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www.inclave.com Open in urlscan Pro
2606:4700:10::6816:27a8  Public Scan

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Submitted URL: https://bit.ly/2YHuv6n#c1527QbfPm393860qKPO10TXN969HOup32
Effective URL: https://www.inclave.com/register
Submission: On November 13 via manual from CA — Scanned from CA

Form analysis 1 forms found in the DOM

POST 

<form data-v-8b94e00e="" method="post" class="pt-4">
  <div data-v-8b94e00e="" class="text-left pb-2"><small data-v-8b94e00e="" class="font-weight-bold text-blue">Account Information</small></div>
  <div data-v-8b94e00e="" class="row">
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-first-name-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-first-name" name="first_name" type="text" placeholder="First Name" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The first name field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-last-name-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-last-name" name="last_name" type="text" placeholder="Last Name" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The last name field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-email-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-email" name="email" type="text" placeholder="E-Mail Address" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The e-mail address field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-password-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-password" name="password" type="password" placeholder="Password" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The password field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
  </div>
  <div data-v-8b94e00e="" class="text-left pb-2"><small data-v-8b94e00e="" class="font-weight-bold text-blue">Personal Information</small></div>
  <div data-v-8b94e00e="" class="row">
    <div data-v-8b94e00e="" class="col-sm-12">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-street-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-street" name="street" type="text" placeholder="Street Address" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The street address field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-city-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-city" name="city" type="text" placeholder="City" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-zip-group" role="group" class="form-group"><!---->
          <div><input data-v-7aa8e70a="" id="input-zip" name="zip" type="text" placeholder="Zip" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12">
      <div data-v-8b94e00e="" class="row">
        <div data-v-8b94e00e="" class="col">
          <div data-v-8b94e00e="" class="group">
            <div data-v-319d3e85="" data-v-8b94e00e="" id="input-country-group" role="group" class="form-group"><!---->
              <div>
                <div data-v-319d3e85="" dir="auto" class="v-select vs--single vs--searchable" name="country">
                  <div id="vs1__combobox" role="combobox" aria-expanded="false" aria-owns="vs1__listbox" aria-label="Search for option" class="vs__dropdown-toggle">
                    <div class="vs__selected-options"><span class="vs__selected"> Canada <!----></span> <input id="input-country" aria-autocomplete="list" aria-labelledby="vs1__combobox" aria-controls="vs1__listbox" type="search" autocomplete="off"
                        class="vs__search"></div>
                    <div class="vs__actions"><button type="button" title="Clear Selected" aria-label="Clear Selected" class="vs__clear" style="display: none;"><svg xmlns="http://www.w3.org/2000/svg" width="10" height="10">
                          <path
                            d="M6.895455 5l2.842897-2.842898c.348864-.348863.348864-.914488 0-1.263636L9.106534.261648c-.348864-.348864-.914489-.348864-1.263636 0L5 3.104545 2.157102.261648c-.348863-.348864-.914488-.348864-1.263636 0L.261648.893466c-.348864.348864-.348864.914489 0 1.263636L3.104545 5 .261648 7.842898c-.348864.348863-.348864.914488 0 1.263636l.631818.631818c.348864.348864.914773.348864 1.263636 0L5 6.895455l2.842898 2.842897c.348863.348864.914772.348864 1.263636 0l.631818-.631818c.348864-.348864.348864-.914489 0-1.263636L6.895455 5z">
                          </path>
                        </svg></button> <svg xmlns="http://www.w3.org/2000/svg" width="14" height="10" role="presentation" class="vs__open-indicator">
                        <path
                          d="M9.211364 7.59931l4.48338-4.867229c.407008-.441854.407008-1.158247 0-1.60046l-.73712-.80023c-.407008-.441854-1.066904-.441854-1.474243 0L7 5.198617 2.51662.33139c-.407008-.441853-1.066904-.441853-1.474243 0l-.737121.80023c-.407008.441854-.407008 1.158248 0 1.600461l4.48338 4.867228L7 10l2.211364-2.40069z">
                        </path>
                      </svg>
                      <div class="vs__spinner" style="display: none;">Loading...</div>
                    </div>
                  </div>
                  <ul id="vs1__listbox" role="listbox" style="display: none; visibility: hidden;"></ul>
                </div>
                <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                  <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
                </div><!----><!----><!---->
              </div>
            </div>
          </div>
        </div>
        <div data-v-8b94e00e="" class="col-sm-12 col-md-6">
          <div data-v-8b94e00e="" class="group">
            <div data-v-319d3e85="" data-v-8b94e00e="" id="input-state-group" role="group" class="form-group"><!---->
              <div>
                <div data-v-319d3e85="" dir="auto" class="v-select vs--single vs--searchable" name="state">
                  <div id="vs4__combobox" role="combobox" aria-expanded="false" aria-owns="vs4__listbox" aria-label="Search for option" class="vs__dropdown-toggle">
                    <div class="vs__selected-options"> <input placeholder="State" id="input-state" aria-autocomplete="list" aria-labelledby="vs4__combobox" aria-controls="vs4__listbox" type="search" autocomplete="off" class="vs__search"></div>
                    <div class="vs__actions"><button type="button" title="Clear Selected" aria-label="Clear Selected" class="vs__clear" style="display: none;"><svg xmlns="http://www.w3.org/2000/svg" width="10" height="10">
                          <path
                            d="M6.895455 5l2.842897-2.842898c.348864-.348863.348864-.914488 0-1.263636L9.106534.261648c-.348864-.348864-.914489-.348864-1.263636 0L5 3.104545 2.157102.261648c-.348863-.348864-.914488-.348864-1.263636 0L.261648.893466c-.348864.348864-.348864.914489 0 1.263636L3.104545 5 .261648 7.842898c-.348864.348863-.348864.914488 0 1.263636l.631818.631818c.348864.348864.914773.348864 1.263636 0L5 6.895455l2.842898 2.842897c.348863.348864.914772.348864 1.263636 0l.631818-.631818c.348864-.348864.348864-.914489 0-1.263636L6.895455 5z">
                          </path>
                        </svg></button> <svg xmlns="http://www.w3.org/2000/svg" width="14" height="10" role="presentation" class="vs__open-indicator">
                        <path
                          d="M9.211364 7.59931l4.48338-4.867229c.407008-.441854.407008-1.158247 0-1.60046l-.73712-.80023c-.407008-.441854-1.066904-.441854-1.474243 0L7 5.198617 2.51662.33139c-.407008-.441853-1.066904-.441853-1.474243 0l-.737121.80023c-.407008.441854-.407008 1.158248 0 1.600461l4.48338 4.867228L7 10l2.211364-2.40069z">
                        </path>
                      </svg>
                      <div class="vs__spinner" style="display: none;">Loading...</div>
                    </div>
                  </div>
                  <ul id="vs4__listbox" role="listbox" style="display: none; visibility: hidden;"></ul>
                </div>
                <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                  <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The state field is required.</span></div>
                </div><!----><!----><!---->
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6 col-lg-12 col-xl-6">
      <div data-v-8b94e00e="" class="group d-flex">
        <div data-v-8b94e00e="" style="width: 125px;">
          <div data-v-319d3e85="" data-v-8b94e00e="" id="input-phone-prefix-group" role="group" class="form-group"><!---->
            <div>
              <div data-v-319d3e85="" dir="auto" class="v-select vs--single vs--searchable" name="phone_prefix">
                <div id="vs2__combobox" role="combobox" aria-expanded="false" aria-owns="vs2__listbox" aria-label="Search for option" class="vs__dropdown-toggle">
                  <div class="vs__selected-options"><span class="vs__selected"> +1 <!----></span> <input id="input-phone-prefix" aria-autocomplete="list" aria-labelledby="vs2__combobox" aria-controls="vs2__listbox" type="search" autocomplete="off"
                      class="vs__search"></div>
                  <div class="vs__actions"><button type="button" title="Clear Selected" aria-label="Clear Selected" class="vs__clear" style="display: none;"><svg xmlns="http://www.w3.org/2000/svg" width="10" height="10">
                        <path
                          d="M6.895455 5l2.842897-2.842898c.348864-.348863.348864-.914488 0-1.263636L9.106534.261648c-.348864-.348864-.914489-.348864-1.263636 0L5 3.104545 2.157102.261648c-.348863-.348864-.914488-.348864-1.263636 0L.261648.893466c-.348864.348864-.348864.914489 0 1.263636L3.104545 5 .261648 7.842898c-.348864.348863-.348864.914488 0 1.263636l.631818.631818c.348864.348864.914773.348864 1.263636 0L5 6.895455l2.842898 2.842897c.348863.348864.914772.348864 1.263636 0l.631818-.631818c.348864-.348864.348864-.914489 0-1.263636L6.895455 5z">
                        </path>
                      </svg></button> <svg xmlns="http://www.w3.org/2000/svg" width="14" height="10" role="presentation" class="vs__open-indicator">
                      <path
                        d="M9.211364 7.59931l4.48338-4.867229c.407008-.441854.407008-1.158247 0-1.60046l-.73712-.80023c-.407008-.441854-1.066904-.441854-1.474243 0L7 5.198617 2.51662.33139c-.407008-.441853-1.066904-.441853-1.474243 0l-.737121.80023c-.407008.441854-.407008 1.158248 0 1.600461l4.48338 4.867228L7 10l2.211364-2.40069z">
                      </path>
                    </svg>
                    <div class="vs__spinner" style="display: none;">Loading...</div>
                  </div>
                </div>
                <ul id="vs2__listbox" role="listbox" style="display: none; visibility: hidden;"></ul>
              </div>
              <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
              </div><!----><!----><!---->
            </div>
          </div>
        </div>
        <div data-v-7aa8e70a="" data-v-8b94e00e="" id="input-phone-group" role="group" class="form-group w-100"><!---->
          <div><input data-v-7aa8e70a="" id="input-phone" name="phone" type="tel" placeholder="Mobile Number" class="form-control">
            <div data-v-79dd982e="" data-v-7aa8e70a="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The mobile number field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6 col-lg-12 col-xl-6">
      <div data-v-8b94e00e="" class="group">
        <div data-v-319d3e85="" data-v-8b94e00e="" id="input-sex-group" role="group" class="form-group"><!---->
          <div>
            <div data-v-319d3e85="" dir="auto" class="v-select vs--single vs--searchable" name="sex">
              <div id="vs3__combobox" role="combobox" aria-expanded="false" aria-owns="vs3__listbox" aria-label="Search for option" class="vs__dropdown-toggle">
                <div class="vs__selected-options"> <input placeholder="Gender" id="input-sex" aria-autocomplete="list" aria-labelledby="vs3__combobox" aria-controls="vs3__listbox" type="search" autocomplete="off" class="vs__search"></div>
                <div class="vs__actions"><button type="button" title="Clear Selected" aria-label="Clear Selected" class="vs__clear" style="display: none;"><svg xmlns="http://www.w3.org/2000/svg" width="10" height="10">
                      <path
                        d="M6.895455 5l2.842897-2.842898c.348864-.348863.348864-.914488 0-1.263636L9.106534.261648c-.348864-.348864-.914489-.348864-1.263636 0L5 3.104545 2.157102.261648c-.348863-.348864-.914488-.348864-1.263636 0L.261648.893466c-.348864.348864-.348864.914489 0 1.263636L3.104545 5 .261648 7.842898c-.348864.348863-.348864.914488 0 1.263636l.631818.631818c.348864.348864.914773.348864 1.263636 0L5 6.895455l2.842898 2.842897c.348863.348864.914772.348864 1.263636 0l.631818-.631818c.348864-.348864.348864-.914489 0-1.263636L6.895455 5z">
                      </path>
                    </svg></button> <svg xmlns="http://www.w3.org/2000/svg" width="14" height="10" role="presentation" class="vs__open-indicator">
                    <path
                      d="M9.211364 7.59931l4.48338-4.867229c.407008-.441854.407008-1.158247 0-1.60046l-.73712-.80023c-.407008-.441854-1.066904-.441854-1.474243 0L7 5.198617 2.51662.33139c-.407008-.441853-1.066904-.441853-1.474243 0l-.737121.80023c-.407008.441854-.407008 1.158248 0 1.600461l4.48338 4.867228L7 10l2.211364-2.40069z">
                    </path>
                  </svg>
                  <div class="vs__spinner" style="display: none;">Loading...</div>
                </div>
              </div>
              <ul id="vs3__listbox" role="listbox" style="display: none; visibility: hidden;"></ul>
            </div>
            <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The gender field is required.</span></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
  </div>
  <div data-v-8b94e00e="" class="row">
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6 col-lg-12 col-xl-6">
      <div data-v-8b94e00e="" class="text-left pb-2"><small data-v-8b94e00e="" class="font-weight-bold text-blue">Date of Birth</small></div>
      <div data-v-8b94e00e="" class="group position-relative">
        <div data-v-8b94e00e="" class="row">
          <div data-v-8b94e00e="" class="col">
            <div data-v-319d3e85="" data-v-8b94e00e="" id="input-dob-day-group" role="group" class="form-group"><!---->
              <div><select data-v-319d3e85="" id="input-dob-day" name="" class="custom-select" placeholder="Day">
                  <option value="">Day</option>
                  <option value="1">1</option>
                  <option value="2">2</option>
                  <option value="3">3</option>
                  <option value="4">4</option>
                  <option value="5">5</option>
                  <option value="6">6</option>
                  <option value="7">7</option>
                  <option value="8">8</option>
                  <option value="9">9</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 data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                  <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
                </div><!----><!----><!---->
              </div>
            </div>
          </div>
          <div data-v-8b94e00e="" class="col">
            <div data-v-319d3e85="" data-v-8b94e00e="" id="input-dob-month-group" role="group" class="form-group"><!---->
              <div><select data-v-319d3e85="" id="input-dob-month" name="" class="custom-select" placeholder="Month">
                  <option value="">Month</option>
                  <option value="1">January</option>
                  <option value="2">February</option>
                  <option value="3">March</option>
                  <option value="4">April</option>
                  <option value="5">May</option>
                  <option value="6">Jun</option>
                  <option value="7">July</option>
                  <option value="8">August</option>
                  <option value="9">September</option>
                  <option value="10">October</option>
                  <option value="11">November</option>
                  <option value="12">December</option>
                </select>
                <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                  <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
                </div><!----><!----><!---->
              </div>
            </div>
          </div>
          <div data-v-8b94e00e="" class="col">
            <div data-v-319d3e85="" data-v-8b94e00e="" id="input-dob-year-group" role="group" class="form-group"><!---->
              <div><select data-v-319d3e85="" id="input-dob-year" name="" class="custom-select" placeholder="Year">
                  <option value="">Year</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>
                </select>
                <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
                  <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
                </div><!----><!----><!---->
              </div>
            </div>
          </div>
        </div>
        <div data-v-79dd982e="" data-v-8b94e00e="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
          <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><span data-v-79dd982e="">The Date of Birth field is required.</span></div>
        </div>
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-12 col-md-6 col-lg-12 col-xl-6">
      <div data-v-8b94e00e="" class="text-left pb-2"><small data-v-8b94e00e="" class="font-weight-bold text-blue"> Preferred Currency </small></div>
      <div data-v-8b94e00e="" class="group position-relative">
        <div data-v-319d3e85="" data-v-8b94e00e="" id="input-phone-prefix-group" role="group" class="form-group"><!---->
          <div>
            <div data-v-319d3e85="" dir="auto" class="v-select vs--single vs--searchable" name="phone_prefix">
              <div id="vs5__combobox" role="combobox" aria-expanded="false" aria-owns="vs5__listbox" aria-label="Search for option" class="vs__dropdown-toggle">
                <div class="vs__selected-options"><span class="vs__selected"> CAD <!----></span> <input id="input-phone-prefix" aria-autocomplete="list" aria-labelledby="vs5__combobox" aria-controls="vs5__listbox" type="search" autocomplete="off"
                    class="vs__search"></div>
                <div class="vs__actions"><button type="button" title="Clear Selected" aria-label="Clear Selected" class="vs__clear" style="display: none;"><svg xmlns="http://www.w3.org/2000/svg" width="10" height="10">
                      <path
                        d="M6.895455 5l2.842897-2.842898c.348864-.348863.348864-.914488 0-1.263636L9.106534.261648c-.348864-.348864-.914489-.348864-1.263636 0L5 3.104545 2.157102.261648c-.348863-.348864-.914488-.348864-1.263636 0L.261648.893466c-.348864.348864-.348864.914489 0 1.263636L3.104545 5 .261648 7.842898c-.348864.348863-.348864.914488 0 1.263636l.631818.631818c.348864.348864.914773.348864 1.263636 0L5 6.895455l2.842898 2.842897c.348863.348864.914772.348864 1.263636 0l.631818-.631818c.348864-.348864.348864-.914489 0-1.263636L6.895455 5z">
                      </path>
                    </svg></button> <svg xmlns="http://www.w3.org/2000/svg" width="14" height="10" role="presentation" class="vs__open-indicator">
                    <path
                      d="M9.211364 7.59931l4.48338-4.867229c.407008-.441854.407008-1.158247 0-1.60046l-.73712-.80023c-.407008-.441854-1.066904-.441854-1.474243 0L7 5.198617 2.51662.33139c-.407008-.441853-1.066904-.441853-1.474243 0l-.737121.80023c-.407008.441854-.407008 1.158248 0 1.600461l4.48338 4.867228L7 10l2.211364-2.40069z">
                    </path>
                  </svg>
                  <div class="vs__spinner" style="display: none;">Loading...</div>
                </div>
              </div>
              <ul id="vs5__listbox" role="listbox" style="display: none; visibility: hidden;"></ul>
            </div>
            <div data-v-79dd982e="" data-v-319d3e85="" aria-hidden="true" hidden="hidden" class="invalid-feedback-wrapper" style="height: 0px; overflow: hidden; transition-property: height; transition-duration: 500ms;">
              <div data-v-79dd982e="" class="d-flex flex-column text-left d-block invalid-feedback"><!----></div>
            </div><!----><!----><!---->
          </div>
        </div>
      </div>
    </div>
  </div>
  <div data-v-8b94e00e="" class="row d-flex justify-content-center pt-4">
    <div data-v-8b94e00e="" class="col-sm-8">
      <div data-v-8b94e00e="" class="b-overlay-wrap position-relative d-inline-block w-100"><button data-v-8b94e00e="" id="submit-registration" type="submit" class="btn btn-warning btn-block text-white py-2 btn-primary"> Sign up </button><!---->
      </div>
    </div>
    <div data-v-8b94e00e="" class="col-sm-8 pt-3"><a data-v-8b94e00e="" id="href-login" href="/login" class="btn btn-secondary btn-block py-2">
                        Already have an account
                    </a></div>
  </div>
</form>

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Account Information
The first name field is required.
The last name field is required.
The e-mail address field is required.
The password field is required.
Personal Information
The street address field is required.


Canada
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The state field is required.
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The mobile number field is required.
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The gender field is required.
Date of Birth
Day12345678910111213141516171819202122232425262728293031

MonthJanuaryFebruaryMarchAprilMayJunJulyAugustSeptemberOctoberNovemberDecember

Year20001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921

The Date of Birth field is required.
Preferred Currency
CAD
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