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URL:
https://www.risehealth.org/event-center/rise-events/msp-conditional-payment-forum/brochure
Submission: On June 30 via api (June 30th 2022, 3:12:31 pm UTC) from US — Scanned from GB

Form analysis
4 forms found in the DOM

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          <div style="text-align: center;"><strong><span style="font-size: 28px;">One More Step!</span></strong></div>
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          <div style="text-align: center;"><span style="font-size: 14px;">Fill out this form to&nbsp;view the brochure.</span><br><br><br></div>
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          <option value="California">California</option>
          <option value="Colorado">Colorado</option>
          <option value="Connecticut">Connecticut</option>
          <option value="Delaware">Delaware</option>
          <option value="District of Columbia">District of Columbia</option>
          <option value="Florida">Florida</option>
          <option value="Georgia">Georgia</option>
          <option value="Hawaii">Hawaii</option>
          <option value="Idaho">Idaho</option>
          <option value="Illinois">Illinois</option>
          <option value="Indiana">Indiana</option>
          <option value="Iowa">Iowa</option>
          <option value="Kansas">Kansas</option>
          <option value="Kentucky">Kentucky</option>
          <option value="Louisiana">Louisiana</option>
          <option value="Maine">Maine</option>
          <option value="Maryland">Maryland</option>
          <option value="Massachusetts">Massachusetts</option>
          <option value="Michigan">Michigan</option>
          <option value="Minnesota">Minnesota</option>
          <option value="Mississippi">Mississippi</option>
          <option value="Missouri">Missouri</option>
          <option value="Montana">Montana</option>
          <option value="Nebraska">Nebraska</option>
          <option value="Nevada">Nevada</option>
          <option value="New Hampshire">New Hampshire</option>
          <option value="New Jersey">New Jersey</option>
          <option value="New Mexico">New Mexico</option>
          <option value="New York">New York</option>
          <option value="North Carolina">North Carolina</option>
          <option value="North Dakota">North Dakota</option>
          <option value="Ohio">Ohio</option>
          <option value="Oklahoma">Oklahoma</option>
          <option value="Oregon">Oregon</option>
          <option value="Pennsylvania">Pennsylvania</option>
          <option value="Rhode Island">Rhode Island</option>
          <option value="South Carolina">South Carolina</option>
          <option value="South Dakota">South Dakota</option>
          <option value="Tennessee">Tennessee</option>
          <option value="Texas">Texas</option>
          <option value="Utah">Utah</option>
          <option value="Vermont">Vermont</option>
          <option value="Virginia">Virginia</option>
          <option value="Washington">Washington</option>
          <option value="West Virginia">West Virginia</option>
          <option value="Wisconsin">Wisconsin</option>
          <option value="Wyoming">Wyoming</option>
        </select><span id="InstructState" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow"><input type="hidden" name="LeadSource" class="mktoField mktoFieldDescriptor mktoFormCol" value="Web Form" style="margin-bottom: 10px;">
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow"><input type="hidden" name="Marketing_Source__c" class="mktoField mktoFieldDescriptor mktoFormCol" value="Brochure Download" style="margin-bottom: 10px;">
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow"><input type="hidden" name="UTM_Campaign__c" class="mktoField mktoFieldDescriptor mktoFormCol" value="" style="margin-bottom: 10px;">
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow"><input type="hidden" name="UTM_Medium__c" class="mktoField mktoFieldDescriptor mktoFormCol" value="" style="margin-bottom: 10px;">
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow"><input type="hidden" name="UTM_Source__c" class="mktoField mktoFieldDescriptor mktoFormCol" value="" style="margin-bottom: 10px;">
    <div class="mktoClear"></div>
  </div>
  <div class="mktoButtonRow"><span class="mktoButtonWrap mktoSimple" style="margin-left: 120px;"><button type="submit" class="mktoButton">Submit</button></span></div><input type="hidden" name="formid" class="mktoField mktoFieldDescriptor"
    value="10450"><input type="hidden" name="munchkinId" class="mktoField mktoFieldDescriptor" value="936-FRZ-719">
</form>

<form id="mktoForm_10451" novalidate="novalidate" class="mktoForm mktoHasWidth mktoLayoutLeft" style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; color: rgb(51, 51, 51); width: 566px;">
  <style type="text/css">
    .mktoForm .mktoButtonWrap.mktoSimple .mktoButton {
      color: #fff;
      border: 1px solid #75ae4c;
      padding: 0.4em 1em;
      font-size: 1em;
      background-color: #99c47c;
      background-image: -webkit-gradient(linear, left top, left bottom, from(#99c47c), to(#75ae4c));
      background-image: -webkit-linear-gradient(top, #99c47c, #75ae4c);
      background-image: -moz-linear-gradient(top, #99c47c, #75ae4c);
      background-image: linear-gradient(to bottom, #99c47c, #75ae4c);
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    .mktoForm .mktoButtonWrap.mktoSimple .mktoButton:hover {
      border: 1px solid #447f19;
    }

    .mktoForm .mktoButtonWrap.mktoSimple .mktoButton:focus {
      outline: none;
      border: 1px solid #447f19;
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    .mktoForm .mktoButtonWrap.mktoSimple .mktoButton:active {
      background-color: #75ae4c;
      background-image: -webkit-gradient(linear, left top, left bottom, from(#75ae4c), to(#99c47c));
      background-image: -webkit-linear-gradient(top, #75ae4c, #99c47c);
      background-image: -moz-linear-gradient(top, #75ae4c, #99c47c);
      background-image: linear-gradient(to bottom, #75ae4c, #99c47c);
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  <div class="mktoFormRow">
    <div class="mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset mktoHasWidth" style="width: 10px;"></div>
      <div class="mktoFieldWrap">
        <div class="mktoHtmlText mktoHasWidth" style="width: 555px;">
          <div style="text-align: center;"><strong><span style="font-size: 28px;">Stay in the Know!</span></strong></div>
        </div>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset mktoHasWidth" style="width: 10px;"></div>
      <div class="mktoFieldWrap">
        <div class="mktoHtmlText mktoHasWidth" style="width: 555px;">
          <div style="text-align: center;"><span style="font-size: 14px;">Sign up&nbsp;below&nbsp;to receive event updates directly to your inbox.</span><br></div>
        </div>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="FirstName" id="LblFirstName" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>First Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="FirstName" name="FirstName" maxlength="255" aria-labelledby="LblFirstName InstructFirstName" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructFirstName" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="LastName" id="LblLastName" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Last Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="LastName" name="LastName" maxlength="255" aria-labelledby="LblLastName InstructLastName" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructLastName" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Email" id="LblEmail" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Email Address:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Email" name="Email" maxlength="255" aria-labelledby="LblEmail InstructEmail" type="email" class="mktoField mktoEmailField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructEmail" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap"><label for="Phone" id="LblPhone" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Phone Number:
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        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Phone" name="Phone" maxlength="255" aria-labelledby="LblPhone InstructPhone" type="tel" class="mktoField mktoTelField mktoHasWidth" style="width: 150px;"><span
          id="InstructPhone" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Title" id="LblTitle" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Job Title:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Title" name="Title" maxlength="255" aria-labelledby="LblTitle InstructTitle" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired" aria-required="true"
          style="width: 150px;"><span id="InstructTitle" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="Company" id="LblCompany" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Company Name:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><input id="Company" name="Company" maxlength="255" aria-labelledby="LblCompany InstructCompany" type="text" class="mktoField mktoTextField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;"><span id="InstructCompany" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="FRA_Job_Function__pc" id="LblFRA_Job_Function__pc" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Job Function:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><select id="FRA_Job_Function__pc" name="FRA_Job_Function__pc" aria-labelledby="LblFRA_Job_Function__pc InstructFRA_Job_Function__pc" class="mktoField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;">
          <option value="">Select...</option>
          <option value="Claims">Claims</option>
          <option value="Compliance">Compliance</option>
          <option value="Defense Paralegal">Defense Paralegal</option>
          <option value="Finance">Finance</option>
          <option value="In-House Corporate Counsel">In-House Corporate Counsel</option>
          <option value="Insurance Staff Counsel">Insurance Staff Counsel</option>
          <option value="Legal">Legal</option>
          <option value="Lien Resolution">Lien Resolution</option>
          <option value="Mandatory Reporting">Mandatory Reporting</option>
          <option value="Medicare Set Asides">Medicare Set Asides</option>
          <option value="Plaintiff Paralegal">Plaintiff Paralegal</option>
          <option value="Risk Management">Risk Management</option>
          <option value="Other">Other</option>
        </select><span id="InstructFRA_Job_Function__pc" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap mktoRequiredField"><label for="wFRACompanyTypeL2" id="LblwFRACompanyTypeL2" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Company Type:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><select id="wFRACompanyTypeL2" name="wFRACompanyTypeL2" aria-labelledby="LblwFRACompanyTypeL2 InstructwFRACompanyTypeL2" class="mktoField mktoHasWidth mktoRequired"
          aria-required="true" style="width: 150px;">
          <option value="">Select...</option>
          <option value="Cities, Counties, Municipalities">Cities, Counties, Municipalities</option>
          <option value="College / University">College / University</option>
          <option value="Law Firm">Law Firm</option>
          <option value="Liability">Liability</option>
          <option value="Medical Malpractice Carriers">Medical Malpractice Carriers</option>
          <option value="Medicare Advantage Organization">Medicare Advantage Organization</option>
          <option value="No-Fault Insurance">No-Fault Insurance</option>
          <option value="Nursing Homes">Nursing Homes</option>
          <option value="Physician Groups">Physician Groups</option>
          <option value="Prescription Drug Plan">Prescription Drug Plan</option>
          <option value="Private &amp; Public Hospitals">Private &amp; Public Hospitals</option>
          <option value="Product Liability Insurers">Product Liability Insurers</option>
          <option value="Product Manufacturers">Product Manufacturers</option>
          <option value="School District">School District</option>
          <option value="Self-Insured Company">Self-Insured Company</option>
          <option value="State Agency and Department">State Agency and Department</option>
          <option value="Third Party Administrator">Third Party Administrator</option>
          <option value="Vendor">Vendor</option>
          <option value="Workers' Compensation">Workers' Compensation</option>
          <option value="Other">Other</option>
        </select><span id="InstructwFRACompanyTypeL2" tabindex="-1" class="mktoInstruction"></span>
        <div class="mktoClear"></div>
      </div>
      <div class="mktoClear"></div>
    </div>
    <div class="mktoClear"></div>
  </div>
  <div class="mktoFormRow">
    <div class="mktoFieldDescriptor mktoFormCol" style="margin-bottom: 10px;">
      <div class="mktoOffset" style="width: 10px;"></div>
      <div class="mktoFieldWrap"><label for="Country" id="LblCountry" class="mktoLabel mktoHasWidth" style="width: 100px;">
          <div class="mktoAsterix">*</div>Country:
        </label>
        <div class="mktoGutter mktoHasWidth" style="width: 10px;"></div><select id="Country" name="Country" aria-labelledby="LblCountry InstructCountry" class="mktoField mktoHasWidth" style="width: 150px;">
          <option value="AF">Afghanistan</option>
          <option value="AX">Aland Islands</option>
          <option value="AL">Albania</option>
          <option value="DZ">Algeria</option>
          <option value="AD">Andorra</option>
          <option value="AO">Angola</option>
          <option value="AI">Anguilla</option>
          <option value="AQ">Antarctica</option>
          <option value="AG">Antigua and Barbuda</option>
          <option value="AR">Argentina</option>
          <option value="AM">Armenia</option>
          <option value="AW">Aruba</option>
          <option value="AU">Australia</option>
          <option value="AT">Austria</option>
          <option value="AZ">Azerbaijan</option>
          <option value="BS">Bahamas</option>
          <option value="BH">Bahrain</option>
          <option value="BD">Bangladesh</option>
          <option value="BB">Barbados</option>
          <option value="BY">Belarus</option>
          <option value="BE">Belgium</option>
          <option value="BZ">Belize</option>
          <option value="BJ">Benin</option>
          <option value="BM">Bermuda</option>
          <option value="BT">Bhutan</option>
          <option value="BO">Bolivia, Plurinational State of</option>
          <option value="BQ">Bonaire, Sint Eustatius and Saba</option>
          <option value="BA">Bosnia and Herzegovina</option>
          <option value="BW">Botswana</option>
          <option value="BV">Bouvet Island</option>
          <option value="BR">Brazil</option>
          <option value="IO">British Indian Ocean Territory</option>
          <option value="BN">Brunei Darussalam</option>
          <option value="BG">Bulgaria</option>
          <option value="BF">Burkina Faso</option>
          <option value="BI">Burundi</option>
          <option value="KH">Cambodia</option>
          <option value="CM">Cameroon</option>
          <option value="CA">Canada</option>
          <option value="CV">Cape Verde</option>
          <option value="KY">Cayman Islands</option>
          <option value="CF">Central African Republic</option>
          <option value="TD">Chad</option>
          <option value="CL">Chile</option>
          <option value="CN">China</option>
          <option value="CX">Christmas Island</option>
          <option value="CC">Cocos (Keeling) Islands</option>
          <option value="CO">Colombia</option>
          <option value="KM">Comoros</option>
          <option value="CD">Congo, the Democratic Republic of the</option>
          <option value="CG">Congo</option>
          <option value="CK">Cook Islands</option>
          <option value="CR">Costa Rica</option>
          <option value="CI">Cote d’Ivoire</option>
          <option value="HR">Croatia</option>
          <option value="CU">Cuba</option>
          <option value="CW">Curaçao</option>
          <option value="CY">Cyprus</option>
          <option value="CZ">Czech Republic</option>
          <option value="DK">Denmark</option>
          <option value="DJ">Djibouti</option>
          <option value="DM">Dominica</option>
          <option value="DO">Dominican Republic</option>
          <option value="EC">Ecuador</option>
          <option value="EG">Egypt</option>
          <option value="SV">El Salvador</option>
          <option value="GQ">Equatorial Guinea</option>
          <option value="ER">Eritrea</option>
          <option value="EE">Estonia</option>
          <option value="ET">Ethiopia</option>
          <option value="FK">Falkland Islands (Malvinas)</option>
          <option value="FO">Faroe Islands</option>
          <option value="FJ">Fiji</option>
          <option value="FI">Finland</option>
          <option value="FR">France</option>
          <option value="GF">French Guiana</option>
          <option value="PF">French Polynesia</option>
          <option value="TF">French Southern Territories</option>
          <option value="GA">Gabon</option>
          <option value="GM">Gambia</option>
          <option value="GE">Georgia</option>
          <option value="DE">Germany</option>
          <option value="GH">Ghana</option>
          <option value="GI">Gibraltar</option>
          <option value="GR">Greece</option>
          <option value="GL">Greenland</option>
          <option value="GD">Grenada</option>
          <option value="GP">Guadeloupe</option>
          <option value="GT">Guatemala</option>
          <option value="GG">Guernsey</option>
          <option value="GN">Guinea</option>
          <option value="GW">Guinea-Bissau</option>
          <option value="GY">Guyana</option>
          <option value="HT">Haiti</option>
          <option value="HM">Heard Island and McDonald Islands</option>
          <option value="VA">Holy See (Vatican City State)</option>
          <option value="HN">Honduras</option>
          <option value="HU">Hungary</option>
          <option value="IS">Iceland</option>
          <option value="IN">India</option>
          <option value="ID">Indonesia</option>
          <option value="IR">Iran, Islamic Republic of</option>
          <option value="IQ">Iraq</option>
          <option value="IE">Ireland</option>
          <option value="IM">Isle of Man</option>
          <option value="IL">Israel</option>
          <option value="IT">Italy</option>
          <option value="JM">Jamaica</option>
          <option value="JP">Japan</option>
          <option value="JE">Jersey</option>
          <option value="JO">Jordan</option>
          <option value="KZ">Kazakhstan</option>
          <option value="KE">Kenya</option>
          <option value="KI">Kiribati</option>
          <option value="KP">Korea, Democratic People’s Republic of</option>
          <option value="KR">Korea, Republic of</option>
          <option value="KW">Kuwait</option>
          <option value="KG">Kyrgyzstan</option>
          <option value="LA">Lao People’s Democratic Republic</option>
          <option value="LV">Latvia</option>
          <option value="LB">Lebanon</option>
          <option value="LS">Lesotho</option>
          <option value="LR">Liberia</option>
          <option value="LY">Libyan Arab Jamahiriya</option>
          <option value="LI">Liechtenstein</option>
          <option value="LT">Lithuania</option>
          <option value="LU">Luxembourg</option>
          <option value="MO">Macao</option>
          <option value="MK">Macedonia, the former Yugoslav Republic of</option>
          <option value="MG">Madagascar</option>
          <option value="MW">Malawi</option>
          <option value="MY">Malaysia</option>
          <option value="MV">Maldives</option>
          <option value="ML">Mali</option>
          <option value="MT">Malta</option>
          <option value="MQ">Martinique</option>
          <option value="MR">Mauritania</option>
          <option value="MU">Mauritius</option>
          <option value="YT">Mayotte</option>
          <option value="MX">Mexico</option>
          <option value="MD">Moldova, Republic of</option>
          <option value="MC">Monaco</option>
          <option value="MN">Mongolia</option>
          <option value="ME">Montenegro</option>
          <option value="MS">Montserrat</option>
          <option value="MA">Morocco</option>
          <option value="MZ">Mozambique</option>
          <option value="MM">Myanmar</option>
          <option value="NA">Namibia</option>
          <option value="NR">Nauru</option>
          <option value="NP">Nepal</option>
          <option value="NL">Netherlands</option>
          <option value="NC">New Caledonia</option>
          <option value="NZ">New Zealand</option>
          <option value="NI">Nicaragua</option>
          <option value="NE">Niger</option>
          <option value="NG">Nigeria</option>
          <option value="NU">Niue</option>
          <option value="NF">Norfolk Island</option>
          <option value="NO">Norway</option>
          <option value="OM">Oman</option>
          <option value="PK">Pakistan</option>
          <option value="PS">Palestine</option>
          <option value="PA">Panama</option>
          <option value="PG">Papua New Guinea</option>
          <option value="PY">Paraguay</option>
          <option value="PE">Peru</option>
          <option value="PH">Philippines</option>
          <option value="PN">Pitcairn</option>
          <option value="PL">Poland</option>
          <option value="PT">Portugal</option>
          <option value="PR">Puerto Rico</option>
          <option value="QA">Qatar</option>
          <option value="RE">Reunion</option>
          <option value="RO">Romania</option>
          <option value="RU">Russian Federation</option>
          <option value="RW">Rwanda</option>
          <option value="BL">Saint Barthélemy</option>
          <option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
          <option value="KN">Saint Kitts and Nevis</option>
          <option value="LC">Saint Lucia</option>
          <option value="MF">Saint Martin (French part)</option>
          <option value="PM">Saint Pierre and Miquelon</option>
          <option value="VC">Saint Vincent and the Grenadines</option>
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Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and
HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei
DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling)
IslandsColombiaComorosCongo, the Democratic Republic of theCongoCook
IslandsCosta RicaCote d’IvoireCroatiaCubaCuraçaoCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl
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ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
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