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Submitted URL: https://u16170196.ct.sendgrid.net/ls/click?upn=6Vw1rby0FlLDxnWUuqC72GG7byjW0D-2FxuRCGPhAqged0udHeM95Mx4vsbXaHWB05FaLzYaZiXVCjROdzS...
Effective URL: https://betobet.com/cl/online-casino?register=true&btag=cx_35288_452669
Submission Tags: falconsandbox
Submission: On September 29 via api from US — Scanned from DE
Effective URL: https://betobet.com/cl/online-casino?register=true&btag=cx_35288_452669
Submission Tags: falconsandbox
Submission: On September 29 via api from US — Scanned from DE
Form analysis 3 forms found in the DOM
POST /cl/auth/login
<form autofill="off" ismxfilled="0" autocomplete="off" method="post" class="needs-validation" id="login-modal-form" action="/cl/auth/login" novalidate="" siq_id="autopick_2707">
<div class="form-group row">
<div class="col">
<label for="login_form[username]" class="form-label form-label-sm align-top form-label-gray">Nombre de usuario</label>
<input id="login_form[username]" type="text" required="" name="login_form[username]" value="" minlength="2" maxlength="50" placeholder="Introduce tu nombre de usuario" autocomplete="off" aria-autocomplete="off"
required-message="Introduce tu nombre de usuario" class="form-control form-control-md data-hj-whitelist">
<div class="invalid-feedback">Introduce tu nombre de usuario</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="login-modal-password-input" class="form-label form-label-sm align-top form-label-gray">Contraseña</label>
<input id="login-modal-password-input" type="text" required="" value="" minlength="2" maxlength="50" placeholder="Introduce tu contraseña" autocomplete="off" aria-autocomplete="off" required-message="Introduce tu contraseña"
class="form-control form-control-md disable-autocomplete">
<div class="invalid-feedback">Introduce tu contraseña</div>
</div>
<input type="hidden" class="hidden-password-field" name="login_form[password]">
</div>
<div class="modal-action-bar">
<button type="submit" class="btn btn-primary btn-block modal-submit-button">Iniciar sesión</button>
</div>
<div class="row">
<div class="col">
<div class="d-flex justify-content-center">
<a href="/cl/recovery/forgotten-password" data-dismiss="modal" data-toggle="modal" data-target="#forgot-password-modal" class="forgotten-psw-link">Contraseña olvidada</a>
</div>
</div>
</div>
</form><form method="" class="validate-form" id="register-user-form" novalidate="" clear-fields="false" data-step="1" siq_id="autopick_9881">
<div class="steps-section row justify-content-center">
<div class="error-container col-lg-10"></div>
<!-- begin step 1 -->
<div class="step-section step-section-1 col-lg-10">
<div class="form-group row">
<div class="col">
<label for="reg_form_email" class="form-label form-label-sm align-top form-label-gray">Correo electrónico</label>
<input id="reg_form_email" type="email" required="" name="reg_form[email]" value="" minlength="2" maxlength="50" placeholder="Correo electrónico" autocomplete="off" aria-autocomplete="off"
required-message="Introduce una dirección de correo válida" class="form-control form-control-md data-hj-whitelist">
<div class="invalid-feedback">Introduce una dirección de correo válida</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="reg_form_username" class="form-label form-label-sm align-top form-label-gray">Nombre de usuario</label>
<input id="reg_form_username" type="text" required="" name="reg_form[username]" value="" minlength="2" maxlength="50" placeholder="Nombre de usuario" autocomplete="off" aria-autocomplete="off"
required-message="Introduce el nombre de usuario" class="form-control form-control-md data-hj-whitelist">
<div class="invalid-feedback">Introduce el nombre de usuario</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="reg_form_password" class="form-label form-label-sm align-top form-label-gray form-label-input-text">Contraseña </label>
<div class="form-relative-group-holder">
<input id="reg_form_password" type="password" name="reg_form[password]" required="" minlength="2" maxlength="50" placeholder="Contraseña" autocomplete="off" aria-autocomplete="off"
required-message="Tu contraseña debe contener al menos tres símbolos." class="form-control form-control-md" aria-describedby="passwordHelpBlock">
<div class="invalid-feedback">Tu contraseña debe contener al menos tres símbolos.</div>
<span class="icon-toggle ds-icon-material">remove_red_eye</span>
</div>
<span id="passwordHelpBlock" class="form-help form-text" style="display: none">
<span class="icon ds-icon-material help-el">info_outline</span> <span class="help-el">Tu contraseña debe contener al menos tres símbolos.</span>
</span>
</div>
</div>
<input type="hidden" id="register-form-confirm-password" class="hidden-password-field" name="reg_form[confirm_password]">
<input type="hidden" id="register-form-coupon-code" class="hidden-password-field" name="reg_form[coupon_code]">
<button id="next-registration-step" type="button" class="btn btn-primary btn-block modal-submit-button">Siguiente</button>
</div>
<!-- end of step 1 -->
<!-- begin step 2 -->
<div class="step-section step-section-2 col-lg-10 d-none">
<div class="form-group row">
<div class="col">
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="reg_form_gender_male" name="reg_form[gender]" value="male" class="custom-control-input grouped-input" checked="checked" required="">
<label class="custom-control-label form-label-sm align-self-center form-label form-label-gray" for="reg_form_gender_male">Hombre</label>
</div>
<div class="custom-control custom-radio custom-control-inline">
<input type="radio" id="reg_form_gender_female" name="reg_form[gender]" value="female" class="custom-control-input grouped-input" required="">
<label class="custom-control-label form-label-sm align-self-center form-label form-label-gray" for="reg_form_gender_female">Mujer</label>
</div>
</div>
<div class="invalid-feedback col-12">Selecciona tu sexo</div>
</div>
<div class="form-group row">
<div class="col">
<label for="reg_form_fname" class="form-label form-label-sm align-top form-label-gray">Nombre</label>
<input id="reg_form_fname" type="text" required="" name="reg_form[fname]" value="" minlength="2" maxlength="50" placeholder="Nombre" autocomplete="off" aria-autocomplete="off" required-message="Introduce el nombre"
class="form-control form-control-md data-hj-whitelist">
<div class="invalid-feedback">Introduce el nombre</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="reg_form_lname" class="form-label form-label-sm align-top form-label-gray">Apellidos</label>
<input id="reg_form_lname" type="text" required="" name="reg_form[lname]" value="" minlength="2" maxlength="50" placeholder="Apellidos" autocomplete="off" aria-autocomplete="off" required-message="Introduce los apellidos"
class="form-control form-control-md data-hj-whitelist">
<div class="invalid-feedback">Introduce los apellidos</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="reg_form_country_id" class="form-label form-label-sm align-top form-label-gray">País</label>
<select id="reg_form_country_id" name="reg_form[country_id]" class="custom-select custom-select-md reg-form-country-id" required="">
<option value="" disabled="" selected="">País</option>
<option data-iso="AL" value="4">Albania</option>
<option data-iso="DZ" value="5">Argelia</option>
<option data-iso="AD" value="7">Andorra</option>
<option data-iso="AO" value="8">Angola</option>
<option data-iso="AI" value="9">Anguila</option>
<option data-iso="AR" value="12">Argentina</option>
<option data-iso="AM" value="13">Armenia</option>
<option data-iso="AT" value="16">Austria</option>
<option data-iso="AZ" value="17">Azerbaiyán</option>
<option data-iso="BS" value="18">Bahamas</option>
<option data-iso="BH" value="19">Baréin</option>
<option data-iso="BD" value="20">Bangladés</option>
<option data-iso="BB" value="21">Barbados</option>
<option data-iso="BY" value="22">Bielorrusia</option>
<option data-iso="BE" value="23">Bélgica</option>
<option data-iso="BZ" value="24">Belize</option>
<option data-iso="BJ" value="25">Benín</option>
<option data-iso="BM" value="26">islas Bermudas</option>
<option data-iso="BT" value="27">Bután</option>
<option data-iso="BO" value="28">Bolivia</option>
<option data-iso="BA" value="29">Bosnia-Herzegovina</option>
<option data-iso="BW" value="30">Botsuana</option>
<option data-iso="BV" value="31">Isla Bouvet</option>
<option data-iso="BR" value="32">Brasil</option>
<option data-iso="BN" value="34">Brunei Darussalam</option>
<option data-iso="BF" value="36">Burkina Faso</option>
<option data-iso="MM" value="37">Birmania (Myanmar)</option>
<option data-iso="BI" value="38">Burundi</option>
<option data-iso="KH" value="39">Camboya</option>
<option data-iso="CM" value="40">Camerún</option>
<option data-iso="CA" value="41">Canadá</option>
<option data-iso="CV" value="42">Cabo Verde</option>
<option data-iso="KY" value="43">Islas Caimán</option>
<option data-iso="CF" value="44">República Centroafricana</option>
<option data-iso="TD" value="45">Chad</option>
<option data-iso="CL" value="46">Chile</option>
<option data-iso="CN" value="47">China</option>
<option data-iso="CX" value="48">Isola di Natale</option>
<option data-iso="CC" value="49">Islas Cocos (Keeling)</option>
<option data-iso="CO" value="50">Colombia</option>
<option data-iso="KM" value="51">Comoras</option>
<option data-iso="CG" value="52">Congo</option>
<option data-iso="CK" value="53">Islas Cook</option>
<option data-iso="CR" value="54">Costa Rica</option>
<option data-iso="HR" value="55">Croacia</option>
<option data-iso="CU" value="56">Cuba</option>
<option data-iso="CZ" value="58">República Checa </option>
<option data-iso="CD" value="59">República Democrática del Congo</option>
<option data-iso="DK" value="60">Dinamarca</option>
<option data-iso="DJ" value="61">Yibuti</option>
<option data-iso="DM" value="62">Dominica</option>
<option data-iso="DO" value="63">República Dominicana</option>
<option data-iso="TL" value="64">Timor Oriental</option>
<option data-iso="EC" value="65">Ecuador</option>
<option data-iso="EG" value="66">Egipto</option>
<option data-iso="SV" value="67">El Salvador</option>
<option data-iso="GQ" value="68">Guinea Ecuatorial</option>
<option data-iso="ER" value="69">Eritrea</option>
<option data-iso="EE" value="70">Estonia</option>
<option data-iso="ET" value="71">Etiopía </option>
<option data-iso="FK" value="72">Islas Malvinas (Islas Malvinas)</option>
<option data-iso="FO" value="73">Islas Faroe</option>
<option data-iso="FJ" value="74">Fiyi</option>
<option data-iso="FI" value="75">Finlandia</option>
<option data-iso="GA" value="80">Gabón</option>
<option data-iso="GM" value="81">Gambia</option>
<option data-iso="GE" value="82">Georgia</option>
<option data-iso="DE" value="83" selected="">Alemania</option>
<option data-iso="GH" value="84">Ghana</option>
<option data-iso="GI" value="85">Gibraltar</option>
<option data-iso="GR" value="86">Grecia</option>
<option data-iso="GL" value="87">Tierra Verde</option>
<option data-iso="GD" value="88">Granada</option>
<option data-iso="GP" value="89">Guadalupe</option>
<option data-iso="GU" value="90">Guam</option>
<option data-iso="GT" value="91">Guatemala</option>
<option data-iso="GN" value="92">Guinea</option>
<option data-iso="GW" value="93">Guinea-Bisáu</option>
<option data-iso="GY" value="94">Guyana</option>
<option data-iso="HT" value="95">Haití</option>
<option data-iso="HM" value="96">Islas Heard y McDonald</option>
<option data-iso="HN" value="97">Honduras</option>
<option data-iso="HK" value="98">Hong Kong</option>
<option data-iso="IS" value="100">Islandia</option>
<option data-iso="IN" value="101">India</option>
<option data-iso="ID" value="102">Indonesia</option>
<option data-iso="IQ" value="104">Irak</option>
<option data-iso="IE" value="105">Irlanda </option>
<option data-iso="IT" value="107">Italia</option>
<option data-iso="CI" value="108">Costa de Marfil</option>
<option data-iso="JM" value="109">Jamaica</option>
<option data-iso="JP" value="110">Japón</option>
<option data-iso="JO" value="111">Jordania</option>
<option data-iso="KZ" value="112">Kazajistán</option>
<option data-iso="KE" value="113">Kenia</option>
<option data-iso="KI" value="114">Kiribati </option>
<option data-iso="KR" value="116">Corea del Sur</option>
<option data-iso="KW" value="117">Kuwait</option>
<option data-iso="KG" value="118">Kirguistán</option>
<option data-iso="LA" value="119">Laos</option>
<option data-iso="LV" value="120">Letonia</option>
<option data-iso="LB" value="121">Líbano</option>
<option data-iso="LS" value="122">Lesoto</option>
<option data-iso="LR" value="123">Liberia</option>
<option data-iso="LY" value="124">Libia</option>
<option data-iso="LI" value="125">Liechtenstein</option>
<option data-iso="LU" value="127">Luxemburgo</option>
<option data-iso="MK" value="129">Macedonia</option>
<option data-iso="MG" value="130">Madagascar</option>
<option data-iso="MW" value="131">Malaui</option>
<option data-iso="MY" value="132">Malasia</option>
<option data-iso="MV" value="133">Maldivas</option>
<option data-iso="ML" value="134">Malí</option>
<option data-iso="MT" value="135">Malta</option>
<option data-iso="MH" value="136">Islas Marshall</option>
<option data-iso="MQ" value="137">Martinica</option>
<option data-iso="MR" value="138">Mauritania</option>
<option data-iso="MU" value="139">Mauricio</option>
<option data-iso="YT" value="140">Mayotte</option>
<option data-iso="MX" value="141">México</option>
<option data-iso="FM" value="142">Micronesia</option>
<option data-iso="MD" value="143">Moldavia </option>
<option data-iso="MC" value="144">Mónaco</option>
<option data-iso="MN" value="145">Mongolia</option>
<option data-iso="ME" value="146">Montenegro</option>
<option data-iso="MS" value="147">Montserrat</option>
<option data-iso="MA" value="148">Marruecos</option>
<option data-iso="MZ" value="149">Mozambique</option>
<option data-iso="NA" value="150">Namibia</option>
<option data-iso="NR" value="151">Nauru</option>
<option data-iso="NP" value="152">Nepal</option>
<option data-iso="NZ" value="157">Nueva Zelanda (Aotearoa)</option>
<option data-iso="NE" value="159">Niger</option>
<option data-iso="NG" value="160">Nigeria</option>
<option data-iso="NU" value="161">Niue</option>
<option data-iso="NF" value="162">Isla Norfolk</option>
<option data-iso="MP" value="163">Islas Marianas del Norte</option>
<option data-iso="NO" value="164">Noruega</option>
<option data-iso="OM" value="165">Omán</option>
<option data-iso="PK" value="166">Pakistán</option>
<option data-iso="PW" value="167">Palaos</option>
<option data-iso="PA" value="169">Panamá</option>
<option data-iso="PG" value="170">Papúa Nueva Guinea </option>
<option data-iso="PY" value="171">Paraguay</option>
<option data-iso="PE" value="172">Perú</option>
<option data-iso="PH" value="173">Filipinas</option>
<option data-iso="PN" value="174">Pitcairn</option>
<option data-iso="PL" value="175">Polonia</option>
<option data-iso="PR" value="177">Puerto Rico</option>
<option data-iso="QA" value="178">Catar</option>
<option data-iso="RS" value="179">Serbia</option>
<option data-iso="RE" value="180">Reunión</option>
<option data-iso="RU" value="182">Rusia</option>
<option data-iso="RW" value="183">Ruanda</option>
<option data-iso="GS" value="184">S. Georgia y S. Sandwich Isls.</option>
<option data-iso="KN" value="185">San Cristóbal y Nieves</option>
<option data-iso="LC" value="186">Santa Lucía</option>
<option data-iso="VC" value="187">San Vicente y las Granadinas</option>
<option data-iso="SM" value="189">San Marino</option>
<option data-iso="ST" value="190">Sao Tomé y Príncipe</option>
<option data-iso="SA" value="191">Arabia Saudita</option>
<option data-iso="SN" value="192">Senegal</option>
<option data-iso="SC" value="194">Seychelles</option>
<option data-iso="SL" value="195">Sierra Leona</option>
<option data-iso="SG" value="196">Singapur</option>
<option data-iso="SI" value="198">Eslovenia</option>
<option data-iso="SB" value="199">Islas Salomón</option>
<option data-iso="SO" value="200">Somalia</option>
<option data-iso="ZA" value="201">Sudáfrica</option>
<option data-iso="ES" value="202">España</option>
<option data-iso="LK" value="203">Sri Lanka</option>
<option data-iso="SH" value="204">Santa helena</option>
<option data-iso="PM" value="205">San Pedro y Miquelón</option>
<option data-iso="SD" value="206">Sudán</option>
<option data-iso="SR" value="207">Surinam</option>
<option data-iso="SJ" value="208">Islas Svalbard y Jan Mayen</option>
<option data-iso="SZ" value="209">Suazilandia</option>
<option data-iso="SE" value="210">Suecia</option>
<option data-iso="CH" value="211">Suiza</option>
<option data-iso="SY" value="212">Siria</option>
<option data-iso="TW" value="213">Taiwán</option>
<option data-iso="TJ" value="214">Tayikistán</option>
<option data-iso="TZ" value="215">Tanzania</option>
<option data-iso="TH" value="216">Tailandia</option>
<option data-iso="TG" value="217">Togo</option>
<option data-iso="TK" value="218">Tokelau</option>
<option data-iso="TO" value="219">Tonga</option>
<option data-iso="TT" value="220">Trinidad y Tobago</option>
<option data-iso="TN" value="221">Túnez</option>
<option data-iso="TR" value="222">Turquía </option>
<option data-iso="TM" value="223">Turkmenistán</option>
<option data-iso="TC" value="224">Islas Turcas y Caicos</option>
<option data-iso="TV" value="225">Tuvalu</option>
<option data-iso="UG" value="226">Uganda</option>
<option data-iso="UA" value="227">Ucrania</option>
<option data-iso="AE" value="228">Emiratos Árabes Unidos</option>
<option data-iso="UY" value="231">Uruguay</option>
<option data-iso="UZ" value="232">Uzbekistán</option>
<option data-iso="VU" value="233">Vanuatu</option>
<option data-iso="VA" value="234">Estado de la Ciudad del Vaticano (Santa Sede)</option>
<option data-iso="VE" value="235">Venezuela</option>
<option data-iso="VN" value="236">Vietnam</option>
<option data-iso="WF" value="239">Islas Wallis y Futuna</option>
<option data-iso="ZM" value="243">Zambia</option>
<option data-iso="ZW" value="244">Zimbabue</option>
<option data-iso="SC" value="249">Escocia</option>
</select>
<div class="invalid-feedback">Selecciona el país</div>
</div>
<div class="col">
<label for="reg_form_currency_id" class="form-label form-label-sm align-top form-label-gray">Divisa</label>
<select id="reg_form_currency_id" name="reg_form[currency_id]" class="custom-select custom-select-md reg-form-currency-id" required="">
<option value="" disabled="" selected="">Divisa</option>
<option value="32">Argentine peso</option>
<option value="14">Baht tailandés</option>
<option value="28">Brazil Real</option>
<option value="27">Canadian dollar</option>
<option value="55">Central African CFA Franc</option>
<option value="31">Chilean Pesos</option>
<option value="34">Colombian Peso</option>
<option value="19">Corea del Sur ganó</option>
<option value="12">Corona checa</option>
<option value="6">Corona danesa</option>
<option value="8">Corona noruega</option>
<option value="2">Dolar americano</option>
<option value="15">Dólar australiano</option>
<option value="20">Dólar de Brunei</option>
<option value="4">Dolar de Hong Kong</option>
<option value="5">dolar de Singapur</option>
<option value="23">Dong de Vietnam</option>
<option value="1" selected="">Euro</option>
<option value="25">Florín húngaro</option>
<option value="9">Franco suizo</option>
<option value="29">Indian Rupees</option>
<option value="53">Kuwaiti Dinar</option>
<option value="21">Leu rumano</option>
<option value="3">Libra británica</option>
<option value="44">Morrocan Dirham</option>
<option value="42">New Zealand Dollar </option>
<option value="46">Nigerian Naira</option>
<option value="47">Pakistani Rupee</option>
<option value="33">Paraguayan peso</option>
<option value="35">Peruvian Sol</option>
<option value="22">Peso mexicano</option>
<option value="41">Philippine Peso</option>
<option value="13">Ringgit malayo</option>
<option value="10">rublo ruso</option>
<option value="17">rupia indonesia</option>
<option value="54">Saudi Riyal</option>
<option value="43">South Africa Rand</option>
<option value="45">Swazi Lilangeni</option>
<option value="30">Taiwan New Dollars</option>
<option value="48">Trinidadian Dollar</option>
<option value="40">Tunisian Dinar</option>
<option value="26">Turkish Lira</option>
<option value="39">Turkmenistani Manats</option>
<option value="38">Ukrainian Grivna</option>
<option value="52">United Arab Emirates Dirham</option>
<option value="36">Uruguayan Peso</option>
<option value="49">West African CFA Franc</option>
<option value="18">yen japonés</option>
<option value="16">Yuan chino</option>
<option value="11">Zloty polaco</option>
</select>
<div class="invalid-feedback">Selecciona la divisa</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="register-user-modal" class="form-label form-label-sm align-top form-label-gray">Número de móvil</label>
<div class="phone-prefix-container d-flex align-items-center">
<input type="hidden" class="phone-prefix-hidden-input" name="reg_form[phone_prefix]" value="49">
<input type="hidden" class="phone-number-hidden-input" name="reg_form[cell_phone]" value="">
<div class="phone-prefix-label d-none">Prefijo</div>
<div class="phone-prefix-country-container align-items-center justify-content-between d-flex">
<i class="flag-icon flag-icon-sm de"></i>
<div class="phone-prefix-value-container d-flex align-items-center">
<span class="phone-prefix-sign">+</span>
<span class="phone-prefix-value">49</span>
</div>
</div>
<select class="custom-select custom-select-md phone-prefix-select phone-validation-group" required="" required-message="Selecciona el prefijo telefónico">
<option value="" disabled="" selected="">País</option>
<option data-phone-prefix="355" data-iso="AL" value="355">Albania</option>
<option data-phone-prefix="213" data-iso="DZ" value="213">Argelia</option>
<option data-phone-prefix="376" data-iso="AD" value="376">Andorra</option>
<option data-phone-prefix="244" data-iso="AO" value="244">Angola</option>
<option data-phone-prefix="1-264" data-iso="AI" value="1-264">Anguila</option>
<option data-phone-prefix="54" data-iso="AR" value="54">Argentina</option>
<option data-phone-prefix="374" data-iso="AM" value="374">Armenia</option>
<option data-phone-prefix="43" data-iso="AT" value="43">Austria</option>
<option data-phone-prefix="994" data-iso="AZ" value="994">Azerbaiyán</option>
<option data-phone-prefix="1-242" data-iso="BS" value="1-242">Bahamas</option>
<option data-phone-prefix="973" data-iso="BH" value="973">Baréin</option>
<option data-phone-prefix="880" data-iso="BD" value="880">Bangladés</option>
<option data-phone-prefix="1-246" data-iso="BB" value="1-246">Barbados</option>
<option data-phone-prefix="375" data-iso="BY" value="375">Bielorrusia</option>
<option data-phone-prefix="32" data-iso="BE" value="32">Bélgica</option>
<option data-phone-prefix="501" data-iso="BZ" value="501">Belize</option>
<option data-phone-prefix="229" data-iso="BJ" value="229">Benín</option>
<option data-phone-prefix="1-441" data-iso="BM" value="1-441">islas Bermudas</option>
<option data-phone-prefix="975" data-iso="BT" value="975">Bután</option>
<option data-phone-prefix="591" data-iso="BO" value="591">Bolivia</option>
<option data-phone-prefix="387" data-iso="BA" value="387">Bosnia-Herzegovina</option>
<option data-phone-prefix="267" data-iso="BW" value="267">Botsuana</option>
<option data-phone-prefix="55" data-iso="BR" value="55">Brasil</option>
<option data-phone-prefix="673" data-iso="BN" value="673">Brunei Darussalam</option>
<option data-phone-prefix="226" data-iso="BF" value="226">Burkina Faso</option>
<option data-phone-prefix="95" data-iso="MM" value="95">Birmania (Myanmar)</option>
<option data-phone-prefix="257" data-iso="BI" value="257">Burundi</option>
<option data-phone-prefix="855" data-iso="KH" value="855">Camboya</option>
<option data-phone-prefix="237" data-iso="CM" value="237">Camerún</option>
<option data-phone-prefix="1" data-iso="CA" value="1">Canadá</option>
<option data-phone-prefix="238" data-iso="CV" value="238">Cabo Verde</option>
<option data-phone-prefix="1-345" data-iso="KY" value="1-345">Islas Caimán</option>
<option data-phone-prefix="236" data-iso="CF" value="236">República Centroafricana</option>
<option data-phone-prefix="235" data-iso="TD" value="235">Chad</option>
<option data-phone-prefix="56" data-iso="CL" value="56">Chile</option>
<option data-phone-prefix="86" data-iso="CN" value="86">China</option>
<option data-phone-prefix="61" data-iso="CX" value="61">Isola di Natale</option>
<option data-phone-prefix="61" data-iso="CC" value="61">Islas Cocos (Keeling)</option>
<option data-phone-prefix="57" data-iso="CO" value="57">Colombia</option>
<option data-phone-prefix="269" data-iso="KM" value="269">Comoras</option>
<option data-phone-prefix="242" data-iso="CG" value="242">Congo</option>
<option data-phone-prefix="682" data-iso="CK" value="682">Islas Cook</option>
<option data-phone-prefix="506" data-iso="CR" value="506">Costa Rica</option>
<option data-phone-prefix="385" data-iso="HR" value="385">Croacia</option>
<option data-phone-prefix="53" data-iso="CU" value="53">Cuba</option>
<option data-phone-prefix="420" data-iso="CZ" value="420">República Checa </option>
<option data-phone-prefix="243" data-iso="CD" value="243">República Democrática del Congo</option>
<option data-phone-prefix="45" data-iso="DK" value="45">Dinamarca</option>
<option data-phone-prefix="253" data-iso="DJ" value="253">Yibuti</option>
<option data-phone-prefix="1-767" data-iso="DM" value="1-767">Dominica</option>
<option data-phone-prefix="1-809 " data-iso="DO" value="1-809 ">República Dominicana</option>
<option data-phone-prefix="670" data-iso="TL" value="670">Timor Oriental</option>
<option data-phone-prefix="593" data-iso="EC" value="593">Ecuador</option>
<option data-phone-prefix="20" data-iso="EG" value="20">Egipto</option>
<option data-phone-prefix="503" data-iso="SV" value="503">El Salvador</option>
<option data-phone-prefix="240" data-iso="GQ" value="240">Guinea Ecuatorial</option>
<option data-phone-prefix="291" data-iso="ER" value="291">Eritrea</option>
<option data-phone-prefix="372" data-iso="EE" value="372">Estonia</option>
<option data-phone-prefix="251" data-iso="ET" value="251">Etiopía </option>
<option data-phone-prefix="500" data-iso="FK" value="500">Islas Malvinas (Islas Malvinas)</option>
<option data-phone-prefix="298" data-iso="FO" value="298">Islas Faroe</option>
<option data-phone-prefix="679" data-iso="FJ" value="679">Fiyi</option>
<option data-phone-prefix="358" data-iso="FI" value="358">Finlandia</option>
<option data-phone-prefix="241" data-iso="GA" value="241">Gabón</option>
<option data-phone-prefix="220" data-iso="GM" value="220">Gambia</option>
<option data-phone-prefix="995" data-iso="GE" value="995">Georgia</option>
<option data-phone-prefix="49" data-iso="DE" value="49" selected="">Alemania</option>
<option data-phone-prefix="233" data-iso="GH" value="233">Ghana</option>
<option data-phone-prefix="350" data-iso="GI" value="350">Gibraltar</option>
<option data-phone-prefix="30" data-iso="GR" value="30">Grecia</option>
<option data-phone-prefix="299" data-iso="GL" value="299">Tierra Verde</option>
<option data-phone-prefix="1-473" data-iso="GD" value="1-473">Granada</option>
<option data-phone-prefix="590" data-iso="GP" value="590">Guadalupe</option>
<option data-phone-prefix="1-671" data-iso="GU" value="1-671">Guam</option>
<option data-phone-prefix="502" data-iso="GT" value="502">Guatemala</option>
<option data-phone-prefix="224" data-iso="GN" value="224">Guinea</option>
<option data-phone-prefix="245" data-iso="GW" value="245">Guinea-Bisáu</option>
<option data-phone-prefix="592" data-iso="GY" value="592">Guyana</option>
<option data-phone-prefix="509" data-iso="HT" value="509">Haití</option>
<option data-phone-prefix=" " data-iso="HM" value=" ">Islas Heard y McDonald</option>
<option data-phone-prefix="504" data-iso="HN" value="504">Honduras</option>
<option data-phone-prefix="852" data-iso="HK" value="852">Hong Kong</option>
<option data-phone-prefix="354" data-iso="IS" value="354">Islandia</option>
<option data-phone-prefix="91" data-iso="IN" value="91">India</option>
<option data-phone-prefix="62" data-iso="ID" value="62">Indonesia</option>
<option data-phone-prefix="964" data-iso="IQ" value="964">Irak</option>
<option data-phone-prefix="353" data-iso="IE" value="353">Irlanda </option>
<option data-phone-prefix="39" data-iso="IT" value="39">Italia</option>
<option data-phone-prefix="225" data-iso="CI" value="225">Costa de Marfil</option>
<option data-phone-prefix="1-876" data-iso="JM" value="1-876">Jamaica</option>
<option data-phone-prefix="81" data-iso="JP" value="81">Japón</option>
<option data-phone-prefix="962" data-iso="JO" value="962">Jordania</option>
<option data-phone-prefix="7" data-iso="KZ" value="7">Kazajistán</option>
<option data-phone-prefix="254" data-iso="KE" value="254">Kenia</option>
<option data-phone-prefix="686" data-iso="KI" value="686">Kiribati </option>
<option data-phone-prefix="82" data-iso="KR" value="82">Corea del Sur</option>
<option data-phone-prefix="965" data-iso="KW" value="965">Kuwait</option>
<option data-phone-prefix="996" data-iso="KG" value="996">Kirguistán</option>
<option data-phone-prefix="856" data-iso="LA" value="856">Laos</option>
<option data-phone-prefix="371" data-iso="LV" value="371">Letonia</option>
<option data-phone-prefix="961" data-iso="LB" value="961">Líbano</option>
<option data-phone-prefix="266" data-iso="LS" value="266">Lesoto</option>
<option data-phone-prefix="231" data-iso="LR" value="231">Liberia</option>
<option data-phone-prefix="218" data-iso="LY" value="218">Libia</option>
<option data-phone-prefix="423" data-iso="LI" value="423">Liechtenstein</option>
<option data-phone-prefix="352" data-iso="LU" value="352">Luxemburgo</option>
<option data-phone-prefix="389" data-iso="MK" value="389">Macedonia</option>
<option data-phone-prefix="261" data-iso="MG" value="261">Madagascar</option>
<option data-phone-prefix="265" data-iso="MW" value="265">Malaui</option>
<option data-phone-prefix="60" data-iso="MY" value="60">Malasia</option>
<option data-phone-prefix="960" data-iso="MV" value="960">Maldivas</option>
<option data-phone-prefix="223" data-iso="ML" value="223">Malí</option>
<option data-phone-prefix="356" data-iso="MT" value="356">Malta</option>
<option data-phone-prefix="692" data-iso="MH" value="692">Islas Marshall</option>
<option data-phone-prefix="596" data-iso="MQ" value="596">Martinica</option>
<option data-phone-prefix="222" data-iso="MR" value="222">Mauritania</option>
<option data-phone-prefix="230" data-iso="MU" value="230">Mauricio</option>
<option data-phone-prefix="262" data-iso="YT" value="262">Mayotte</option>
<option data-phone-prefix="52" data-iso="MX" value="52">México</option>
<option data-phone-prefix="691" data-iso="FM" value="691">Micronesia</option>
<option data-phone-prefix="373" data-iso="MD" value="373">Moldavia </option>
<option data-phone-prefix="377" data-iso="MC" value="377">Mónaco</option>
<option data-phone-prefix="976" data-iso="MN" value="976">Mongolia</option>
<option data-phone-prefix="382" data-iso="ME" value="382">Montenegro</option>
<option data-phone-prefix="1-664" data-iso="MS" value="1-664">Montserrat</option>
<option data-phone-prefix="212" data-iso="MA" value="212">Marruecos</option>
<option data-phone-prefix="258" data-iso="MZ" value="258">Mozambique</option>
<option data-phone-prefix="264" data-iso="NA" value="264">Namibia</option>
<option data-phone-prefix="674" data-iso="NR" value="674">Nauru</option>
<option data-phone-prefix="977" data-iso="NP" value="977">Nepal</option>
<option data-phone-prefix="64" data-iso="NZ" value="64">Nueva Zelanda (Aotearoa)</option>
<option data-phone-prefix="227" data-iso="NE" value="227">Niger</option>
<option data-phone-prefix="234" data-iso="NG" value="234">Nigeria</option>
<option data-phone-prefix="683" data-iso="NU" value="683">Niue</option>
<option data-phone-prefix="672" data-iso="NF" value="672">Isla Norfolk</option>
<option data-phone-prefix="1-670" data-iso="MP" value="1-670">Islas Marianas del Norte</option>
<option data-phone-prefix="47" data-iso="NO" value="47">Noruega</option>
<option data-phone-prefix="968" data-iso="OM" value="968">Omán</option>
<option data-phone-prefix="92" data-iso="PK" value="92">Pakistán</option>
<option data-phone-prefix="680" data-iso="PW" value="680">Palaos</option>
<option data-phone-prefix="507" data-iso="PA" value="507">Panamá</option>
<option data-phone-prefix="675" data-iso="PG" value="675">Papúa Nueva Guinea </option>
<option data-phone-prefix="595" data-iso="PY" value="595">Paraguay</option>
<option data-phone-prefix="51" data-iso="PE" value="51">Perú</option>
<option data-phone-prefix="63" data-iso="PH" value="63">Filipinas</option>
<option data-phone-prefix="870" data-iso="PN" value="870">Pitcairn</option>
<option data-phone-prefix="48" data-iso="PL" value="48">Polonia</option>
<option data-phone-prefix="1-787 " data-iso="PR" value="1-787 ">Puerto Rico</option>
<option data-phone-prefix="974" data-iso="QA" value="974">Catar</option>
<option data-phone-prefix="381" data-iso="RS" value="381">Serbia</option>
<option data-phone-prefix="262" data-iso="RE" value="262">Reunión</option>
<option data-phone-prefix="7" data-iso="RU" value="7">Rusia</option>
<option data-phone-prefix="250" data-iso="RW" value="250">Ruanda</option>
<option data-phone-prefix="1-869" data-iso="KN" value="1-869">San Cristóbal y Nieves</option>
<option data-phone-prefix="1-758" data-iso="LC" value="1-758">Santa Lucía</option>
<option data-phone-prefix="1-784" data-iso="VC" value="1-784">San Vicente y las Granadinas</option>
<option data-phone-prefix="378" data-iso="SM" value="378">San Marino</option>
<option data-phone-prefix="239" data-iso="ST" value="239">Sao Tomé y Príncipe</option>
<option data-phone-prefix="966" data-iso="SA" value="966">Arabia Saudita</option>
<option data-phone-prefix="221" data-iso="SN" value="221">Senegal</option>
<option data-phone-prefix="44" data-iso="SC" value="44">Seychelles</option>
<option data-phone-prefix="232" data-iso="SL" value="232">Sierra Leona</option>
<option data-phone-prefix="65" data-iso="SG" value="65">Singapur</option>
<option data-phone-prefix="386" data-iso="SI" value="386">Eslovenia</option>
<option data-phone-prefix="677" data-iso="SB" value="677">Islas Salomón</option>
<option data-phone-prefix="252" data-iso="SO" value="252">Somalia</option>
<option data-phone-prefix="27" data-iso="ZA" value="27">Sudáfrica</option>
<option data-phone-prefix="34" data-iso="ES" value="34">España</option>
<option data-phone-prefix="94" data-iso="LK" value="94">Sri Lanka</option>
<option data-phone-prefix="290" data-iso="SH" value="290">Santa helena</option>
<option data-phone-prefix="508" data-iso="PM" value="508">San Pedro y Miquelón</option>
<option data-phone-prefix="249" data-iso="SD" value="249">Sudán</option>
<option data-phone-prefix="597" data-iso="SR" value="597">Surinam</option>
<option data-phone-prefix="47" data-iso="SJ" value="47">Islas Svalbard y Jan Mayen</option>
<option data-phone-prefix="268" data-iso="SZ" value="268">Suazilandia</option>
<option data-phone-prefix="46" data-iso="SE" value="46">Suecia</option>
<option data-phone-prefix="41" data-iso="CH" value="41">Suiza</option>
<option data-phone-prefix="963" data-iso="SY" value="963">Siria</option>
<option data-phone-prefix="886" data-iso="TW" value="886">Taiwán</option>
<option data-phone-prefix="992" data-iso="TJ" value="992">Tayikistán</option>
<option data-phone-prefix="255" data-iso="TZ" value="255">Tanzania</option>
<option data-phone-prefix="66" data-iso="TH" value="66">Tailandia</option>
<option data-phone-prefix="228" data-iso="TG" value="228">Togo</option>
<option data-phone-prefix="690" data-iso="TK" value="690">Tokelau</option>
<option data-phone-prefix="676" data-iso="TO" value="676">Tonga</option>
<option data-phone-prefix="1-868" data-iso="TT" value="1-868">Trinidad y Tobago</option>
<option data-phone-prefix="216" data-iso="TN" value="216">Túnez</option>
<option data-phone-prefix="90" data-iso="TR" value="90">Turquía </option>
<option data-phone-prefix="993" data-iso="TM" value="993">Turkmenistán</option>
<option data-phone-prefix="1-649" data-iso="TC" value="1-649">Islas Turcas y Caicos</option>
<option data-phone-prefix="688" data-iso="TV" value="688">Tuvalu</option>
<option data-phone-prefix="256" data-iso="UG" value="256">Uganda</option>
<option data-phone-prefix="380" data-iso="UA" value="380">Ucrania</option>
<option data-phone-prefix="971" data-iso="AE" value="971">Emiratos Árabes Unidos</option>
<option data-phone-prefix="598" data-iso="UY" value="598">Uruguay</option>
<option data-phone-prefix="998" data-iso="UZ" value="998">Uzbekistán</option>
<option data-phone-prefix="678" data-iso="VU" value="678">Vanuatu</option>
<option data-phone-prefix="379" data-iso="VA" value="379">Estado de la Ciudad del Vaticano (Santa Sede)</option>
<option data-phone-prefix="58" data-iso="VE" value="58">Venezuela</option>
<option data-phone-prefix="84" data-iso="VN" value="84">Vietnam</option>
<option data-phone-prefix="681" data-iso="WF" value="681">Islas Wallis y Futuna</option>
<option data-phone-prefix="260" data-iso="ZM" value="260">Zambia</option>
<option data-phone-prefix="263" data-iso="ZW" value="263">Zimbabue</option>
</select>
</div>
<input id="register-user-modal" type="text" required="" value="" minlength="5" maxlength="50" placeholder="Número de móvil" autocomplete="off" aria-autocomplete="off" required-message="Introduce el número de teléfono móvil"
class="form-control form-control-md data-hj-whitelist reg-form-cell-phone phone-validation-group">
<div class="invalid-feedback">Introduce el número de teléfono móvil</div>
<div class="help-message phone-help-message form-label-gray form-label-sm">Ejemplo de número de teléfono: +49 XXXX XXXXXXX</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label class="form-label form-label-sm form-label-gray align-top input-group-label">Fecha de nacimiento</label>
<div class="row">
<div class="col">
<select id="reg_form_birthday_day" name="reg_form[birthday][day]" class="custom-select custom-select-md grouped-input date-select" required="">
<option value="" disabled="" selected="">Día</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<div class="col">
<select id="reg_form_birthday_month" name="reg_form[birthday][month]" class="custom-select custom-select-md grouped-input date-select" required="">
<option value="" disabled="" selected="">Mes</option>
<option value="1">Enero</option>
<option value="2">Febrero</option>
<option value="3">Marzo</option>
<option value="4">Abril</option>
<option value="5">Mayo</option>
<option value="6">Junio</option>
<option value="7">Julio</option>
<option value="8">Agosto</option>
<option value="9">Septiembre</option>
<option value="10">Octubre</option>
<option value="11">Noviembre</option>
<option value="12">Diciembre</option>
</select>
</div>
<div class="col">
<select id="reg_form_birthday_year" name="reg_form[birthday][year]" class="custom-select custom-select-md grouped-input date-select" required="">
<option value="" disabled="" selected="">Año</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select>
</div>
<div class="invalid-feedback col-12">Selecciona la fecha de nacimiento</div>
</div>
</div>
</div>
<div class="form-group row mb-0">
<div class="col">
<div class="custom-control custom-checkbox">
<input type="checkbox" class="custom-control-input" id="reg_form_terms_accepted" required="" name="reg_form[terms_accepted]">
<label class="custom-control-label form-label form-label-sm " for="reg_form_terms_accepted"> Acepto los <a href="/terms-and-conditions" class="info-link help-popup">Términos y condiciones</a> y
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<input type="checkbox" class="custom-control-input" id="reg_form_newsletter" name="reg_form[is_in_mail_list]" checked="checked" value="1">
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</form><form method="" id="forgot-password-form" class="validate-form " novalidate="" siq_id="autopick_6326">
<div class="row">
<div class="col-lg-10 offset-lg-1">
<div class="row">
<div class="col">
</div>
</div>
</div>
<div class="col-lg-10 offset-lg-1">
<div class="row">
<div class="col error-container"></div>
</div>
</div>
<div class="col-lg-10 offset-lg-1">
<div class="form-group row">
<div class="col">
<label for="forgot-password-form_username" class="form-label form-label-sm align-top form-label-gray">Nombre de usuario</label>
<input id="forgot-password-form_username" type="text" required="" name="username" value="" minlength="2" maxlength="50" placeholder="Nombre de usuario" autocomplete="off" aria-autocomplete="off"
required-message="Introduce el nombre de usuario" class="form-control form-control-md ">
<div class="invalid-feedback">Introduce el nombre de usuario</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label for="forgot-password-form_email" class="form-label form-label-sm align-top form-label-gray">Correo electrónico</label>
<input id="forgot-password-form_email" type="email" required="" name="email" value="" minlength="2" maxlength="50" placeholder="Correo electrónico" autocomplete="off" aria-autocomplete="off"
required-message="Introduce una dirección de correo válida" class="form-control form-control-md ">
<div class="invalid-feedback">Introduce una dirección de correo válida</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<label class="form-label form-label-sm form-label-gray input-group-label align-top">Fecha de nacimiento</label>
<div class="row">
<div class="col">
<select id="forgot-password-form_birthday_day" name="birthday[day]" class="custom-select custom-select-md grouped-input birthday-date" required="">
<option value="" disabled="" selected="">Día</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
</div>
<div class="col">
<select id="forgot-password-form_birthday_month" name="birthday[month]" class="custom-select custom-select-md grouped-input birthday-date" required="">
<option value="" disabled="" selected="">Mes</option>
<option value="01">Enero</option>
<option value="02">Febrero</option>
<option value="03">Marzo</option>
<option value="04">Abril</option>
<option value="05">Mayo</option>
<option value="06">Junio</option>
<option value="07">Julio</option>
<option value="08">Agosto</option>
<option value="09">Septiembre</option>
<option value="10">Octubre</option>
<option value="11">Noviembre</option>
<option value="12">Diciembre</option>
</select>
</div>
<div class="col">
<select id="forgot-password-form_birthday_year" name="birthday[year]" class="custom-select custom-select-md grouped-input birthday-date" required="">
<option value="" disabled="" selected="">Año</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select>
</div>
<div class="invalid-feedback col-12">Selecciona la fecha de nacimiento</div>
</div>
</div>
</div>
<div class="form-group row">
<div class="col">
<button type="submit" id="submit-forgot-password-form" class="btn btn-primary btn-block modal-submit-button">Recuperar</button>
</div>
</div>
</div>
</div>
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