any of the rights or obligations of this Agreement (in whole or part) without Our prior consent. Any attempt to resell, assign or transfer rights without our
consent will entitle us to cancel the Contract without liability to you<br> Your business purposes and shall not, without our prior written consent, make available, copy, reproduce, transmit,Disseminate, sell, licence, distribute,
publish, broadcast or otherwise circulate the Knowledge Pack (or any part of it) to any other person other than in Information through their website. If you do not want us to continue using this information please notify us at
info@precision-globe.com<br> Please email info@precision-globe.com for a copy of the Precision Evolution Global Inc’s. Privacy Policy.</li>
<li>This agreement is governed by and will be construed in accordance with Canadian law and each party irrevocably agrees that the courts of US & Canada will have the non-exclusive jurisdiction to deal with any disputes arising out of
or in connection with this agreement</li>
<li>The working language of the Event is English. Delegates requiring an interpretation service must make their own arrangements</li>
</ul>
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* Home * Browse Events * View All Categories * View All Events * About * Testimonials * Solutions * Venture Capital Connections * Lead generation * Business Development Consulting * Contact Us Book a Demo Registration Form Precision in Medical Devices Summit (San Diego) FIELDS MARKED * ARE MANDATORY. PLEASE COMPLETE EACH FIELD TO ENSURE YOUR QUALIFIED PARTICIPATION AT THE SUMMIT. × Note: This pass is NOT applicable for suppliers, vendors, CROs, solution provider companies, and consultants. Passes will be reviewed and accepted based on eligibility. Title * Title Mrs. Mr. Ms. Miss. Dr. First Name * Last Name * Corporate Email* Please use your corporate/business email address. 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Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana IS Yemen Zaire Zambia Zimbabwe Budget * Budget Responsibility USD 100,000 – USD 1,000,000 USD 1,000,000 – USD 10,000,000 USD 10,000,000 – USD 50,000,000 USD 50,000,000 + Point Of Contact (If Any) I am interested in speaking at the Summit I am interested in becoming a Panelist. WHAT ARE YOUR KEY PRIORITIES FOR THE NEXT 6 TO 18 MONTHS? Key Priorty Key Priorty Key Priorty WHICH OTHER COLLEAGUES AND DECISION MAKERS SHOULD ALSO BE INVITED FROM ANY MEDICAL DEVICES, PHARMA OR BIOTECH COMPANIES? Name Email Job Title Name Email Job Title Name Email Job Title WHAT ARE YOUR INDUSTRY SECTORS?* Hospital and Healthcare Pharmaceutical Biotechnology Medical Devices IVD Other? Please Specify WHEN IS YOUR NEXT MEDICAL DEVICE PROJECT DUE TO START? Please Select In less than 6 months 6-12 months 12+ Months WHAT IS YOUR ROLE IN PURCHASING DECISION FOR YOUR COMPANY? Decision Maker Recommended Influence Other SCOPE OF RESPONSIBILITY? Departmental Regional European International National Other? Please Specify WHAT IS YOUR COMPANY’S THERAPEUTIC FOCUS? HOW MANY DEVICES DOES YOUR COMPANY R&D PORTFOLIO HAVE? * WHAT PRODUCTS AND SERVICES ARE YOU PLANNING TO PURCHASE IN THE NEXT 6-18 MONTHS?* Clinical Trial Design Biocompatibility Tests Project Management Prototype Development Licensing And Registration Sterilize & Packaging Performance Evaluations Chemical Characterization Medical Device Testing Pre-Clinical Testing Sterility Assurance and Microbiology Tests Toxicological Risk Assessment (TRA) Analytical Chemistry Accelerated Aging Testing Medical Imaging Software Safety Reporting Regulatory Requirements Clinical Testing Clinical Monitoring Feasibility Assessment Global Medical Safety Clinical Development Design & Development Medical Translation & Localization Medical Device Engineering Post-Market Surveillance Regulatory Affairs Device Design Quality Assurance Medical Writing & Reporting CE-Marking Research and Development Other? Please Specify WHAT ARE THE TOP THREE SOLUTION PROVIDERS YOU WOULD LIKE TO SEE AT THIS EVENT? HOW DID YOU HEAR ABOUT US? How Did you Hear about us? Social Media Google From a Colleague From a Precision Global Member Other Please let us know WHAT IS YOUR COMPANY SIZE? Please Select 1-50 Employees 51 - 200 Employees 201 - 1000 Employees 1001+ Employees Feel free to share your personal bio Image Drag and drop a file here or click Ooops, something wrong appended. placeholder.jpg Drag and drop or click to replace 600x450 recommended VIP Complementary Pass Your Electronic Signature Date Any Comments? Terms & Conditions Please read these instructions first The following questionnaire is needed to register your position at the event. Kindly provide as much information as possible as this will help in shaping the agenda and matching your needs with supplier's services. You can also pre-select the sessions and decision makers you want to meet through the details we will share prior the event. Your Complimentary Delegate Package includes: Selection of keynote presentations, conference sessions and group discussions Copy of the conference brochure, including member details and speaker documents 1-to-1 networking meetings with peers and solution providers (Optional) Forum Operations Manager dedicated to pre-event, on-site and post-event support Profiling and invitation of solution providers which best fit your requirements GDPR: By Using this website, you agree to the Precision Evolution Global Privacy Policy and Statement. SCOPE OF AGREEMENT These are the conditions of the contract between you, the Client ("You'' and "your") and Precision Evolution Global Inc. (" Precision Globe.", "PEG",” we” "us" and "our") Governing your use of our services, including event attendance as set out in your Booking form. This agreement constitutes the entire agreement between Precision Evolution Global and you. 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Delegates requiring an interpretation service must make their own arrangements Register Now PLEASE READ THESE INSTRUCTIONS FIRST The following questionnaire is needed to register your position at the event. Kindly provide as much information as possible as this will help in shaping the agenda and matching your needs with supplier's services. You can also pre-select the sessions and decision makers you want to meet through the details we will share prior the event. YOUR COMPLIMENTARY DELEGATE PACKAGE INCLUDES: * Selection of keynote presentations, conference sessions and group discussions * Copy of the conference brochure, including member details and speaker documents * 1-to-1 networking meetings with peers and solution providers (Optional) * Forum Operations Manager dedicated to pre-event, on-site and post-event support * Profiling and invitation of solution providers which best fit your requirements I agree, Continue Join our newsletter to stay up to date on features and releases. 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