application.usb-ed.com
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146.232.96.90
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URL:
http://application.usb-ed.com/?oID=48b78d7c-dfad-ed11-811d-005056b8008e
Submission: On August 24 via api from ZA — Scanned from DE
Submission: On August 24 via api from ZA — Scanned from DE
Form analysis 1 forms found in the DOM
POST /
<form action="/" id="frmApplication" method="post" autocomplete="off"><input value="" id="usNumber" name="UsNumber" type="hidden">
<input value="None" data-val="true" data-val-required="The VoucherStatus field is required." id="voucherStatus" name="VoucherStatus" type="hidden">
<input value="False" data-val="true" data-val-required="The HasVoucher field is required." id="hasVoucher" name="HasVoucher" type="hidden">
<input value="" id="enrolment" name="Enrolment" type="hidden">
<input id="validationSection" name="ValidationSection" type="hidden" value="">
<input value="failed" id="selectedTab" name="SelectedTab" type="hidden">
<input value="" id="accountGuid" name="AccountGuid" type="hidden">
<input value="General" data-val="true" data-val-required="The ShortCourseOfferingType field is required." id="shortCourseOfferingType" name="ShortCourseOfferingType" type="hidden">
<input value="None" data-val="true" data-val-required="The AccountType field is required." id="accountType" name="AccountType" type="hidden">
<input value="False" data-val="true" data-val-required="The IsMasterStart field is required." id="isMasterStart" name="IsMasterStart" type="hidden">
<input value="False" data-val="true" data-val-required="The IsBasilRead field is required." id="isBasilRead" name="IsBasilRead" type="hidden">
<input id="QualifyForVoucher" value="False" data-val="true" data-val-required="The QualifyForVoucher field is required." name="QualifyForVoucher" type="hidden">
<input value="False" data-val="true" data-val-required="The HasUploadedRequiredDocuments field is required." id="hasUploadedRequiredDocuments" name="HasUploadedRequiredDocuments" type="hidden">
<input value="0" data-val="true" data-val-required="The ApplicantStatus field is required." id="applicantStatus" name="ApplicantStatus" type="hidden">
<input value="false" data-val="true" data-val-required="The EmailSectionValidated field is required." id="emailSectionValidated" name="EmailSectionValidated" type="hidden">
<input value="false" data-val="true" data-val-required="The Boolean field is required." id="displayNameApproved" name="DisplayNameApproved" type="hidden">
<input data-val="true" data-val-required="The Section1Validated field is required." id="section1Validated" name="Section1Validated" type="hidden" value="false">
<input data-val="true" data-val-required="The Section2Validated field is required." id="section2Validated" name="Section2Validated" type="hidden" value="false">
<input data-val="true" data-val-required="The Section3Validated field is required." id="section3Validated" name="Section3Validated" type="hidden" value="false">
<input data-val="true" data-val-required="The Section4Validated field is required." id="section4Validated" name="Section4Validated" type="hidden" value="false">
<input data-val="true" data-val-required="The Section5Validated field is required." id="section5Validated" name="Section5Validated" type="hidden" value="false">
<input data-val="true" data-val-required="The Section6Validated field is required." id="section6Validated" name="Section6Validated" type="hidden" value="False">
<input value="< Select Option >" id="selectedCountry" name="SelectedCountry" type="hidden">
<input id="dateOfBirthDay" name="DateOfBirthDay" type="hidden" value="">
<input id="dateOfBirthMonth" name="DateOfBirthMonth" type="hidden" value="">
<input id="dateOfBirthYear" name="DateOfBirthYear" type="hidden" value="">
<input id="courseName" name="CourseName" type="hidden" value="Women in Leadership">
<input id="courseStartDate" name="CourseStartDate" type="hidden" value="12 Apr 2023">
<input data-val="true" data-val-required="The DirectOfferingLink field is required." id="directOfferingLink" name="DirectOfferingLink" type="hidden" value="true">
<input data-val="true" data-val-required="The ApplicationClosed field is required." id="applicationClosed" name="ApplicationClosed" type="hidden" value="False">
<input id="shortCourseId" name="ShortCourseId" type="hidden" value="">
<input id="shortCourseOfferingId" name="ShortCourseOfferingId" type="hidden" value="48b78d7c-dfad-ed11-811d-005056b8008e">
<input id="webTokenId" name="WebTokenId" type="hidden" value="">
<input data-val="true" data-val-required="The Offering field is required." id="offering" name="Offering" type="hidden" value="3ef3cab9-4ada-e711-80e6-005056b8603d">
<input id="identificationDocumentUploadKey" name="IdentificationDocumentUploadKey" type="hidden" value="">
<input id="qualificationDocumentUploadKey" name="QualificationDocumentUploadKey" type="hidden" value="">
<input id="cvDocumentUploadKey" name="CVDocumentUploadKey" type="hidden" value="">
<input data-val="true" data-val-required="The InsideCRM field is required." id="insideCRM" name="InsideCRM" type="hidden" value="false">
<input id="directOfferingLink" name="DirectOfferingLink" type="hidden" value="True">
<header class="main stickyNav">
<!-- Brand -->
<h1 class="brand-logo">
<a href="./" title="The University of Stellenbosch Business School Executive Development">
<!--span class="usb"><img src="assets/svg/brand/usb-logo-colour.svg" alt="University of Stellenbosch"></span-->
<span><img src="./Content/img/usb-logo-colour.svg" width="158" height="43" alt="Logo"></span>
<!--span class="ed"><img src="assets/svg/brand/usb-logo-colour.svg" alt="Executive Development"></span-->
</a>
</h1>
</header>
<main>
<header class="banner theme">
<div class="container">
<div class="row">
<!-- Copy -->
<div class="col-1-1">
<div class="feature-copy">
<h1 class="lg">Short Course Application Form</h1>
</div>
</div>
</div>
</div>
<div class="course-theme"></div>
</header>
<section class="bg-base bg-leaves">
<div class="container">
<div class="row">
<div class="col-1-1 card-content">
<div class="headerContainer">
<div class="validation-summary-valid" data-valmsg-summary="true">
<ul>
<li style="display:none"></li>
</ul>
</div>
</div>
<hr>
<div id="emailAddress">
<div id="emailAddressSection">
<fieldset>
<legend>Have you studied at USB-ED before or saved an incomplete application?</legend>
<div><br>
<span>Enter your email address to search for a previously added/saved application. </span><br><br>
</div>
<div style="padding-top: 10px;">
<label for="RegisteredEmail">E-mail address</label><br>
<input id="RegisteredEmail" name="RegisteredEmail" type="text" value="" autocomplete="off">
</div>
</fieldset>
<fieldset>
<legend> Clicking continue without entering an email address will create a new application</legend>
<div><br>
<input type="submit" id="emailAddressBtn" class="navigateButton emailAddressButton" value="Continue" style="float: none;">
</div>
</fieldset>
</div>
<!-- modal with message -->
<div id="default" role="dialog" class="modal" tabindex="-1" style="">
<!-- content -->
<div class="window">
<!-- with header -->
<header>
<h3>Application</h3>
</header>
<div class="main">
<div class="content">
<p class="lg"><strong>Please have the following on hand before you begin the application process:</strong></p>
<div class="electronicContainer">
<ul class="electornicCopies">Electronic copies of: <li>ID/Passport</li>
<li>Matric certificate/AO level OR Abridged CV</li>
</ul>
</div>
</div>
<!-- with button & link -->
<div class="controls">
<p>
<span onclick="closeModal()" class="btn invert closeModal" title="Continue to the application process">Continue to the application process</span>
</p>
</div>
</div>
<!-- close button -->
<span onclick="closeModal()" id="btnClosePopup" title="Close" class="btn-close closeModal" aria-label="Close this modal"><span>Close</span><span>window</span></span>
</div>
</div>
</div>
<div id="qualifications" style="display: none;">
<fieldset id="workExperienceSection" class="workExperienceContainer">
<legend>Current Employment</legend>
<div class="selector radio">
<label> <input data-val="true" data-val-required="The Employed field is required." id="currentlyEmployeed" name="Employed" type="radio" value="True"> Currently Employed<span></span>
</label>
</div>
<div class="selector radio">
<br>
<label> <input checked="checked" id="currentlyNotEmployeed" name="Employed" type="radio" value="False"> Currently Not Employed<span></span>
</label>
</div>
<br>
<div id="workExperienceContainer" style="display: none;">
<div>
<label>Industry</label><br>
<select id="industry" name="Industry">
<option value="">< Select Option ></option>
<option value="c051300f-0a36-e511-80c8-005056b8008e">Agriculture and Environmental Science</option>
<option value="c251300f-0a36-e511-80c8-005056b8008e">Business Management and Entrepreneurship</option>
<option value="c451300f-0a36-e511-80c8-005056b8008e">Communication and Marketing</option>
<option value="c651300f-0a36-e511-80c8-005056b8008e">Consultancy Services</option>
<option value="c851300f-0a36-e511-80c8-005056b8008e">Defence and Security services</option>
<option value="ca51300f-0a36-e511-80c8-005056b8008e">Education and Development</option>
<option value="cc51300f-0a36-e511-80c8-005056b8008e">Electronics and ICT</option>
<option value="ce51300f-0a36-e511-80c8-005056b8008e">Engineering and Construction</option>
<option value="d051300f-0a36-e511-80c8-005056b8008e">Financial Services & Insurance</option>
<option value="d251300f-0a36-e511-80c8-005056b8008e">Food and Beverages</option>
<option value="d451300f-0a36-e511-80c8-005056b8008e">Health and Wellness</option>
<option value="d651300f-0a36-e511-80c8-005056b8008e">Hospitality, Sport and Recreation</option>
<option value="d851300f-0a36-e511-80c8-005056b8008e">Law and Human Rights</option>
<option value="da51300f-0a36-e511-80c8-005056b8008e">Mining and Energy</option>
<option value="6233659e-e70c-e811-80ef-005056b8008e">Other</option>
<option value="dc51300f-0a36-e511-80c8-005056b8008e">Property</option>
<option value="de51300f-0a36-e511-80c8-005056b8008e">Public Sector and NGO</option>
<option value="e051300f-0a36-e511-80c8-005056b8008e">Religious, Social and Political Studies</option>
<option value="e251300f-0a36-e511-80c8-005056b8008e">Retail and Trade</option>
<option value="e451300f-0a36-e511-80c8-005056b8008e">Transport and Logistics</option>
<option value="e651300f-0a36-e511-80c8-005056b8008e">Veterinary and Animal Science</option>
</select>
</div>
<div>
<label>Work Area</label><br>
<select id="workArea" name="WorkArea">
<option value="">< Select Option ></option>
<option value="cb7d0695-0936-e511-80c8-005056b8008e">Administration</option>
<option value="cd7d0695-0936-e511-80c8-005056b8008e">Arts and Media</option>
<option value="cf7d0695-0936-e511-80c8-005056b8008e">Education and Training</option>
<option value="d17d0695-0936-e511-80c8-005056b8008e">Engineering</option>
<option value="d37d0695-0936-e511-80c8-005056b8008e">Environment and Nature</option>
<option value="d57d0695-0936-e511-80c8-005056b8008e">Finance</option>
<option value="d77d0695-0936-e511-80c8-005056b8008e">Health</option>
<option value="d97d0695-0936-e511-80c8-005056b8008e">Human Resources</option>
<option value="db7d0695-0936-e511-80c8-005056b8008e">IT</option>
<option value="dd7d0695-0936-e511-80c8-005056b8008e">Law</option>
<option value="df7d0695-0936-e511-80c8-005056b8008e">Management</option>
<option value="e17d0695-0936-e511-80c8-005056b8008e">Manufacturing</option>
<option value="e37d0695-0936-e511-80c8-005056b8008e">Marketing</option>
<option value="31190fa9-e70c-e811-80ef-005056b8008e">Other</option>
<option value="e57d0695-0936-e511-80c8-005056b8008e">Production</option>
<option value="e77d0695-0936-e511-80c8-005056b8008e">Religion</option>
<option value="e97d0695-0936-e511-80c8-005056b8008e">Research and Innovation</option>
<option value="eb7d0695-0936-e511-80c8-005056b8008e">Sales</option>
<option value="ed7d0695-0936-e511-80c8-005056b8008e">Sport and Fitness</option>
<option value="ef7d0695-0936-e511-80c8-005056b8008e">Strategy and Planning</option>
<option value="cb7d0695-0936-e511-80c8-005056b8008e">Administration</option>
<option value="cd7d0695-0936-e511-80c8-005056b8008e">Arts and Media</option>
<option value="cf7d0695-0936-e511-80c8-005056b8008e">Education and Training</option>
<option value="d17d0695-0936-e511-80c8-005056b8008e">Engineering</option>
<option value="d37d0695-0936-e511-80c8-005056b8008e">Environment and Nature</option>
<option value="d57d0695-0936-e511-80c8-005056b8008e">Finance</option>
<option value="d77d0695-0936-e511-80c8-005056b8008e">Health</option>
<option value="d97d0695-0936-e511-80c8-005056b8008e">Human Resources</option>
<option value="db7d0695-0936-e511-80c8-005056b8008e">IT</option>
<option value="dd7d0695-0936-e511-80c8-005056b8008e">Law</option>
<option value="df7d0695-0936-e511-80c8-005056b8008e">Management</option>
<option value="e17d0695-0936-e511-80c8-005056b8008e">Manufacturing</option>
<option value="e37d0695-0936-e511-80c8-005056b8008e">Marketing</option>
<option value="31190fa9-e70c-e811-80ef-005056b8008e">Other</option>
<option value="e57d0695-0936-e511-80c8-005056b8008e">Production</option>
<option value="e77d0695-0936-e511-80c8-005056b8008e">Religion</option>
<option value="e97d0695-0936-e511-80c8-005056b8008e">Research and Innovation</option>
<option value="eb7d0695-0936-e511-80c8-005056b8008e">Sales</option>
<option value="ed7d0695-0936-e511-80c8-005056b8008e">Sport and Fitness</option>
<option value="ef7d0695-0936-e511-80c8-005056b8008e">Strategy and Planning</option>
</select>
</div>
<div>
<label>Job Title</label><br>
<input value="" id="JobTitle" name="JobTitle" type="text" autocomplete="off">
</div>
<div>
<label>Current Employer</label><br>
<input value="" id="Employer" name="Employer" type="text" autocomplete="off">
</div>
<div>
<label>Employer Contact Number</label><br>
<input value="" id="EmployerContactNumber" name="EmployerContactNumber" type="text" autocomplete="off">
</div>
</div>
</fieldset>
<div>
<!--#region dropdowns-->
<script src="https://www.google.com/recaptcha/api.js" async="" defer=""></script>
<script>
var correctCaptcha = function(response) {
if (response != undefined && response.length > 0) {
document.getElementById("qualificationBtn").style.visibility = "visible";
}
}
</script>
<input id="shortCourseId" name="ShortCourseId" type="hidden" value="">
<input id="shortCourseOfferingId" name="ShortCourseOfferingId" type="hidden" value="48b78d7c-dfad-ed11-811d-005056b8008e">
<input id="courseName" name="CourseName" type="hidden" value="Women in Leadership">
<fieldset class="qualificationContainer" style="margin-top: 12px;">
<legend>Academic qualifications and employment</legend>
<br>
<label class="field-label">Highest Academic Qualification</label>
<div id="academicContainer">
<div>
<label for="QualificationType">Qualification Type</label> <span class="required">*</span><br>
<select data-val="true" data-val-required="The Qualification Type field is required." id="qualificationType" name="QualificationType">
<option value="">< Select Option ></option>
<option value="ab6abdbe-0936-e511-80c8-005056b8008e">Grade 12</option>
<option value="a76abdbe-0936-e511-80c8-005056b8008e">Certificate, Diploma</option>
<option value="a56abdbe-0936-e511-80c8-005056b8008e">B Degree</option>
<option value="ad6abdbe-0936-e511-80c8-005056b8008e">Post Graduate, Honours</option>
<option value="a96abdbe-0936-e511-80c8-005056b8008e">Doctorate, Masters</option>
<option value="2b934f13-5b4a-e511-80cb-005056b8008e">Other</option>
</select>
<br>
<span class="info"> if other, please specify</span><br>
<input value="" id="qualificationTypeOther" name="QualificationTypeOther" type="text" autocomplete="off">
</div>
<div id="qualificationField">
<label for="QualificationField">Qualification Field</label><br>
<select id="qualificationFields" name="QualificationField">
<option value="">< Select Option ></option>
<option value="c3d6990b-0836-e511-80c8-005056b8008e">Agriculture & Forestry</option>
<option value="c5d6990b-0836-e511-80c8-005056b8008e">Arts & Humanities</option>
<option value="c7d6990b-0836-e511-80c8-005056b8008e">Commerce</option>
<option value="c9d6990b-0836-e511-80c8-005056b8008e">Education</option>
<option value="cbd6990b-0836-e511-80c8-005056b8008e">Engineering</option>
<option value="cdd6990b-0836-e511-80c8-005056b8008e">Health Sciences</option>
<option value="cfd6990b-0836-e511-80c8-005056b8008e">Information Technology</option>
<option value="d1d6990b-0836-e511-80c8-005056b8008e">Law</option>
<option value="d3d6990b-0836-e511-80c8-005056b8008e">Natural & Physical Science</option>
<option value="d5d6990b-0836-e511-80c8-005056b8008e">Theology</option>
</select>
</div>
<div>
<label for="QualificationInstitution">Qualification Institution</label><br>
<input value="" id="QualificationInstitution" name="QualificationInstitution" type="text" autocomplete="off">
</div>
<div>
<label>Year Achieved</label><br>
<select id="yearAchieved" name="YearAchieved">
<option value="">< Select Option ></option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
</select>
</div>
</div>
<!--#endregion-->
<br>
<label class="field-label">Copy of Qualifications</label>
<div class="uploadDocuments">
<label>Copy of Identity document</label>
<span class="required">*</span>
<div>
<label for="fileuploadId" class="custom-file-upload">Select file...</label>
<input id="fileuploadId" type="file" name="files[]">
<span style="vertical-align: top" id="upload_Id"></span> <progress style="display: none" class="progress-bar" id="idUploadProgress"></progress>
<span style="vertical-align: top" id="idUploadResult"></span>
</div>
<label class="uploadLabel">Matric or equivalent NQF level 4 certificate <span class="required">*</span></label>
<div>
<label for="fileuploadCert" class="custom-file-upload">Select file...</label>
<input id="fileuploadCert" type="file" name="files[]">
<span style="vertical-align: top" id="upload_Certificate"></span> <progress style="display: none" class="progress-bar" id="certificateUploadProgress"></progress>
<span style="vertical-align: top" id="certUploadResult"></span>
</div>
<div id="divCV">
<label>Copy of CV document</label>
<div>
<label for="fileuploadCV" class="custom-file-upload">Select file...</label>
<input id="fileuploadCV" type="file" name="files[]">
<span style="vertical-align: top" id="upload_CV"></span> <progress style="display: none" class="progress-bar" id="cvUploadProgress"></progress>
<span style="vertical-align: top" id="cvUploadResult"></span>
</div>
</div>
</div>
<div class="qualificationNavigateButton">
<input type="submit" id="qualificationBtn" class="navigateButton qualificationButton" value="Next">
</div>
</fieldset>
<!--#endregion-->
</div>
</div>
<div id="personalInformation" style="display: none;">
<fieldset class="courseInfoContainer">
<legend>Field of Study</legend>
<div>
<label for="course"><strong>Course:</strong></label>
<span style="margin-left:134px;">
<label for="Offering">Women in Leadership</label>
</span>
<div>
<label><strong>Course start date:</strong></label>
<label id="offeringStartDate" style="margin-left: 59px;">12 Apr 2023</label>
</div>
</div>
</fieldset>
<link href="../css/enrol-with-form-ui.min.css" rel="stylesheet">
<fieldset class="personalInfoContainer" style="margin-top: 24px;">
<legend>Personal Information</legend>
<div class="personalInformationSection">
<div><span id="ErrorDate" style="display: none; color: red;">Please enter correct date format for year. eg 1900 or later</span></div>
<div class="studentDetails fieldRow inline">
<div>
<label for="Email">E-mail address</label>
<span class="required">*</span><br>
<input data-val="true" data-val-required="The E-mail address field is required." id="email" name="Email" type="text" value="" autocomplete="off">
</div>
<div>
<label for="Surname">Surname</label>
<span class="required">*</span><br>
<input placeholder="As it appears in your ID or Passport" value="" data-bind="value:surname" data-val="true" data-val-required="The Surname field is required." id="Surname" name="Surname" type="text" autocomplete="off">
</div>
<span class="infoBox" style="color:black!important;">
<label> On completion of your studies, the following name will be displayed on your certificate. This is a read only display. Please make any changes in the surname and first name fields. Please check spacing and
punctuation.</label>
<input readonly="readonly" data-bind="value:fullName" id="displayName" name="NameOnCertificate" tabindex="-1" type="text" value="" autocomplete="off">
<br>
<b>Please select the checkboxes below to confirm:</b> <br><br>
<input type="checkbox" id="fullNameExcepted">The name that will be displayed on your certificate<a style="color: red">*</a>
<br><br>
<b>To agree to our Privacy policy</b><br><br>
<input type="checkbox" id="privacyPolicy">By Submission of this page, I consent to the terms of USB-ED's <a href="https://usb-ed.com/legal">Privacy Policy </a>
</span>
<div>
<label for="FirstNames">First Names</label>
<span class="required">*</span><br>
<input placeholder="As it appears in your ID or Passport" value="" data-bind="value:firstNames , event{ blur: initialsChanged} " data-val="true" data-val-required="The First Names field is required." id="FirstNames"
name="FirstNames" type="text" autocomplete="off">
</div>
<div>
<label for="NameCalledBy">Name called by</label>
<span class="required">*</span><br>
<input value="" data-bind="value:nameCalledBy" data-val="true" data-val-required="The Name called by field is required." id="NameCalledBy" name="NameCalledBy" type="text" autocomplete="off">
</div>
<div>
<label for="Initials">Initials</label>
<span class="required">*</span><br>
<input value="" data-bind="value:initials, event:{ change: initialsChanged}" data-val="true" data-val-required="The Initials field is required." id="initials" name="Initials" type="text" autocomplete="off" maxlength="1">
</div>
<div>
<label for="Title">Title</label>
<span class="required">*</span><br>
<select class="form-control select-add-placeholder" data-val="true" data-val-required="The Title field is required." id="title" name="Title">
<option value="">< Select Option ></option>
<option value="2ac1855b-0736-e511-80c8-005056b8008e">2nd Lieutenant</option>
<option value="2cc1855b-0736-e511-80c8-005056b8008e">Adjudant</option>
<option value="2ec1855b-0736-e511-80c8-005056b8008e">Adjudant-General</option>
<option value="32c1855b-0736-e511-80c8-005056b8008e">Advocate</option>
<option value="34c1855b-0736-e511-80c8-005056b8008e">Archbishop</option>
<option value="b68763c9-ed7f-e611-80d9-005056b8008e">Archbishop Emeritus</option>
<option value="36c1855b-0736-e511-80c8-005056b8008e">Baron</option>
<option value="38c1855b-0736-e511-80c8-005056b8008e">Baroness</option>
<option value="3ac1855b-0736-e511-80c8-005056b8008e">Bishop</option>
<option value="3cc1855b-0736-e511-80c8-005056b8008e">Brigadier</option>
<option value="3ec1855b-0736-e511-80c8-005056b8008e">Brigadier General</option>
<option value="40c1855b-0736-e511-80c8-005056b8008e">Brother</option>
<option value="42c1855b-0736-e511-80c8-005056b8008e">Candidate</option>
<option value="44c1855b-0736-e511-80c8-005056b8008e">Candidate Officer</option>
<option value="46c1855b-0736-e511-80c8-005056b8008e">Captain</option>
<option value="d73b5d5a-5f85-eb11-8110-005056b8008e">Captain (SA Navy)</option>
<option value="48c1855b-0736-e511-80c8-005056b8008e">Chaplain</option>
<option value="4ac1855b-0736-e511-80c8-005056b8008e">Chief Justice</option>
<option value="4cc1855b-0736-e511-80c8-005056b8008e">Colonel</option>
<option value="4ec1855b-0736-e511-80c8-005056b8008e">Commandant</option>
<option value="50c1855b-0736-e511-80c8-005056b8008e">Commandant-General</option>
<option value="52c1855b-0736-e511-80c8-005056b8008e">Commander</option>
<option value="54c1855b-0736-e511-80c8-005056b8008e">Commodore</option>
<option value="56c1855b-0736-e511-80c8-005056b8008e">Constable</option>
<option value="58c1855b-0736-e511-80c8-005056b8008e">Corporal</option>
<option value="5ac1855b-0736-e511-80c8-005056b8008e">Countess</option>
<option value="5cc1855b-0736-e511-80c8-005056b8008e">Director General</option>
<option value="5ec1855b-0736-e511-80c8-005056b8008e">Doctor/Docter</option>
<option value="60c1855b-0736-e511-80c8-005056b8008e">Dr Right Honourable</option>
<option value="62c1855b-0736-e511-80c8-005056b8008e">Dr The Honourable</option>
<option value="64c1855b-0736-e511-80c8-005056b8008e">Earl</option>
<option value="66c1855b-0736-e511-80c8-005056b8008e">Eminence</option>
<option value="68c1855b-0736-e511-80c8-005056b8008e">Ensign</option>
<option value="6ac1855b-0736-e511-80c8-005056b8008e">Father</option>
<option value="6cc1855b-0736-e511-80c8-005056b8008e">Field-Cornet</option>
<option value="6ec1855b-0736-e511-80c8-005056b8008e">Field-Marshal</option>
<option value="70c1855b-0736-e511-80c8-005056b8008e">General</option>
<option value="72c1855b-0736-e511-80c8-005056b8008e">Governor</option>
<option value="74c1855b-0736-e511-80c8-005056b8008e">Governor-General</option>
<option value="76c1855b-0736-e511-80c8-005056b8008e">Honourable</option>
<option value="78c1855b-0736-e511-80c8-005056b8008e">Judge</option>
<option value="7ac1855b-0736-e511-80c8-005056b8008e">Judge President</option>
<option value="f092308f-b068-e811-80f0-005056b8008e">Lady</option>
<option value="7cc1855b-0736-e511-80c8-005056b8008e">Lance-Corporal</option>
<option value="7ec1855b-0736-e511-80c8-005056b8008e">Lieutenant</option>
<option value="84c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Colonel</option>
<option value="80c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Commander</option>
<option value="82c1855b-0736-e511-80c8-005056b8008e">Lieutenant-General</option>
<option value="ab350689-b068-e811-80f0-005056b8008e">Lord</option>
<option value="86c1855b-0736-e511-80c8-005056b8008e">Madame</option>
<option value="8cc1855b-0736-e511-80c8-005056b8008e">Maj-Genl</option>
<option value="88c1855b-0736-e511-80c8-005056b8008e">Major</option>
<option value="8ac1855b-0736-e511-80c8-005056b8008e">Major-General</option>
<option value="8ec1855b-0736-e511-80c8-005056b8008e">Midshipman</option>
<option value="90c1855b-0736-e511-80c8-005056b8008e">Minister</option>
<option value="92c1855b-0736-e511-80c8-005056b8008e">Miss</option>
<option value="96c1855b-0736-e511-80c8-005056b8008e">Mr</option>
<option value="94c1855b-0736-e511-80c8-005056b8008e">Mrs</option>
<option value="98c1855b-0736-e511-80c8-005056b8008e">Ms</option>
<option value="2e04d2a8-ed7f-e611-80d9-005056b8008e">Mx</option>
<option value="9ac1855b-0736-e511-80c8-005056b8008e">Pastor</option>
<option value="9cc1855b-0736-e511-80c8-005056b8008e">President</option>
<option value="9ec1855b-0736-e511-80c8-005056b8008e">Prince</option>
<option value="a0c1855b-0736-e511-80c8-005056b8008e">Princess</option>
<option value="a2c1855b-0736-e511-80c8-005056b8008e">Private</option>
<option value="a6c1855b-0736-e511-80c8-005056b8008e">Prof Dr</option>
<option value="a4c1855b-0736-e511-80c8-005056b8008e">Professor</option>
<option value="a8c1855b-0736-e511-80c8-005056b8008e">Rear-Admiral</option>
<option value="aac1855b-0736-e511-80c8-005056b8008e">Reverand</option>
<option value="2ac1855b-0736-e511-80c8-005056b8008e">2nd Lieutenant</option>
<option value="acc1855b-0736-e511-80c8-005056b8008e">Reverend</option>
<option value="aec1855b-0736-e511-80c8-005056b8008e">Right Honourable</option>
<option value="b0c1855b-0736-e511-80c8-005056b8008e">Senator</option>
<option value="2cc1855b-0736-e511-80c8-005056b8008e">Adjudant</option>
<option value="b2c1855b-0736-e511-80c8-005056b8008e">Sergeant</option>
<option value="b4c1855b-0736-e511-80c8-005056b8008e">Sergeant-Major</option>
<option value="b6c1855b-0736-e511-80c8-005056b8008e">Sir</option>
<option value="b8c1855b-0736-e511-80c8-005056b8008e">Sister</option>
<option value="bac1855b-0736-e511-80c8-005056b8008e">Sub-Lieutenant</option>
<option value="2ec1855b-0736-e511-80c8-005056b8008e">Adjudant-General</option>
<option value="bcc1855b-0736-e511-80c8-005056b8008e">The Honourable</option>
<option value="32c1855b-0736-e511-80c8-005056b8008e">Advocate</option>
<option value="34c1855b-0736-e511-80c8-005056b8008e">Archbishop</option>
<option value="bec1855b-0736-e511-80c8-005056b8008e">Unknown</option>
<option value="b68763c9-ed7f-e611-80d9-005056b8008e">Archbishop Emeritus</option>
<option value="c0c1855b-0736-e511-80c8-005056b8008e">Vise-Admiral</option>
<option value="36c1855b-0736-e511-80c8-005056b8008e">Baron</option>
<option value="c2c1855b-0736-e511-80c8-005056b8008e">Warrant Officer</option>
<option value="38c1855b-0736-e511-80c8-005056b8008e">Baroness</option>
<option value="3ac1855b-0736-e511-80c8-005056b8008e">Bishop</option>
<option value="3cc1855b-0736-e511-80c8-005056b8008e">Brigadier</option>
<option value="3ec1855b-0736-e511-80c8-005056b8008e">Brigadier General</option>
<option value="40c1855b-0736-e511-80c8-005056b8008e">Brother</option>
<option value="42c1855b-0736-e511-80c8-005056b8008e">Candidate</option>
<option value="44c1855b-0736-e511-80c8-005056b8008e">Candidate Officer</option>
<option value="46c1855b-0736-e511-80c8-005056b8008e">Captain</option>
<option value="d73b5d5a-5f85-eb11-8110-005056b8008e">Captain (SA Navy)</option>
<option value="48c1855b-0736-e511-80c8-005056b8008e">Chaplain</option>
<option value="4ac1855b-0736-e511-80c8-005056b8008e">Chief Justice</option>
<option value="4cc1855b-0736-e511-80c8-005056b8008e">Colonel</option>
<option value="4ec1855b-0736-e511-80c8-005056b8008e">Commandant</option>
<option value="50c1855b-0736-e511-80c8-005056b8008e">Commandant-General</option>
<option value="52c1855b-0736-e511-80c8-005056b8008e">Commander</option>
<option value="54c1855b-0736-e511-80c8-005056b8008e">Commodore</option>
<option value="56c1855b-0736-e511-80c8-005056b8008e">Constable</option>
<option value="58c1855b-0736-e511-80c8-005056b8008e">Corporal</option>
<option value="5ac1855b-0736-e511-80c8-005056b8008e">Countess</option>
<option value="5cc1855b-0736-e511-80c8-005056b8008e">Director General</option>
<option value="5ec1855b-0736-e511-80c8-005056b8008e">Doctor/Docter</option>
<option value="60c1855b-0736-e511-80c8-005056b8008e">Dr Right Honourable</option>
<option value="62c1855b-0736-e511-80c8-005056b8008e">Dr The Honourable</option>
<option value="64c1855b-0736-e511-80c8-005056b8008e">Earl</option>
<option value="66c1855b-0736-e511-80c8-005056b8008e">Eminence</option>
<option value="68c1855b-0736-e511-80c8-005056b8008e">Ensign</option>
<option value="6ac1855b-0736-e511-80c8-005056b8008e">Father</option>
<option value="6cc1855b-0736-e511-80c8-005056b8008e">Field-Cornet</option>
<option value="6ec1855b-0736-e511-80c8-005056b8008e">Field-Marshal</option>
<option value="70c1855b-0736-e511-80c8-005056b8008e">General</option>
<option value="72c1855b-0736-e511-80c8-005056b8008e">Governor</option>
<option value="74c1855b-0736-e511-80c8-005056b8008e">Governor-General</option>
<option value="76c1855b-0736-e511-80c8-005056b8008e">Honourable</option>
<option value="78c1855b-0736-e511-80c8-005056b8008e">Judge</option>
<option value="7ac1855b-0736-e511-80c8-005056b8008e">Judge President</option>
<option value="f092308f-b068-e811-80f0-005056b8008e">Lady</option>
<option value="7cc1855b-0736-e511-80c8-005056b8008e">Lance-Corporal</option>
<option value="7ec1855b-0736-e511-80c8-005056b8008e">Lieutenant</option>
<option value="84c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Colonel</option>
<option value="80c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Commander</option>
<option value="82c1855b-0736-e511-80c8-005056b8008e">Lieutenant-General</option>
<option value="ab350689-b068-e811-80f0-005056b8008e">Lord</option>
<option value="86c1855b-0736-e511-80c8-005056b8008e">Madame</option>
<option value="8cc1855b-0736-e511-80c8-005056b8008e">Maj-Genl</option>
<option value="88c1855b-0736-e511-80c8-005056b8008e">Major</option>
<option value="8ac1855b-0736-e511-80c8-005056b8008e">Major-General</option>
<option value="8ec1855b-0736-e511-80c8-005056b8008e">Midshipman</option>
<option value="90c1855b-0736-e511-80c8-005056b8008e">Minister</option>
<option value="92c1855b-0736-e511-80c8-005056b8008e">Miss</option>
<option value="96c1855b-0736-e511-80c8-005056b8008e">Mr</option>
<option value="94c1855b-0736-e511-80c8-005056b8008e">Mrs</option>
<option value="98c1855b-0736-e511-80c8-005056b8008e">Ms</option>
<option value="2e04d2a8-ed7f-e611-80d9-005056b8008e">Mx</option>
<option value="9ac1855b-0736-e511-80c8-005056b8008e">Pastor</option>
<option value="9cc1855b-0736-e511-80c8-005056b8008e">President</option>
<option value="9ec1855b-0736-e511-80c8-005056b8008e">Prince</option>
<option value="a0c1855b-0736-e511-80c8-005056b8008e">Princess</option>
<option value="a2c1855b-0736-e511-80c8-005056b8008e">Private</option>
<option value="a6c1855b-0736-e511-80c8-005056b8008e">Prof Dr</option>
<option value="a4c1855b-0736-e511-80c8-005056b8008e">Professor</option>
<option value="a8c1855b-0736-e511-80c8-005056b8008e">Rear-Admiral</option>
<option value="aac1855b-0736-e511-80c8-005056b8008e">Reverand</option>
<option value="acc1855b-0736-e511-80c8-005056b8008e">Reverend</option>
<option value="aec1855b-0736-e511-80c8-005056b8008e">Right Honourable</option>
<option value="b0c1855b-0736-e511-80c8-005056b8008e">Senator</option>
<option value="b2c1855b-0736-e511-80c8-005056b8008e">Sergeant</option>
<option value="b4c1855b-0736-e511-80c8-005056b8008e">Sergeant-Major</option>
<option value="b6c1855b-0736-e511-80c8-005056b8008e">Sir</option>
<option value="b8c1855b-0736-e511-80c8-005056b8008e">Sister</option>
<option value="bac1855b-0736-e511-80c8-005056b8008e">Sub-Lieutenant</option>
<option value="bcc1855b-0736-e511-80c8-005056b8008e">The Honourable</option>
<option value="bec1855b-0736-e511-80c8-005056b8008e">Unknown</option>
<option value="c0c1855b-0736-e511-80c8-005056b8008e">Vise-Admiral</option>
<option value="c2c1855b-0736-e511-80c8-005056b8008e">Warrant Officer</option>
<option value="2ac1855b-0736-e511-80c8-005056b8008e">2nd Lieutenant</option>
<option value="2cc1855b-0736-e511-80c8-005056b8008e">Adjudant</option>
<option value="2ec1855b-0736-e511-80c8-005056b8008e">Adjudant-General</option>
<option value="32c1855b-0736-e511-80c8-005056b8008e">Advocate</option>
<option value="34c1855b-0736-e511-80c8-005056b8008e">Archbishop</option>
<option value="b68763c9-ed7f-e611-80d9-005056b8008e">Archbishop Emeritus</option>
<option value="36c1855b-0736-e511-80c8-005056b8008e">Baron</option>
<option value="38c1855b-0736-e511-80c8-005056b8008e">Baroness</option>
<option value="3ac1855b-0736-e511-80c8-005056b8008e">Bishop</option>
<option value="3cc1855b-0736-e511-80c8-005056b8008e">Brigadier</option>
<option value="3ec1855b-0736-e511-80c8-005056b8008e">Brigadier General</option>
<option value="40c1855b-0736-e511-80c8-005056b8008e">Brother</option>
<option value="42c1855b-0736-e511-80c8-005056b8008e">Candidate</option>
<option value="44c1855b-0736-e511-80c8-005056b8008e">Candidate Officer</option>
<option value="46c1855b-0736-e511-80c8-005056b8008e">Captain</option>
<option value="d73b5d5a-5f85-eb11-8110-005056b8008e">Captain (SA Navy)</option>
<option value="48c1855b-0736-e511-80c8-005056b8008e">Chaplain</option>
<option value="4ac1855b-0736-e511-80c8-005056b8008e">Chief Justice</option>
<option value="4cc1855b-0736-e511-80c8-005056b8008e">Colonel</option>
<option value="4ec1855b-0736-e511-80c8-005056b8008e">Commandant</option>
<option value="50c1855b-0736-e511-80c8-005056b8008e">Commandant-General</option>
<option value="52c1855b-0736-e511-80c8-005056b8008e">Commander</option>
<option value="54c1855b-0736-e511-80c8-005056b8008e">Commodore</option>
<option value="56c1855b-0736-e511-80c8-005056b8008e">Constable</option>
<option value="58c1855b-0736-e511-80c8-005056b8008e">Corporal</option>
<option value="5ac1855b-0736-e511-80c8-005056b8008e">Countess</option>
<option value="5cc1855b-0736-e511-80c8-005056b8008e">Director General</option>
<option value="5ec1855b-0736-e511-80c8-005056b8008e">Doctor/Docter</option>
<option value="60c1855b-0736-e511-80c8-005056b8008e">Dr Right Honourable</option>
<option value="62c1855b-0736-e511-80c8-005056b8008e">Dr The Honourable</option>
<option value="64c1855b-0736-e511-80c8-005056b8008e">Earl</option>
<option value="66c1855b-0736-e511-80c8-005056b8008e">Eminence</option>
<option value="68c1855b-0736-e511-80c8-005056b8008e">Ensign</option>
<option value="6ac1855b-0736-e511-80c8-005056b8008e">Father</option>
<option value="6cc1855b-0736-e511-80c8-005056b8008e">Field-Cornet</option>
<option value="6ec1855b-0736-e511-80c8-005056b8008e">Field-Marshal</option>
<option value="70c1855b-0736-e511-80c8-005056b8008e">General</option>
<option value="72c1855b-0736-e511-80c8-005056b8008e">Governor</option>
<option value="74c1855b-0736-e511-80c8-005056b8008e">Governor-General</option>
<option value="76c1855b-0736-e511-80c8-005056b8008e">Honourable</option>
<option value="78c1855b-0736-e511-80c8-005056b8008e">Judge</option>
<option value="7ac1855b-0736-e511-80c8-005056b8008e">Judge President</option>
<option value="f092308f-b068-e811-80f0-005056b8008e">Lady</option>
<option value="7cc1855b-0736-e511-80c8-005056b8008e">Lance-Corporal</option>
<option value="7ec1855b-0736-e511-80c8-005056b8008e">Lieutenant</option>
<option value="84c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Colonel</option>
<option value="80c1855b-0736-e511-80c8-005056b8008e">Lieutenant-Commander</option>
<option value="82c1855b-0736-e511-80c8-005056b8008e">Lieutenant-General</option>
<option value="ab350689-b068-e811-80f0-005056b8008e">Lord</option>
<option value="86c1855b-0736-e511-80c8-005056b8008e">Madame</option>
<option value="8cc1855b-0736-e511-80c8-005056b8008e">Maj-Genl</option>
<option value="88c1855b-0736-e511-80c8-005056b8008e">Major</option>
<option value="8ac1855b-0736-e511-80c8-005056b8008e">Major-General</option>
<option value="8ec1855b-0736-e511-80c8-005056b8008e">Midshipman</option>
<option value="90c1855b-0736-e511-80c8-005056b8008e">Minister</option>
<option value="92c1855b-0736-e511-80c8-005056b8008e">Miss</option>
<option value="96c1855b-0736-e511-80c8-005056b8008e">Mr</option>
<option value="94c1855b-0736-e511-80c8-005056b8008e">Mrs</option>
<option value="98c1855b-0736-e511-80c8-005056b8008e">Ms</option>
<option value="2e04d2a8-ed7f-e611-80d9-005056b8008e">Mx</option>
<option value="9ac1855b-0736-e511-80c8-005056b8008e">Pastor</option>
<option value="9cc1855b-0736-e511-80c8-005056b8008e">President</option>
<option value="9ec1855b-0736-e511-80c8-005056b8008e">Prince</option>
<option value="a0c1855b-0736-e511-80c8-005056b8008e">Princess</option>
<option value="a2c1855b-0736-e511-80c8-005056b8008e">Private</option>
<option value="a6c1855b-0736-e511-80c8-005056b8008e">Prof Dr</option>
<option value="a4c1855b-0736-e511-80c8-005056b8008e">Professor</option>
<option value="a8c1855b-0736-e511-80c8-005056b8008e">Rear-Admiral</option>
<option value="aac1855b-0736-e511-80c8-005056b8008e">Reverand</option>
<option value="acc1855b-0736-e511-80c8-005056b8008e">Reverend</option>
<option value="aec1855b-0736-e511-80c8-005056b8008e">Right Honourable</option>
<option value="b0c1855b-0736-e511-80c8-005056b8008e">Senator</option>
<option value="b2c1855b-0736-e511-80c8-005056b8008e">Sergeant</option>
<option value="b4c1855b-0736-e511-80c8-005056b8008e">Sergeant-Major</option>
<option value="b6c1855b-0736-e511-80c8-005056b8008e">Sir</option>
<option value="b8c1855b-0736-e511-80c8-005056b8008e">Sister</option>
<option value="bac1855b-0736-e511-80c8-005056b8008e">Sub-Lieutenant</option>
<option value="bcc1855b-0736-e511-80c8-005056b8008e">The Honourable</option>
<option value="bec1855b-0736-e511-80c8-005056b8008e">Unknown</option>
<option value="c0c1855b-0736-e511-80c8-005056b8008e">Vise-Admiral</option>
<option value="c2c1855b-0736-e511-80c8-005056b8008e">Warrant Officer</option>
</select>
</div>
<div>
<label for="Gender">Gender</label>
<span class="required">*</span><br>
<select data-val="true" data-val-required="The Gender field is required." id="gender" name="Gender">
<option value="">< Select Option ></option>
<option value="2ff8e63b-0a36-e511-80c8-005056b8008e">Female</option>
<option value="31f8e63b-0a36-e511-80c8-005056b8008e">Male</option>
<option value="a2539194-3246-e711-80dc-005056b8008e">Non Binary</option>
<option value="2ff8e63b-0a36-e511-80c8-005056b8008e">Female</option>
<option value="31f8e63b-0a36-e511-80c8-005056b8008e">Male</option>
<option value="a2539194-3246-e711-80dc-005056b8008e">Non Binary</option>
<option value="2ff8e63b-0a36-e511-80c8-005056b8008e">Female</option>
<option value="31f8e63b-0a36-e511-80c8-005056b8008e">Male</option>
<option value="a2539194-3246-e711-80dc-005056b8008e">Non Binary</option>
</select>
</div>
<div>
<label for="Nationality">Nationality</label>
<span class="required">*</span><br>
<select data-val="true" data-val-required="The Nationality field is required." id="nationality" name="Nationality">
<option value="">< Select Option ></option>
<option value="3b89e0e1-0736-e511-80c8-005056b8008e">South Africa</option>
<option value="c587e0e1-0736-e511-80c8-005056b8008e">Afghanistan</option>
<option value="c787e0e1-0736-e511-80c8-005056b8008e">Albania</option>
<option value="c987e0e1-0736-e511-80c8-005056b8008e">Algeria</option>
<option value="cb87e0e1-0736-e511-80c8-005056b8008e">All Nationalities Except Rsa</option>
<option value="cd87e0e1-0736-e511-80c8-005056b8008e">American Samoa</option>
<option value="cf87e0e1-0736-e511-80c8-005056b8008e">Angola</option>
<option value="d187e0e1-0736-e511-80c8-005056b8008e">Antigua</option>
<option value="d387e0e1-0736-e511-80c8-005056b8008e">Argentina</option>
<option value="d587e0e1-0736-e511-80c8-005056b8008e">Armenia</option>
<option value="d787e0e1-0736-e511-80c8-005056b8008e">Australia</option>
<option value="d987e0e1-0736-e511-80c8-005056b8008e">Austria</option>
<option value="db87e0e1-0736-e511-80c8-005056b8008e">Bahamas</option>
<option value="dd87e0e1-0736-e511-80c8-005056b8008e">Bahrain</option>
<option value="df87e0e1-0736-e511-80c8-005056b8008e">Bangladesh</option>
<option value="e187e0e1-0736-e511-80c8-005056b8008e">Barbados</option>
<option value="e387e0e1-0736-e511-80c8-005056b8008e">Belgium</option>
<option value="e587e0e1-0736-e511-80c8-005056b8008e">Belize</option>
<option value="06b75206-c3fc-e611-80da-005056b8008e">Benin</option>
<option value="e787e0e1-0736-e511-80c8-005056b8008e">Bermuda</option>
<option value="b65437c9-7faa-ec11-8115-005056b8008e">Bhutan</option>
<option value="e987e0e1-0736-e511-80c8-005056b8008e">Bolivia</option>
<option value="eb87e0e1-0736-e511-80c8-005056b8008e">Bophuthatswana</option>
<option value="ed87e0e1-0736-e511-80c8-005056b8008e">Borneo</option>
<option value="ef87e0e1-0736-e511-80c8-005056b8008e">Botswana</option>
<option value="f187e0e1-0736-e511-80c8-005056b8008e">Brazil</option>
<option value="f387e0e1-0736-e511-80c8-005056b8008e">British Virgin Island</option>
<option value="f587e0e1-0736-e511-80c8-005056b8008e">Bulgaria</option>
<option value="f787e0e1-0736-e511-80c8-005056b8008e">Burkina Vaso</option>
<option value="f987e0e1-0736-e511-80c8-005056b8008e">Burma</option>
<option value="fb87e0e1-0736-e511-80c8-005056b8008e">Burundi</option>
<option value="fd87e0e1-0736-e511-80c8-005056b8008e">Cambodia</option>
<option value="ff87e0e1-0736-e511-80c8-005056b8008e">Cameroon</option>
<option value="0188e0e1-0736-e511-80c8-005056b8008e">Canada</option>
<option value="0388e0e1-0736-e511-80c8-005056b8008e">Cape Verde Islands</option>
<option value="0588e0e1-0736-e511-80c8-005056b8008e">Cayman Island</option>
<option value="0788e0e1-0736-e511-80c8-005056b8008e">Central African Republic</option>
<option value="0988e0e1-0736-e511-80c8-005056b8008e">Central African Republic</option>
<option value="0b88e0e1-0736-e511-80c8-005056b8008e">Chad</option>
<option value="0d88e0e1-0736-e511-80c8-005056b8008e">Chile</option>
<option value="0f88e0e1-0736-e511-80c8-005056b8008e">China</option>
<option value="1188e0e1-0736-e511-80c8-005056b8008e">Christmas Island</option>
<option value="1388e0e1-0736-e511-80c8-005056b8008e">Ciskei</option>
<option value="1588e0e1-0736-e511-80c8-005056b8008e">Cocos Island</option>
<option value="1788e0e1-0736-e511-80c8-005056b8008e">Columbia</option>
<option value="1988e0e1-0736-e511-80c8-005056b8008e">Comores</option>
<option value="1b88e0e1-0736-e511-80c8-005056b8008e">Congo</option>
<option value="1d88e0e1-0736-e511-80c8-005056b8008e">Congo</option>
<option value="1f88e0e1-0736-e511-80c8-005056b8008e">Cook Island</option>
<option value="2188e0e1-0736-e511-80c8-005056b8008e">CostaRica</option>
<option value="2388e0e1-0736-e511-80c8-005056b8008e">Countries In Asia</option>
<option value="2588e0e1-0736-e511-80c8-005056b8008e">Countries In Australasia And Oceania</option>
<option value="2788e0e1-0736-e511-80c8-005056b8008e">Countries In Europe</option>
<option value="2988e0e1-0736-e511-80c8-005056b8008e">Countries In North America</option>
<option value="2b88e0e1-0736-e511-80c8-005056b8008e">Countries In South America</option>
<option value="2d88e0e1-0736-e511-80c8-005056b8008e">Croasia</option>
<option value="2f88e0e1-0736-e511-80c8-005056b8008e">Cuba</option>
<option value="3188e0e1-0736-e511-80c8-005056b8008e">Cyprus</option>
<option value="c3992398-0be0-e711-80ec-005056b8008e">Czech Republic</option>
<option value="3388e0e1-0736-e511-80c8-005056b8008e">Czechoslovakia</option>
<option value="3588e0e1-0736-e511-80c8-005056b8008e">Democratic Republic Of Congo</option>
<option value="3788e0e1-0736-e511-80c8-005056b8008e">Democratic Republic Of Congo</option>
<option value="3988e0e1-0736-e511-80c8-005056b8008e">Denmark</option>
<option value="79dbd553-298a-e611-80d9-005056b8008e">Djibouti</option>
<option value="3b88e0e1-0736-e511-80c8-005056b8008e">Dominica</option>
<option value="3d88e0e1-0736-e511-80c8-005056b8008e">Dominican Republic</option>
<option value="3f88e0e1-0736-e511-80c8-005056b8008e">East Germany</option>
<option value="4188e0e1-0736-e511-80c8-005056b8008e">East Malaysian Sabah</option>
<option value="4388e0e1-0736-e511-80c8-005056b8008e">East Malaysian Sarawak</option>
<option value="4588e0e1-0736-e511-80c8-005056b8008e">Ecuador</option>
<option value="4788e0e1-0736-e511-80c8-005056b8008e">Egypt</option>
<option value="4988e0e1-0736-e511-80c8-005056b8008e">El Salvador</option>
<option value="04116f5e-298a-e611-80d9-005056b8008e">Equatorial Guinea</option>
<option value="4b88e0e1-0736-e511-80c8-005056b8008e">Eritrea</option>
<option value="4d88e0e1-0736-e511-80c8-005056b8008e">Estland</option>
<option value="4f88e0e1-0736-e511-80c8-005056b8008e">Ethiopia</option>
<option value="5188e0e1-0736-e511-80c8-005056b8008e">Falkland Islands</option>
<option value="5388e0e1-0736-e511-80c8-005056b8008e">Faroe Islands</option>
<option value="5588e0e1-0736-e511-80c8-005056b8008e">Fiji</option>
<option value="5788e0e1-0736-e511-80c8-005056b8008e">Finland</option>
<option value="5988e0e1-0736-e511-80c8-005056b8008e">France</option>
<option value="5b88e0e1-0736-e511-80c8-005056b8008e">French Guyana</option>
<option value="5d88e0e1-0736-e511-80c8-005056b8008e">French Polynesia</option>
<option value="5f88e0e1-0736-e511-80c8-005056b8008e">Gabon</option>
<option value="6188e0e1-0736-e511-80c8-005056b8008e">Gambia</option>
<option value="6388e0e1-0736-e511-80c8-005056b8008e">Gazankulu</option>
<option value="6588e0e1-0736-e511-80c8-005056b8008e">Germany</option>
<option value="6788e0e1-0736-e511-80c8-005056b8008e">Ghana</option>
<option value="6988e0e1-0736-e511-80c8-005056b8008e">Gibraltar</option>
<option value="6b88e0e1-0736-e511-80c8-005056b8008e">Greece</option>
<option value="6d88e0e1-0736-e511-80c8-005056b8008e">Greenland</option>
<option value="6f88e0e1-0736-e511-80c8-005056b8008e">Grenada</option>
<option value="7188e0e1-0736-e511-80c8-005056b8008e">Guadeloupe</option>
<option value="7388e0e1-0736-e511-80c8-005056b8008e">Guam</option>
<option value="7588e0e1-0736-e511-80c8-005056b8008e">Guatemala</option>
<option value="7788e0e1-0736-e511-80c8-005056b8008e">Guinea</option>
<option value="7988e0e1-0736-e511-80c8-005056b8008e">Guinea Bissau</option>
<option value="7b88e0e1-0736-e511-80c8-005056b8008e">Guyana</option>
<option value="7d88e0e1-0736-e511-80c8-005056b8008e">Haiti</option>
<option value="7f88e0e1-0736-e511-80c8-005056b8008e">Honduras</option>
<option value="8188e0e1-0736-e511-80c8-005056b8008e">HongKong</option>
<option value="8388e0e1-0736-e511-80c8-005056b8008e">Hungary</option>
<option value="8588e0e1-0736-e511-80c8-005056b8008e">Iceland</option>
<option value="8788e0e1-0736-e511-80c8-005056b8008e">India</option>
<option value="8988e0e1-0736-e511-80c8-005056b8008e">Indonesia</option>
<option value="8b88e0e1-0736-e511-80c8-005056b8008e">Iran</option>
<option value="8d88e0e1-0736-e511-80c8-005056b8008e">Iraq</option>
<option value="8f88e0e1-0736-e511-80c8-005056b8008e">Ireland</option>
<option value="9188e0e1-0736-e511-80c8-005056b8008e">Isle Of Man</option>
<option value="9388e0e1-0736-e511-80c8-005056b8008e">Israel</option>
<option value="9588e0e1-0736-e511-80c8-005056b8008e">Italy</option>
<option value="9788e0e1-0736-e511-80c8-005056b8008e">Ivory Coast</option>
<option value="9988e0e1-0736-e511-80c8-005056b8008e">Jamaica</option>
<option value="9b88e0e1-0736-e511-80c8-005056b8008e">Japan</option>
<option value="9d88e0e1-0736-e511-80c8-005056b8008e">Jordan</option>
<option value="9f88e0e1-0736-e511-80c8-005056b8008e">Kangwane</option>
<option value="a188e0e1-0736-e511-80c8-005056b8008e">Kazakhstan</option>
<option value="a388e0e1-0736-e511-80c8-005056b8008e">Kenya</option>
<option value="a588e0e1-0736-e511-80c8-005056b8008e">Kuwait</option>
<option value="a788e0e1-0736-e511-80c8-005056b8008e">Kwandebele</option>
<option value="a988e0e1-0736-e511-80c8-005056b8008e">Kwazulu</option>
<option value="ab88e0e1-0736-e511-80c8-005056b8008e">Laos</option>
<option value="ad88e0e1-0736-e511-80c8-005056b8008e">Lebanon</option>
<option value="af88e0e1-0736-e511-80c8-005056b8008e">Lebowa</option>
<option value="b188e0e1-0736-e511-80c8-005056b8008e">Lesotho</option>
<option value="b388e0e1-0736-e511-80c8-005056b8008e">Letland</option>
<option value="b588e0e1-0736-e511-80c8-005056b8008e">Liberia</option>
<option value="b788e0e1-0736-e511-80c8-005056b8008e">Libya</option>
<option value="b988e0e1-0736-e511-80c8-005056b8008e">Lichtenstein</option>
<option value="bb88e0e1-0736-e511-80c8-005056b8008e">Litaue</option>
<option value="bd88e0e1-0736-e511-80c8-005056b8008e">Luxembourg</option>
<option value="bf88e0e1-0736-e511-80c8-005056b8008e">Macao</option>
<option value="c188e0e1-0736-e511-80c8-005056b8008e">Madagascar</option>
<option value="c388e0e1-0736-e511-80c8-005056b8008e">Malawi</option>
<option value="c588e0e1-0736-e511-80c8-005056b8008e">Malaysia</option>
<option value="c788e0e1-0736-e511-80c8-005056b8008e">Maldives</option>
<option value="c988e0e1-0736-e511-80c8-005056b8008e">Mali</option>
<option value="cb88e0e1-0736-e511-80c8-005056b8008e">Malta</option>
<option value="cd88e0e1-0736-e511-80c8-005056b8008e">Martinique</option>
<option value="cf88e0e1-0736-e511-80c8-005056b8008e">Mauritania</option>
<option value="d188e0e1-0736-e511-80c8-005056b8008e">Mauritius</option>
<option value="d388e0e1-0736-e511-80c8-005056b8008e">Mexico</option>
<option value="d588e0e1-0736-e511-80c8-005056b8008e">Monaco</option>
<option value="d788e0e1-0736-e511-80c8-005056b8008e">Mongolia</option>
<option value="d988e0e1-0736-e511-80c8-005056b8008e">Montserrat</option>
<option value="db88e0e1-0736-e511-80c8-005056b8008e">Morocco</option>
<option value="dd88e0e1-0736-e511-80c8-005056b8008e">Mozambique</option>
<option value="df88e0e1-0736-e511-80c8-005056b8008e">Namibia</option>
<option value="e188e0e1-0736-e511-80c8-005056b8008e">Nauro</option>
<option value="e388e0e1-0736-e511-80c8-005056b8008e">Nepal</option>
<option value="e588e0e1-0736-e511-80c8-005056b8008e">Netherlands</option>
<option value="e788e0e1-0736-e511-80c8-005056b8008e">Netherlands Antille</option>
<option value="e988e0e1-0736-e511-80c8-005056b8008e">New Caledonia</option>
<option value="eb88e0e1-0736-e511-80c8-005056b8008e">New Guinea</option>
<option value="ed88e0e1-0736-e511-80c8-005056b8008e">New Zealand</option>
<option value="ef88e0e1-0736-e511-80c8-005056b8008e">Nicaragua</option>
<option value="f188e0e1-0736-e511-80c8-005056b8008e">Niger</option>
<option value="f388e0e1-0736-e511-80c8-005056b8008e">Nigeri</option>
<option value="f588e0e1-0736-e511-80c8-005056b8008e">Nigeria</option>
<option value="f788e0e1-0736-e511-80c8-005056b8008e">Norfolk Island</option>
<option value="f988e0e1-0736-e511-80c8-005056b8008e">North Korea</option>
<option value="fb88e0e1-0736-e511-80c8-005056b8008e">North Vietnam</option>
<option value="fd88e0e1-0736-e511-80c8-005056b8008e">Norway</option>
<option value="ff88e0e1-0736-e511-80c8-005056b8008e">Oman</option>
<option value="0189e0e1-0736-e511-80c8-005056b8008e">Other Countries In Africa</option>
<option value="0389e0e1-0736-e511-80c8-005056b8008e">Pakistan</option>
<option value="0589e0e1-0736-e511-80c8-005056b8008e">Palestine</option>
<option value="0789e0e1-0736-e511-80c8-005056b8008e">Panama</option>
<option value="0989e0e1-0736-e511-80c8-005056b8008e">Panama Canal Zone</option>
<option value="0b89e0e1-0736-e511-80c8-005056b8008e">Paraguay</option>
<option value="0d89e0e1-0736-e511-80c8-005056b8008e">Peru</option>
<option value="0f89e0e1-0736-e511-80c8-005056b8008e">Philippines</option>
<option value="1189e0e1-0736-e511-80c8-005056b8008e">Pitcairn Island</option>
<option value="1389e0e1-0736-e511-80c8-005056b8008e">Poland</option>
<option value="1589e0e1-0736-e511-80c8-005056b8008e">Portugal</option>
<option value="1789e0e1-0736-e511-80c8-005056b8008e">Puerto Rico</option>
<option value="1989e0e1-0736-e511-80c8-005056b8008e">Qatar</option>
<option value="1b89e0e1-0736-e511-80c8-005056b8008e">Qwa Qwa</option>
<option value="1d89e0e1-0736-e511-80c8-005056b8008e">Reunion</option>
<option value="1f89e0e1-0736-e511-80c8-005056b8008e">Rodriques</option>
<option value="2189e0e1-0736-e511-80c8-005056b8008e">Romania</option>
<option value="2389e0e1-0736-e511-80c8-005056b8008e">Russia</option>
<option value="2589e0e1-0736-e511-80c8-005056b8008e">Rwanda</option>
<option value="2789e0e1-0736-e511-80c8-005056b8008e">Ryukyu</option>
<option value="2989e0e1-0736-e511-80c8-005056b8008e">San Marino</option>
<option value="5e663f66-298a-e611-80d9-005056b8008e">Sao Tome and Principe</option>
<option value="2b89e0e1-0736-e511-80c8-005056b8008e">Saudi Arabia</option>
<option value="2d89e0e1-0736-e511-80c8-005056b8008e">Senegal</option>
<option value="2f89e0e1-0736-e511-80c8-005056b8008e">Serbia And Montenegro</option>
<option value="3189e0e1-0736-e511-80c8-005056b8008e">Seychelles</option>
<option value="3389e0e1-0736-e511-80c8-005056b8008e">Sierra Leone</option>
<option value="3589e0e1-0736-e511-80c8-005056b8008e">Singapore</option>
<option value="3789e0e1-0736-e511-80c8-005056b8008e">Slovak Republic</option>
<option value="3989e0e1-0736-e511-80c8-005056b8008e">Somalia</option>
<option value="3d89e0e1-0736-e511-80c8-005056b8008e">South Korea</option>
<option value="3f89e0e1-0736-e511-80c8-005056b8008e">South Vietnam</option>
<option value="4189e0e1-0736-e511-80c8-005056b8008e">Spain</option>
<option value="4389e0e1-0736-e511-80c8-005056b8008e">Sri Lanka</option>
<option value="4589e0e1-0736-e511-80c8-005056b8008e">St. Helena</option>
<option value="4789e0e1-0736-e511-80c8-005056b8008e">St. Kitts-Nevis & Anqutlla</option>
<option value="4989e0e1-0736-e511-80c8-005056b8008e">St. Lycia</option>
<option value="4b89e0e1-0736-e511-80c8-005056b8008e">St. Pierre & Miquelon</option>
<option value="4d89e0e1-0736-e511-80c8-005056b8008e">St. Vincent</option>
<option value="4f89e0e1-0736-e511-80c8-005056b8008e">Sudan</option>
<option value="5189e0e1-0736-e511-80c8-005056b8008e">Suriname</option>
<option value="5389e0e1-0736-e511-80c8-005056b8008e">Swaziland</option>
<option value="5589e0e1-0736-e511-80c8-005056b8008e">Sweden</option>
<option value="5789e0e1-0736-e511-80c8-005056b8008e">Switzerland</option>
<option value="5989e0e1-0736-e511-80c8-005056b8008e">Syria</option>
<option value="5b89e0e1-0736-e511-80c8-005056b8008e">Taiwan</option>
<option value="5d89e0e1-0736-e511-80c8-005056b8008e">Tanzania</option>
<option value="5f89e0e1-0736-e511-80c8-005056b8008e">Thailand</option>
<option value="6189e0e1-0736-e511-80c8-005056b8008e">Togo</option>
<option value="6389e0e1-0736-e511-80c8-005056b8008e">Tokelau Island</option>
<option value="6589e0e1-0736-e511-80c8-005056b8008e">Tonga</option>
<option value="6789e0e1-0736-e511-80c8-005056b8008e">Transkei</option>
<option value="6989e0e1-0736-e511-80c8-005056b8008e">Trinidad & Tobago</option>
<option value="6b89e0e1-0736-e511-80c8-005056b8008e">Trucial States</option>
<option value="6d89e0e1-0736-e511-80c8-005056b8008e">Tunisia</option>
<option value="6f89e0e1-0736-e511-80c8-005056b8008e">Turkey</option>
<option value="7189e0e1-0736-e511-80c8-005056b8008e">Turkish & Caicas Islands</option>
<option value="7389e0e1-0736-e511-80c8-005056b8008e">UAR Egypt</option>
<option value="7589e0e1-0736-e511-80c8-005056b8008e">Uganda</option>
<option value="7789e0e1-0736-e511-80c8-005056b8008e">Ukrain</option>
<option value="7989e0e1-0736-e511-80c8-005056b8008e">Ukrain</option>
<option value="7b89e0e1-0736-e511-80c8-005056b8008e">United Arab Emirate</option>
<option value="7d89e0e1-0736-e511-80c8-005056b8008e">United Kingdom</option>
<option value="7f89e0e1-0736-e511-80c8-005056b8008e">United States Of America</option>
<option value="8189e0e1-0736-e511-80c8-005056b8008e">Upper Volta</option>
<option value="8389e0e1-0736-e511-80c8-005056b8008e">Uruguay</option>
<option value="8589e0e1-0736-e511-80c8-005056b8008e">Vatican</option>
<option value="8789e0e1-0736-e511-80c8-005056b8008e">Venda</option>
<option value="8989e0e1-0736-e511-80c8-005056b8008e">Venezuela</option>
<option value="8b89e0e1-0736-e511-80c8-005056b8008e">Vietnamese</option>
<option value="8d89e0e1-0736-e511-80c8-005056b8008e">Virgin Island USA</option>
<option value="8f89e0e1-0736-e511-80c8-005056b8008e">Wales</option>
<option value="9189e0e1-0736-e511-80c8-005056b8008e">West Germany</option>
<option value="9389e0e1-0736-e511-80c8-005056b8008e">West Samoa</option>
<option value="9589e0e1-0736-e511-80c8-005056b8008e">Yemen</option>
<option value="9789e0e1-0736-e511-80c8-005056b8008e">Yugoslavia</option>
<option value="9989e0e1-0736-e511-80c8-005056b8008e">Zambia</option>
<option value="9b89e0e1-0736-e511-80c8-005056b8008e">Zimbabwe</option>
</select>
</div>
<div class="personal-SA" style="display: none;">
<label for="Ethnicity">Ethnicity</label>
<span class="required">*</span><br>
<select id="ethnicity" name="Ethnicity">
<option value="">< Select Option ></option>
<option value="9a61f10c-0c36-e511-80c8-005056b8008e">African</option>
<option value="7613f0aa-3246-e711-80dc-005056b8008e">Asian</option>
<option value="9c61f10c-0c36-e511-80c8-005056b8008e">Coloured</option>
<option value="9e61f10c-0c36-e511-80c8-005056b8008e">Indian</option>
<option value="b2faedb7-3246-e711-80dc-005056b8008e">Prefer not to say</option>
<option value="a061f10c-0c36-e511-80c8-005056b8008e">White</option>
</select>
<span class="info"> Please select the ethnicity group you associate with.</span>
</div>
<div class="personal-nonSA">
<label for="Ethnicity">Ethnicity</label>
<span class="required">*</span><br>
<select id="ethnicityNonSA" name="EthnicityNonSA">
<option value="">< Select Option ></option>
<option value="9a61f10c-0c36-e511-80c8-005056b8008e">African</option>
<option value="9e61f10c-0c36-e511-80c8-005056b8008e">Asian</option>
<option value="a061f10c-0c36-e511-80c8-005056b8008e">Caucasian</option>
<option value="9c61f10c-0c36-e511-80c8-005056b8008e">Mixed</option>
<option value="9a61f10c-0c36-e511-80c8-005056b8008e">Other</option>
</select>
<span class="info"> Please select the ethnicity group you associate with.</span>
</div>
<div class="personal-SA" style="display: none;">
<label for="IdNumber">Identity Number</label>
<span class="required">*</span><br>
<input value="" id="identityNumber" name="IdNumber" type="text" autocomplete="off">
</div>
<label for="DateOfBirth">Date of Birth</label>
<span class="required">*</span><br>
<input data-val="true" data-val-date="The field Date of Birth must be a date." data-val-range=" Value for Date of Birth must be greater than 1900/01/01." data-val-range-max="01/01/2090 00:00:00"
data-val-range-min="01/01/1900 00:00:00" data-val-required="The Date of Birth field is required." id="dateOfBirth" name="DateOfBirth" type="text" value="01-01-0001" autocomplete="off" class="hasDatepicker">
<div class="personal-nonSA" id="foreignIdType">
<label for="ForeignIdType">Type of identification:</label>
<span class="required">*</span><br>
<select id="documentType" name="ForeignIdType">
<option value="">< Select Option ></option>
<option value="8812171e-0a36-e511-80c8-005056b8008e">Foreign Identification Number</option>
<option value="8a12171e-0a36-e511-80c8-005056b8008e">ID Number</option>
<option value="8c12171e-0a36-e511-80c8-005056b8008e">Passport Number</option>
<option value="8812171e-0a36-e511-80c8-005056b8008e">Foreign Identification Number</option>
<option value="8a12171e-0a36-e511-80c8-005056b8008e">ID Number</option>
<option value="8c12171e-0a36-e511-80c8-005056b8008e">Passport Number</option>
</select>
</div>
<div class="personal-nonSA1 personal-foreign" id="personal-foreign" style="display: none">
<label id="idType">< Select Option ></label>
<span class="required">*</span><br>
<input id="foreignIdNumber" name="ForeignIdNumber" type="text" value="" autocomplete="off"> <br>
<span style="color:#000;">Expiry date:<br></span>
<input data-val="true" data-val-date="The field Foreign Id Expiry Date must be a date." data-val-range=" Value for Foreign Id Expiry Date must be greater than 1900/01/01." data-val-range-max="01/01/2090 00:00:00"
data-val-range-min="01/01/1900 00:00:00" id="idExpiryDate" name="ForeignIdExpiryDate" type="text" value="" autocomplete="off" class="hasDatepicker">
</div>
<div>
<label for="Language">Home Language</label>
<span class="required">*</span><br>
<select data-val="true" data-val-required="The Home Language field is required." id="language" name="Language">
<option value="">< Select Option ></option>
<option value="19b7599a-0736-e511-80c8-005056b8008e">Afr/Eng</option>
<option value="1bb7599a-0736-e511-80c8-005056b8008e">Afrikaans</option>
<option value="1db7599a-0736-e511-80c8-005056b8008e">Arabic</option>
<option value="1fb7599a-0736-e511-80c8-005056b8008e">Bulgaric</option>
<option value="21b7599a-0736-e511-80c8-005056b8008e">Chichewa</option>
<option value="23b7599a-0736-e511-80c8-005056b8008e">Chinese</option>
<option value="25b7599a-0736-e511-80c8-005056b8008e">Czech</option>
<option value="27b7599a-0736-e511-80c8-005056b8008e">Damara</option>
<option value="19b7599a-0736-e511-80c8-005056b8008e">Afr/Eng</option>
<option value="29b7599a-0736-e511-80c8-005056b8008e">Danish</option>
<option value="1bb7599a-0736-e511-80c8-005056b8008e">Afrikaans</option>
<option value="2bb7599a-0736-e511-80c8-005056b8008e">Dutch</option>
<option value="1db7599a-0736-e511-80c8-005056b8008e">Arabic</option>
<option value="2db7599a-0736-e511-80c8-005056b8008e">Eastern</option>
<option value="1fb7599a-0736-e511-80c8-005056b8008e">Bulgaric</option>
<option value="2fb7599a-0736-e511-80c8-005056b8008e">English</option>
<option value="21b7599a-0736-e511-80c8-005056b8008e">Chichewa</option>
<option value="5d95207c-0ce0-e711-80ec-005056b8008e">Farsi
</option>
<option value="23b7599a-0736-e511-80c8-005056b8008e">Chinese</option>
<option value="25b7599a-0736-e511-80c8-005056b8008e">Czech</option>
<option value="31b7599a-0736-e511-80c8-005056b8008e">Finnish</option>
<option value="27b7599a-0736-e511-80c8-005056b8008e">Damara</option>
<option value="33b7599a-0736-e511-80c8-005056b8008e">Flemish</option>
<option value="29b7599a-0736-e511-80c8-005056b8008e">Danish</option>
<option value="2bb7599a-0736-e511-80c8-005056b8008e">Dutch</option>
<option value="35b7599a-0736-e511-80c8-005056b8008e">French</option>
<option value="2db7599a-0736-e511-80c8-005056b8008e">Eastern</option>
<option value="2fb7599a-0736-e511-80c8-005056b8008e">English</option>
<option value="37b7599a-0736-e511-80c8-005056b8008e">German</option>
<option value="5d95207c-0ce0-e711-80ec-005056b8008e">Farsi
</option>
<option value="31b7599a-0736-e511-80c8-005056b8008e">Finnish</option>
<option value="39b7599a-0736-e511-80c8-005056b8008e">Greek</option>
<option value="33b7599a-0736-e511-80c8-005056b8008e">Flemish</option>
<option value="35b7599a-0736-e511-80c8-005056b8008e">French</option>
<option value="3bb7599a-0736-e511-80c8-005056b8008e">Gujerati</option>
<option value="37b7599a-0736-e511-80c8-005056b8008e">German</option>
<option value="3db7599a-0736-e511-80c8-005056b8008e">Hebrew</option>
<option value="39b7599a-0736-e511-80c8-005056b8008e">Greek</option>
<option value="3fb7599a-0736-e511-80c8-005056b8008e">Herero</option>
<option value="3bb7599a-0736-e511-80c8-005056b8008e">Gujerati</option>
<option value="41b7599a-0736-e511-80c8-005056b8008e">Hindi</option>
<option value="3db7599a-0736-e511-80c8-005056b8008e">Hebrew</option>
<option value="43b7599a-0736-e511-80c8-005056b8008e">Hungarian</option>
<option value="3fb7599a-0736-e511-80c8-005056b8008e">Herero</option>
<option value="45b7599a-0736-e511-80c8-005056b8008e">Italian</option>
<option value="41b7599a-0736-e511-80c8-005056b8008e">Hindi</option>
<option value="47b7599a-0736-e511-80c8-005056b8008e">Japanese</option>
<option value="43b7599a-0736-e511-80c8-005056b8008e">Hungarian</option>
<option value="49b7599a-0736-e511-80c8-005056b8008e">Kikamba</option>
<option value="45b7599a-0736-e511-80c8-005056b8008e">Italian</option>
<option value="4bb7599a-0736-e511-80c8-005056b8008e">Korean</option>
<option value="4db7599a-0736-e511-80c8-005056b8008e">Lebanese</option>
<option value="4fb7599a-0736-e511-80c8-005056b8008e">Memon</option>
<option value="47b7599a-0736-e511-80c8-005056b8008e">Japanese</option>
<option value="51b7599a-0736-e511-80c8-005056b8008e">Nama</option>
<option value="53b7599a-0736-e511-80c8-005056b8008e">Ndebele</option>
<option value="49b7599a-0736-e511-80c8-005056b8008e">Kikamba</option>
<option value="55b7599a-0736-e511-80c8-005056b8008e">Ndonga</option>
<option value="4bb7599a-0736-e511-80c8-005056b8008e">Korean</option>
<option value="57b7599a-0736-e511-80c8-005056b8008e">Norwegian</option>
<option value="59b7599a-0736-e511-80c8-005056b8008e">Owambo</option>
<option value="4db7599a-0736-e511-80c8-005056b8008e">Lebanese</option>
<option value="5bb7599a-0736-e511-80c8-005056b8008e">Pedi</option>
<option value="4fb7599a-0736-e511-80c8-005056b8008e">Memon</option>
<option value="5db7599a-0736-e511-80c8-005056b8008e">Polish</option>
<option value="51b7599a-0736-e511-80c8-005056b8008e">Nama</option>
<option value="5fb7599a-0736-e511-80c8-005056b8008e">Portuguese</option>
<option value="53b7599a-0736-e511-80c8-005056b8008e">Ndebele</option>
<option value="55b7599a-0736-e511-80c8-005056b8008e">Ndonga</option>
<option value="61b7599a-0736-e511-80c8-005056b8008e">Romanic</option>
<option value="57b7599a-0736-e511-80c8-005056b8008e">Norwegian</option>
<option value="63b7599a-0736-e511-80c8-005056b8008e">Russian</option>
<option value="59b7599a-0736-e511-80c8-005056b8008e">Owambo</option>
<option value="65b7599a-0736-e511-80c8-005056b8008e">Semitic</option>
<option value="5bb7599a-0736-e511-80c8-005056b8008e">Pedi</option>
<option value="67b7599a-0736-e511-80c8-005056b8008e">Shimbundu</option>
<option value="5db7599a-0736-e511-80c8-005056b8008e">Polish</option>
<option value="69b7599a-0736-e511-80c8-005056b8008e">Shona</option>
<option value="5fb7599a-0736-e511-80c8-005056b8008e">Portuguese</option>
<option value="6bb7599a-0736-e511-80c8-005056b8008e">Sotho (Northern)</option>
<option value="6db7599a-0736-e511-80c8-005056b8008e">Sotho (Southern)</option>
<option value="07b34b0c-a424-ee11-8120-005056b8008e">South African Sign Language</option>
<option value="6fb7599a-0736-e511-80c8-005056b8008e">Spanish</option>
<option value="61b7599a-0736-e511-80c8-005056b8008e">Romanic</option>
<option value="5f95207c-0ce0-e711-80ec-005056b8008e">Swahiri
</option>
<option value="63b7599a-0736-e511-80c8-005056b8008e">Russian</option>
<option value="71b7599a-0736-e511-80c8-005056b8008e">Swati</option>
<option value="65b7599a-0736-e511-80c8-005056b8008e">Semitic</option>
<option value="67b7599a-0736-e511-80c8-005056b8008e">Shimbundu</option>
<option value="73b7599a-0736-e511-80c8-005056b8008e">Swazi</option>
<option value="69b7599a-0736-e511-80c8-005056b8008e">Shona</option>
<option value="75b7599a-0736-e511-80c8-005056b8008e">Swedish</option>
<option value="6bb7599a-0736-e511-80c8-005056b8008e">Sotho (Northern)</option>
<option value="77b7599a-0736-e511-80c8-005056b8008e">Swiss</option>
<option value="6db7599a-0736-e511-80c8-005056b8008e">Sotho (Southern)</option>
<option value="79b7599a-0736-e511-80c8-005056b8008e">Taiwanese</option>
<option value="7bb7599a-0736-e511-80c8-005056b8008e">Tamil</option>
<option value="07b34b0c-a424-ee11-8120-005056b8008e">South African Sign Language</option>
<option value="7db7599a-0736-e511-80c8-005056b8008e">Tigregna</option>
<option value="6fb7599a-0736-e511-80c8-005056b8008e">Spanish</option>
<option value="5f95207c-0ce0-e711-80ec-005056b8008e">Swahiri
</option>
<option value="71b7599a-0736-e511-80c8-005056b8008e">Swati</option>
<option value="73b7599a-0736-e511-80c8-005056b8008e">Swazi</option>
<option value="75b7599a-0736-e511-80c8-005056b8008e">Swedish</option>
<option value="7fb7599a-0736-e511-80c8-005056b8008e">Tsonga</option>
<option value="77b7599a-0736-e511-80c8-005056b8008e">Swiss</option>
<option value="81b7599a-0736-e511-80c8-005056b8008e">Tswana</option>
<option value="79b7599a-0736-e511-80c8-005056b8008e">Taiwanese</option>
<option value="7bb7599a-0736-e511-80c8-005056b8008e">Tamil</option>
<option value="83b7599a-0736-e511-80c8-005056b8008e">Turkish</option>
<option value="7db7599a-0736-e511-80c8-005056b8008e">Tigregna</option>
<option value="85b7599a-0736-e511-80c8-005056b8008e">Urdu</option>
<option value="7fb7599a-0736-e511-80c8-005056b8008e">Tsonga</option>
<option value="81b7599a-0736-e511-80c8-005056b8008e">Tswana</option>
<option value="87b7599a-0736-e511-80c8-005056b8008e">Venda</option>
<option value="83b7599a-0736-e511-80c8-005056b8008e">Turkish</option>
<option value="85b7599a-0736-e511-80c8-005056b8008e">Urdu</option>
<option value="87b7599a-0736-e511-80c8-005056b8008e">Venda</option>
<option value="8bb7599a-0736-e511-80c8-005056b8008e">Zulu</option>
<option value="89b7599a-0736-e511-80c8-005056b8008e">Xhosa</option>
<option value="8bb7599a-0736-e511-80c8-005056b8008e">Zulu</option>
<option value="19b7599a-0736-e511-80c8-005056b8008e">Afr/Eng</option>
<option value="1bb7599a-0736-e511-80c8-005056b8008e">Afrikaans</option>
<option value="1db7599a-0736-e511-80c8-005056b8008e">Arabic</option>
<option value="1fb7599a-0736-e511-80c8-005056b8008e">Bulgaric</option>
<option value="21b7599a-0736-e511-80c8-005056b8008e">Chichewa</option>
<option value="23b7599a-0736-e511-80c8-005056b8008e">Chinese</option>
<option value="25b7599a-0736-e511-80c8-005056b8008e">Czech</option>
<option value="27b7599a-0736-e511-80c8-005056b8008e">Damara</option>
<option value="29b7599a-0736-e511-80c8-005056b8008e">Danish</option>
<option value="2bb7599a-0736-e511-80c8-005056b8008e">Dutch</option>
<option value="2db7599a-0736-e511-80c8-005056b8008e">Eastern</option>
<option value="2fb7599a-0736-e511-80c8-005056b8008e">English</option>
<option value="5d95207c-0ce0-e711-80ec-005056b8008e">Farsi
</option>
<option value="31b7599a-0736-e511-80c8-005056b8008e">Finnish</option>
<option value="33b7599a-0736-e511-80c8-005056b8008e">Flemish</option>
<option value="35b7599a-0736-e511-80c8-005056b8008e">French</option>
<option value="37b7599a-0736-e511-80c8-005056b8008e">German</option>
<option value="39b7599a-0736-e511-80c8-005056b8008e">Greek</option>
<option value="3bb7599a-0736-e511-80c8-005056b8008e">Gujerati</option>
<option value="3db7599a-0736-e511-80c8-005056b8008e">Hebrew</option>
<option value="3fb7599a-0736-e511-80c8-005056b8008e">Herero</option>
<option value="41b7599a-0736-e511-80c8-005056b8008e">Hindi</option>
<option value="43b7599a-0736-e511-80c8-005056b8008e">Hungarian</option>
<option value="45b7599a-0736-e511-80c8-005056b8008e">Italian</option>
<option value="47b7599a-0736-e511-80c8-005056b8008e">Japanese</option>
<option value="49b7599a-0736-e511-80c8-005056b8008e">Kikamba</option>
<option value="4bb7599a-0736-e511-80c8-005056b8008e">Korean</option>
<option value="4db7599a-0736-e511-80c8-005056b8008e">Lebanese</option>
<option value="4fb7599a-0736-e511-80c8-005056b8008e">Memon</option>
<option value="51b7599a-0736-e511-80c8-005056b8008e">Nama</option>
<option value="53b7599a-0736-e511-80c8-005056b8008e">Ndebele</option>
<option value="55b7599a-0736-e511-80c8-005056b8008e">Ndonga</option>
<option value="57b7599a-0736-e511-80c8-005056b8008e">Norwegian</option>
<option value="59b7599a-0736-e511-80c8-005056b8008e">Owambo</option>
<option value="5bb7599a-0736-e511-80c8-005056b8008e">Pedi</option>
<option value="5db7599a-0736-e511-80c8-005056b8008e">Polish</option>
<option value="5fb7599a-0736-e511-80c8-005056b8008e">Portuguese</option>
<option value="61b7599a-0736-e511-80c8-005056b8008e">Romanic</option>
<option value="63b7599a-0736-e511-80c8-005056b8008e">Russian</option>
<option value="65b7599a-0736-e511-80c8-005056b8008e">Semitic</option>
<option value="67b7599a-0736-e511-80c8-005056b8008e">Shimbundu</option>
<option value="69b7599a-0736-e511-80c8-005056b8008e">Shona</option>
<option value="6bb7599a-0736-e511-80c8-005056b8008e">Sotho (Northern)</option>
<option value="6db7599a-0736-e511-80c8-005056b8008e">Sotho (Southern)</option>
<option value="07b34b0c-a424-ee11-8120-005056b8008e">South African Sign Language</option>
<option value="6fb7599a-0736-e511-80c8-005056b8008e">Spanish</option>
<option value="5f95207c-0ce0-e711-80ec-005056b8008e">Swahiri
</option>
<option value="71b7599a-0736-e511-80c8-005056b8008e">Swati</option>
<option value="73b7599a-0736-e511-80c8-005056b8008e">Swazi</option>
<option value="75b7599a-0736-e511-80c8-005056b8008e">Swedish</option>
<option value="77b7599a-0736-e511-80c8-005056b8008e">Swiss</option>
<option value="79b7599a-0736-e511-80c8-005056b8008e">Taiwanese</option>
<option value="7bb7599a-0736-e511-80c8-005056b8008e">Tamil</option>
<option value="7db7599a-0736-e511-80c8-005056b8008e">Tigregna</option>
<option value="7fb7599a-0736-e511-80c8-005056b8008e">Tsonga</option>
<option value="81b7599a-0736-e511-80c8-005056b8008e">Tswana</option>
<option value="83b7599a-0736-e511-80c8-005056b8008e">Turkish</option>
<option value="85b7599a-0736-e511-80c8-005056b8008e">Urdu</option>
<option value="87b7599a-0736-e511-80c8-005056b8008e">Venda</option>
<option value="89b7599a-0736-e511-80c8-005056b8008e">Xhosa</option>
<option value="8bb7599a-0736-e511-80c8-005056b8008e">Zulu</option>
</select>
</div>
<div>
<label for="Disability">Disability</label>
<span class="required">*</span><br>
<select data-val="true" data-val-required="The Disability field is required." id="disability" name="Disability">
<option value="">< Select Option ></option>
<option value="a9ff68a9-0736-e511-80c8-005056b8008e">Blindness</option>
<option value="abff68a9-0736-e511-80c8-005056b8008e">Cerebral Paralysis</option>
<option value="adff68a9-0736-e511-80c8-005056b8008e">Chronic Health Impairment</option>
<option value="afff68a9-0736-e511-80c8-005056b8008e">Deafness</option>
<option value="b1ff68a9-0736-e511-80c8-005056b8008e">Diagnosed Mental Health Disorder</option>
<option value="b3ff68a9-0736-e511-80c8-005056b8008e">Diagnosed Reading Disorder</option>
<option value="b5ff68a9-0736-e511-80c8-005056b8008e">Diagnosed Writing Disorder</option>
<option value="b7ff68a9-0736-e511-80c8-005056b8008e">Mobility or Orthopedic Disability</option>
<option value="b9ff68a9-0736-e511-80c8-005056b8008e">Neurological Disability</option>
<option selected="selected" value="bbff68a9-0736-e511-80c8-005056b8008e">None</option>
<option value="bdff68a9-0736-e511-80c8-005056b8008e">Other Disability of Condition</option>
<option value="bfff68a9-0736-e511-80c8-005056b8008e">Other Hearing Disability</option>
<option value="c1ff68a9-0736-e511-80c8-005056b8008e">Other Visual Disability</option>
<option value="c3ff68a9-0736-e511-80c8-005056b8008e">Speech Disorder</option>
</select>
</div>
<div>
<label for="DietaryRequirements">Dietary requirements</label>
<span class="required">*</span><br>
<select id="dietaryRequirements" name="DietaryRequirements">
<option value="">< Select Option ></option>
<option value="8660dea9-0936-e511-80c8-005056b8008e">Diabetic</option>
<option value="8860dea9-0936-e511-80c8-005056b8008e">Halaal</option>
<option value="8a60dea9-0936-e511-80c8-005056b8008e">Kosher</option>
<option selected="selected" value="8c60dea9-0936-e511-80c8-005056b8008e">None</option>
<option value="64681d1a-744a-e511-80cb-005056b8008e">Other</option>
<option value="8e60dea9-0936-e511-80c8-005056b8008e">Vegan</option>
<option value="9060dea9-0936-e511-80c8-005056b8008e">Vegetarian</option>
</select>
<span class="info"> <br> if other, please specify</span><br>
<input id="DietaryRequirementsOther" name="DietaryRequirementsOther" type="text" value="" autocomplete="off">
</div>
<div id="usesWheelchairContainer">
<label for="UsesWheelchair">Uses Wheelchair</label>
<span class="placeHolder"></span>
<br>
<select data-val="true" data-val-required="The Uses Wheelchair field is required." id="usesWheelchair" name="UsesWheelchair">
<option value="">< Select Option ></option>
<option value="true">Yes</option>
<option selected="selected" value="false">No</option>
</select>
</div>
</div>
<br>
<input type="submit" class="navigateButton personalInfoButton" value="Next" data-bind="enable: displayNameApproved()" disabled="">
<span id="nameConfirmed" data-bind="visible: !displayNameApproved()">Please select the checkbox above to confirm the name that will be displayed on your certificate of competence.</span>
</div>
</fieldset>
</div>
<div id="contactInformation" style="display: none;">
<div>
<br>
<fieldset class="postal-address-container" style="padding-bottom: 24px;">
<div>
<label for="ContactNumber">Contact Number</label>
<span class="required">*</span><br>
<input value="" data-val="true" data-val-required="The Contact Number field is required." id="ContactNumber" name="ContactNumber" type="text" autocomplete="off">
<span class="info"> (e.g +27219184488)</span>
</div>
</fieldset>
</div>
<div>
<br>
<fieldset class="postal-address-container">
<legend>Postal Address</legend> Please complete this section by first selecting the country.<br><br>
<div class="fieldRow inline">
<label>Country</label><br>
<span class="placeHolder1"></span>
<select data-val="true" data-val-required="The Country field is required." id="countries" name="PostalCountry">
<option value="">< Select Option ></option>
<option value="6723b8f9-0736-e511-80c8-005056b8008e">Afghanistan</option>
<option value="ff24b8f9-0736-e511-80c8-005056b8008e">South Africa</option>
<option value="6923b8f9-0736-e511-80c8-005056b8008e">Aland Islands</option>
<option value="6b23b8f9-0736-e511-80c8-005056b8008e">Albania</option>
<option value="6d23b8f9-0736-e511-80c8-005056b8008e">Algeria</option>
<option value="6f23b8f9-0736-e511-80c8-005056b8008e">American Samoa</option>
<option value="7123b8f9-0736-e511-80c8-005056b8008e">Andorra</option>
<option value="7323b8f9-0736-e511-80c8-005056b8008e">Angola</option>
<option value="7523b8f9-0736-e511-80c8-005056b8008e">Anguilla</option>
<option value="7723b8f9-0736-e511-80c8-005056b8008e">Antarctica</option>
<option value="7923b8f9-0736-e511-80c8-005056b8008e">Antigua and Barbuda</option>
<option value="7b23b8f9-0736-e511-80c8-005056b8008e">Argentina</option>
<option value="7d23b8f9-0736-e511-80c8-005056b8008e">Armenia</option>
<option value="7f23b8f9-0736-e511-80c8-005056b8008e">Aruba</option>
<option value="8123b8f9-0736-e511-80c8-005056b8008e">Australia</option>
<option value="8323b8f9-0736-e511-80c8-005056b8008e">Austria</option>
<option value="8523b8f9-0736-e511-80c8-005056b8008e">Azerbaijan</option>
<option value="8723b8f9-0736-e511-80c8-005056b8008e">Bahamas</option>
<option value="8923b8f9-0736-e511-80c8-005056b8008e">Bahrain</option>
<option value="8b23b8f9-0736-e511-80c8-005056b8008e">Bangladesh</option>
<option value="8d23b8f9-0736-e511-80c8-005056b8008e">Barbados</option>
<option value="8f23b8f9-0736-e511-80c8-005056b8008e">Belarus</option>
<option value="9123b8f9-0736-e511-80c8-005056b8008e">Belgium</option>
<option value="9323b8f9-0736-e511-80c8-005056b8008e">Belize</option>
<option value="9523b8f9-0736-e511-80c8-005056b8008e">Benin</option>
<option value="9723b8f9-0736-e511-80c8-005056b8008e">Bermuda</option>
<option value="9923b8f9-0736-e511-80c8-005056b8008e">Bhutan</option>
<option value="9b23b8f9-0736-e511-80c8-005056b8008e">Bolivia</option>
<option value="9d23b8f9-0736-e511-80c8-005056b8008e">Bonaire, Sint Eustatius and SABA</option>
<option value="9f23b8f9-0736-e511-80c8-005056b8008e">Bosnia and Herzegovina</option>
<option value="a123b8f9-0736-e511-80c8-005056b8008e">Botswana</option>
<option value="a323b8f9-0736-e511-80c8-005056b8008e">Bouvet Island</option>
<option value="a523b8f9-0736-e511-80c8-005056b8008e">Brazil</option>
<option value="a723b8f9-0736-e511-80c8-005056b8008e">British Indian Ocean Territory</option>
<option value="a923b8f9-0736-e511-80c8-005056b8008e">Brunei Darussalam</option>
<option value="ab23b8f9-0736-e511-80c8-005056b8008e">Bulgaria</option>
<option value="ad23b8f9-0736-e511-80c8-005056b8008e">Burkina Faso</option>
<option value="af23b8f9-0736-e511-80c8-005056b8008e">Burundi</option>
<option value="b123b8f9-0736-e511-80c8-005056b8008e">Cambodia</option>
<option value="b323b8f9-0736-e511-80c8-005056b8008e">Cameroon</option>
<option value="b523b8f9-0736-e511-80c8-005056b8008e">Canada</option>
<option value="b723b8f9-0736-e511-80c8-005056b8008e">Cape Verde</option>
<option value="b923b8f9-0736-e511-80c8-005056b8008e">Cayman Islands</option>
<option value="bb23b8f9-0736-e511-80c8-005056b8008e">Central African Republic</option>
<option value="bd23b8f9-0736-e511-80c8-005056b8008e">Chad</option>
<option value="bf23b8f9-0736-e511-80c8-005056b8008e">Chile</option>
<option value="c123b8f9-0736-e511-80c8-005056b8008e">China</option>
<option value="c323b8f9-0736-e511-80c8-005056b8008e">Christmas Island</option>
<option value="c523b8f9-0736-e511-80c8-005056b8008e">Cocos (Keeling) Islands</option>
<option value="c723b8f9-0736-e511-80c8-005056b8008e">Colombia</option>
<option value="c923b8f9-0736-e511-80c8-005056b8008e">Comoros</option>
<option value="cb23b8f9-0736-e511-80c8-005056b8008e">Congo</option>
<option value="cd23b8f9-0736-e511-80c8-005056b8008e">Cook Islands</option>
<option value="cf23b8f9-0736-e511-80c8-005056b8008e">Costa Rica</option>
<option value="d123b8f9-0736-e511-80c8-005056b8008e">Croatia</option>
<option value="d323b8f9-0736-e511-80c8-005056b8008e">Cuba</option>
<option value="d523b8f9-0736-e511-80c8-005056b8008e">Curacao</option>
<option value="d723b8f9-0736-e511-80c8-005056b8008e">Cyprus</option>
<option value="d923b8f9-0736-e511-80c8-005056b8008e">Czech Republic</option>
<option value="db23b8f9-0736-e511-80c8-005056b8008e">Democratic Republic of the Congo</option>
<option value="dd23b8f9-0736-e511-80c8-005056b8008e">Denmark</option>
<option value="df23b8f9-0736-e511-80c8-005056b8008e">Djibouti</option>
<option value="e123b8f9-0736-e511-80c8-005056b8008e">Dominica</option>
<option value="e323b8f9-0736-e511-80c8-005056b8008e">Dominican Republic</option>
<option value="e523b8f9-0736-e511-80c8-005056b8008e">Ecuador</option>
<option value="e723b8f9-0736-e511-80c8-005056b8008e">Egypt</option>
<option value="e923b8f9-0736-e511-80c8-005056b8008e">El Salvador</option>
<option value="eb23b8f9-0736-e511-80c8-005056b8008e">Equatorial Guinea</option>
<option value="ed23b8f9-0736-e511-80c8-005056b8008e">Eritrea</option>
<option value="ef23b8f9-0736-e511-80c8-005056b8008e">Estonia</option>
<option value="f123b8f9-0736-e511-80c8-005056b8008e">Ethiopia</option>
<option value="f323b8f9-0736-e511-80c8-005056b8008e">Falkland Islands</option>
<option value="f523b8f9-0736-e511-80c8-005056b8008e">Faroe Islands</option>
<option value="f723b8f9-0736-e511-80c8-005056b8008e">Fiji</option>
<option value="f923b8f9-0736-e511-80c8-005056b8008e">Finland</option>
<option value="fb23b8f9-0736-e511-80c8-005056b8008e">France</option>
<option value="fd23b8f9-0736-e511-80c8-005056b8008e">French Guiana</option>
<option value="ff23b8f9-0736-e511-80c8-005056b8008e">French Polynesia</option>
<option value="0124b8f9-0736-e511-80c8-005056b8008e">French Southern Territories</option>
<option value="0324b8f9-0736-e511-80c8-005056b8008e">Gabon</option>
<option value="0524b8f9-0736-e511-80c8-005056b8008e">Gambia</option>
<option value="0724b8f9-0736-e511-80c8-005056b8008e">Georgia</option>
<option value="0924b8f9-0736-e511-80c8-005056b8008e">Germany</option>
<option value="0b24b8f9-0736-e511-80c8-005056b8008e">Ghana</option>
<option value="0d24b8f9-0736-e511-80c8-005056b8008e">Gibraltar</option>
<option value="0f24b8f9-0736-e511-80c8-005056b8008e">Greece</option>
<option value="1124b8f9-0736-e511-80c8-005056b8008e">Greenland</option>
<option value="1324b8f9-0736-e511-80c8-005056b8008e">Grenada</option>
<option value="1524b8f9-0736-e511-80c8-005056b8008e">Guadeloupe</option>
<option value="1724b8f9-0736-e511-80c8-005056b8008e">Guam</option>
<option value="1924b8f9-0736-e511-80c8-005056b8008e">Guatemala</option>
<option value="1b24b8f9-0736-e511-80c8-005056b8008e">Guernsey</option>
<option value="1d24b8f9-0736-e511-80c8-005056b8008e">Guinea</option>
<option value="1f24b8f9-0736-e511-80c8-005056b8008e">Guinea-Bissau</option>
<option value="2124b8f9-0736-e511-80c8-005056b8008e">Guyana</option>
<option value="2324b8f9-0736-e511-80c8-005056b8008e">Haiti</option>
<option value="2524b8f9-0736-e511-80c8-005056b8008e">Heard Island And Mcdonald Islands</option>
<option value="2724b8f9-0736-e511-80c8-005056b8008e">Holy See</option>
<option value="2924b8f9-0736-e511-80c8-005056b8008e">Honduras</option>
<option value="2b24b8f9-0736-e511-80c8-005056b8008e">Hong Kong</option>
<option value="2d24b8f9-0736-e511-80c8-005056b8008e">Hungary</option>
<option value="2f24b8f9-0736-e511-80c8-005056b8008e">Iceland</option>
<option value="3124b8f9-0736-e511-80c8-005056b8008e">India</option>
<option value="3324b8f9-0736-e511-80c8-005056b8008e">Indonesia</option>
<option value="3524b8f9-0736-e511-80c8-005056b8008e">Iran (Islamic Republic of)</option>
<option value="3724b8f9-0736-e511-80c8-005056b8008e">Iraq</option>
<option value="3924b8f9-0736-e511-80c8-005056b8008e">Ireland</option>
<option value="3b24b8f9-0736-e511-80c8-005056b8008e">Isle Of Man</option>
<option value="3d24b8f9-0736-e511-80c8-005056b8008e">Israel</option>
<option value="3f24b8f9-0736-e511-80c8-005056b8008e">Italy</option>
<option value="4124b8f9-0736-e511-80c8-005056b8008e">Ivory Coast</option>
<option value="4324b8f9-0736-e511-80c8-005056b8008e">Jamaica</option>
<option value="4524b8f9-0736-e511-80c8-005056b8008e">Japan</option>
<option value="4724b8f9-0736-e511-80c8-005056b8008e">Jordan</option>
<option value="4924b8f9-0736-e511-80c8-005056b8008e">Kazakhstan</option>
<option value="4b24b8f9-0736-e511-80c8-005056b8008e">Kenya</option>
<option value="4d24b8f9-0736-e511-80c8-005056b8008e">Kiribati</option>
<option value="4f24b8f9-0736-e511-80c8-005056b8008e">Korea, Democratic People's Rep. (North Korea)</option>
<option value="5124b8f9-0736-e511-80c8-005056b8008e">Korea, Republic of (South Korea)</option>
<option value="5324b8f9-0736-e511-80c8-005056b8008e">Kuwait</option>
<option value="5524b8f9-0736-e511-80c8-005056b8008e">Kyrgyzstan</option>
<option value="5724b8f9-0736-e511-80c8-005056b8008e">Lao, People's Democratic Republic</option>
<option value="5924b8f9-0736-e511-80c8-005056b8008e">Latvia</option>
<option value="5b24b8f9-0736-e511-80c8-005056b8008e">Lebanon</option>
<option value="5d24b8f9-0736-e511-80c8-005056b8008e">Lesotho</option>
<option value="5f24b8f9-0736-e511-80c8-005056b8008e">Liberia</option>
<option value="6124b8f9-0736-e511-80c8-005056b8008e">Libya</option>
<option value="6324b8f9-0736-e511-80c8-005056b8008e">Liechtenstein</option>
<option value="6524b8f9-0736-e511-80c8-005056b8008e">Lithuania</option>
<option value="6724b8f9-0736-e511-80c8-005056b8008e">Luxembourg</option>
<option value="6924b8f9-0736-e511-80c8-005056b8008e">Macau</option>
<option value="6b24b8f9-0736-e511-80c8-005056b8008e">Macedonia, Rep. of</option>
<option value="6d24b8f9-0736-e511-80c8-005056b8008e">Madagascar</option>
<option value="6f24b8f9-0736-e511-80c8-005056b8008e">Malawi</option>
<option value="7124b8f9-0736-e511-80c8-005056b8008e">Malaysia</option>
<option value="7324b8f9-0736-e511-80c8-005056b8008e">Maldives</option>
<option value="7524b8f9-0736-e511-80c8-005056b8008e">Mali</option>
<option value="7724b8f9-0736-e511-80c8-005056b8008e">Malta</option>
<option value="7924b8f9-0736-e511-80c8-005056b8008e">Marshall Islands</option>
<option value="7b24b8f9-0736-e511-80c8-005056b8008e">Martinique</option>
<option value="7d24b8f9-0736-e511-80c8-005056b8008e">Mauritania</option>
<option value="7f24b8f9-0736-e511-80c8-005056b8008e">Mauritius</option>
<option value="8124b8f9-0736-e511-80c8-005056b8008e">Mayotte</option>
<option value="8324b8f9-0736-e511-80c8-005056b8008e">Mexico</option>
<option value="8524b8f9-0736-e511-80c8-005056b8008e">Micronesia, Federal States of</option>
<option value="8724b8f9-0736-e511-80c8-005056b8008e">Moldova, Republic of</option>
<option value="8924b8f9-0736-e511-80c8-005056b8008e">Monaco</option>
<option value="8b24b8f9-0736-e511-80c8-005056b8008e">Mongolia</option>
<option value="8d24b8f9-0736-e511-80c8-005056b8008e">Montenegro</option>
<option value="8f24b8f9-0736-e511-80c8-005056b8008e">Montserrat</option>
<option value="9124b8f9-0736-e511-80c8-005056b8008e">Morocco</option>
<option value="9324b8f9-0736-e511-80c8-005056b8008e">Mozambique</option>
<option value="9524b8f9-0736-e511-80c8-005056b8008e">Myanmar, Burma</option>
<option value="9724b8f9-0736-e511-80c8-005056b8008e">Namibia</option>
<option value="9924b8f9-0736-e511-80c8-005056b8008e">Nauru</option>
<option value="9b24b8f9-0736-e511-80c8-005056b8008e">Nepal</option>
<option value="9d24b8f9-0736-e511-80c8-005056b8008e">Netherlands</option>
<option value="9f24b8f9-0736-e511-80c8-005056b8008e">New Caledonia</option>
<option value="a124b8f9-0736-e511-80c8-005056b8008e">New Zealand</option>
<option value="a324b8f9-0736-e511-80c8-005056b8008e">Nicaragua</option>
<option value="a524b8f9-0736-e511-80c8-005056b8008e">Niger</option>
<option value="a724b8f9-0736-e511-80c8-005056b8008e">Nigeria</option>
<option value="a924b8f9-0736-e511-80c8-005056b8008e">Niue</option>
<option value="ab24b8f9-0736-e511-80c8-005056b8008e">Norfolk Island</option>
<option value="ad24b8f9-0736-e511-80c8-005056b8008e">Northern Mariana Islands</option>
<option value="af24b8f9-0736-e511-80c8-005056b8008e">Norway</option>
<option value="b124b8f9-0736-e511-80c8-005056b8008e">Oman</option>
<option value="b324b8f9-0736-e511-80c8-005056b8008e">Pakistan</option>
<option value="b524b8f9-0736-e511-80c8-005056b8008e">Palau</option>
<option value="b724b8f9-0736-e511-80c8-005056b8008e">Palestinian territories</option>
<option value="b924b8f9-0736-e511-80c8-005056b8008e">Panama</option>
<option value="bb24b8f9-0736-e511-80c8-005056b8008e">Papua New Guinea</option>
<option value="bd24b8f9-0736-e511-80c8-005056b8008e">Paraguay</option>
<option value="bf24b8f9-0736-e511-80c8-005056b8008e">Peru</option>
<option value="c124b8f9-0736-e511-80c8-005056b8008e">Philippines</option>
<option value="c324b8f9-0736-e511-80c8-005056b8008e">Pitcairn Island</option>
<option value="c524b8f9-0736-e511-80c8-005056b8008e">Poland</option>
<option value="c724b8f9-0736-e511-80c8-005056b8008e">Portugal</option>
<option value="c924b8f9-0736-e511-80c8-005056b8008e">Puerto Rico</option>
<option value="cb24b8f9-0736-e511-80c8-005056b8008e">Qatar</option>
<option value="cd24b8f9-0736-e511-80c8-005056b8008e">Reunion Island</option>
<option value="cf24b8f9-0736-e511-80c8-005056b8008e">Romania</option>
<option value="d124b8f9-0736-e511-80c8-005056b8008e">Russian Federation</option>
<option value="d324b8f9-0736-e511-80c8-005056b8008e">Rwanda</option>
<option value="d524b8f9-0736-e511-80c8-005056b8008e">Saint Barthelemy</option>
<option value="d724b8f9-0736-e511-80c8-005056b8008e">Saint Helena</option>
<option value="d924b8f9-0736-e511-80c8-005056b8008e">Saint Kitts and Nevis</option>
<option value="db24b8f9-0736-e511-80c8-005056b8008e">Saint Lucia</option>
<option value="dd24b8f9-0736-e511-80c8-005056b8008e">Saint Martin (French Part)</option>
<option value="df24b8f9-0736-e511-80c8-005056b8008e">Saint Pierre And Miquelon</option>
<option value="e124b8f9-0736-e511-80c8-005056b8008e">Saint Vincent and the Grenadines</option>
<option value="e324b8f9-0736-e511-80c8-005056b8008e">Samoa</option>
<option value="e524b8f9-0736-e511-80c8-005056b8008e">San Marino</option>
<option value="e724b8f9-0736-e511-80c8-005056b8008e">Sao Tome and Principe</option>
<option value="e924b8f9-0736-e511-80c8-005056b8008e">Saudi Arabia</option>
<option value="eb24b8f9-0736-e511-80c8-005056b8008e">Senegal</option>
<option value="ed24b8f9-0736-e511-80c8-005056b8008e">Serbia</option>
<option value="ef24b8f9-0736-e511-80c8-005056b8008e">Seychelles</option>
<option value="f124b8f9-0736-e511-80c8-005056b8008e">Sierra Leone</option>
<option value="f324b8f9-0736-e511-80c8-005056b8008e">Singapore</option>
<option value="f524b8f9-0736-e511-80c8-005056b8008e">Sint Maarten (Dutch part)</option>
<option value="f724b8f9-0736-e511-80c8-005056b8008e">Slovakia (Slovak Republic)</option>
<option value="f924b8f9-0736-e511-80c8-005056b8008e">Slovenia</option>
<option value="fb24b8f9-0736-e511-80c8-005056b8008e">Solomon Islands</option>
<option value="fd24b8f9-0736-e511-80c8-005056b8008e">Somalia</option>
<option value="0125b8f9-0736-e511-80c8-005056b8008e">South Georgia And The South Sandwich Islands</option>
<option value="0325b8f9-0736-e511-80c8-005056b8008e">South Sudan</option>
<option value="0525b8f9-0736-e511-80c8-005056b8008e">Spain</option>
<option value="0725b8f9-0736-e511-80c8-005056b8008e">Sri Lanka</option>
<option value="0925b8f9-0736-e511-80c8-005056b8008e">Sudan</option>
<option value="0b25b8f9-0736-e511-80c8-005056b8008e">Suriname</option>
<option value="0d25b8f9-0736-e511-80c8-005056b8008e">Svalbard And Jan Mayen Islands</option>
<option value="0f25b8f9-0736-e511-80c8-005056b8008e">Swaziland</option>
<option value="1125b8f9-0736-e511-80c8-005056b8008e">Sweden</option>
<option value="1325b8f9-0736-e511-80c8-005056b8008e">Switzerland</option>
<option value="1525b8f9-0736-e511-80c8-005056b8008e">Syria, Syrian Arab Republic</option>
<option value="1725b8f9-0736-e511-80c8-005056b8008e">Taiwan (Republic of China)</option>
<option value="1925b8f9-0736-e511-80c8-005056b8008e">Tajikistan</option>
<option value="1b25b8f9-0736-e511-80c8-005056b8008e">Tanzania</option>
<option value="1d25b8f9-0736-e511-80c8-005056b8008e">Thailand</option>
<option value="1f25b8f9-0736-e511-80c8-005056b8008e">Timor-Leste (East Timor)</option>
<option value="2125b8f9-0736-e511-80c8-005056b8008e">Togo</option>
<option value="2325b8f9-0736-e511-80c8-005056b8008e">Tokelau</option>
<option value="2525b8f9-0736-e511-80c8-005056b8008e">Tonga</option>
<option value="2725b8f9-0736-e511-80c8-005056b8008e">Trinidad and Tobago</option>
<option value="2925b8f9-0736-e511-80c8-005056b8008e">Tunisia</option>
<option value="2b25b8f9-0736-e511-80c8-005056b8008e">Turkey</option>
<option value="2d25b8f9-0736-e511-80c8-005056b8008e">Turkmenistan</option>
<option value="2f25b8f9-0736-e511-80c8-005056b8008e">Turks and Caicos Islands</option>
<option value="3125b8f9-0736-e511-80c8-005056b8008e">Tuvalu</option>
<option value="3325b8f9-0736-e511-80c8-005056b8008e">Uganda</option>
<option value="3525b8f9-0736-e511-80c8-005056b8008e">Ukraine</option>
<option value="3725b8f9-0736-e511-80c8-005056b8008e">United Arab Emirates</option>
<option value="3925b8f9-0736-e511-80c8-005056b8008e">United Kingdom</option>
<option value="3b25b8f9-0736-e511-80c8-005056b8008e">United States</option>
<option value="3d25b8f9-0736-e511-80c8-005056b8008e">Uruguay</option>
<option value="3f25b8f9-0736-e511-80c8-005056b8008e">Uzbekistan</option>
<option value="4125b8f9-0736-e511-80c8-005056b8008e">Vanuatu</option>
<option value="4325b8f9-0736-e511-80c8-005056b8008e">Vatican City State (Holy See)</option>
<option value="4525b8f9-0736-e511-80c8-005056b8008e">Venezuela</option>
<option value="4725b8f9-0736-e511-80c8-005056b8008e">Vietnam</option>
<option value="4925b8f9-0736-e511-80c8-005056b8008e">Virgin Islands (British)</option>
<option value="4b25b8f9-0736-e511-80c8-005056b8008e">Virgin Islands (U.S.)</option>
<option value="4d25b8f9-0736-e511-80c8-005056b8008e">Wallis and Futuna Islands</option>
<option value="4f25b8f9-0736-e511-80c8-005056b8008e">Western Sahara</option>
<option value="5125b8f9-0736-e511-80c8-005056b8008e">Yemen</option>
<option value="5325b8f9-0736-e511-80c8-005056b8008e">Zambia</option>
<option value="5525b8f9-0736-e511-80c8-005056b8008e">Zimbabwe</option>
</select>
<div id="postalContainer">
<div id="street-postbox">
<div class="postal-SA" style="display: none;">
<label>Postal Code</label>
<span class="required">*</span><br>
<input value="" class="meduimText" id="postalAfrigisId" name="PostalPostalCode" type="text" autocomplete="off">
<input id="postalDistribution" type="button" value="Search">
<div>
<label></label>
<label>Please select from dropdown</label>
<span class="required">*</span><br>
<select name="PostalAfrigis" id="distributionAreaList"></select>
</div>
<div>
<label>Province</label>
<span> </span><br>
<select id="provinces" name="Province">
<option value="">< Select Option ></option>
<option value="0cb9d57a-0b36-e511-80c8-005056b8008e">Eastern Cape</option>
<option value="b3f1821e-0b36-e511-80c8-005056b8008e">Free State</option>
<option value="cc02d25f-0a36-e511-80c8-005056b8008e">Gauteng</option>
<option value="fb05831e-0b36-e511-80c8-005056b8008e">Kwazulu-Natal</option>
<option value="4e0dd25f-0a36-e511-80c8-005056b8008e">Limpopo</option>
<option value="e60bd25f-0a36-e511-80c8-005056b8008e">Mpumalanga</option>
<option value="ccc1d57a-0b36-e511-80c8-005056b8008e">Northern Cape</option>
<option value="780bd25f-0a36-e511-80c8-005056b8008e">North West</option>
<option value="1ac7d57a-0b36-e511-80c8-005056b8008e">Western Cape</option>
</select>
</div>
</div>
<div>
<label>Street / Post Box</label>
<span class="required">*</span><br>
<input value="" id="PostalStreet1" name="PostalStreet1" type="text" autocomplete="off">
</div>
<div>
<label></label>
<span class="placeHolder"></span><br>
<input value="" id="PostalStreet2" name="PostalStreet2" type="text" autocomplete="off">
</div>
<div>
<label>Suburb</label>
<span class="required">*</span>
<span class="placeHolder"></span><br>
<input value="" id="postalSuburb" name="PostalSuburb" type="text" autocomplete="off">
</div>
<div>
<label>City / Town</label>
<span class="required">*</span>
<span class="placeHolder"></span><br>
<input value="" id="postalCity" name="PostalCity" type="text" autocomplete="off">
</div>
<div id="divSAPostal" style="display: none;">
<label>Postal Code</label>
<span class="placeHolder"></span><br>
<input value="" id="postalCode" name="PostalPostalCode" readonly="readonly" type="text" autocomplete="off">
</div>
<div id="divNonSAPostal">
<label>Postal Code</label>
<span class="placeHolder"></span><br>
<input value="" id="nonSApostalCode" name="NonSAPostalCode" type="text" autocomplete="off">
</div>
<div class="postal-nonSA">
<span class="placeHolder1"></span>
<div>
<label for="SelectedCountry">Country</label>
<span class="placeHolder"></span><br>
<input value="" id="country" name="SelectedCountry" readonly="readonly" type="text" autocomplete="off">
</div>
</div>
</div>
</div>
</div>
</fieldset>
</div>
<div class="contactInfoNavigateButton">
<input type="submit" class="navigateButton contactInfoButton" value="Next">
</div>
</div>
<div id="marketing" style="display: none;">
<div id="executiveDevelopment">
<div id="executiveDevelopmentSection">
<br>
<fieldset class="executiveContainer">
<legend>How did you hear about USB Executive Development?</legend>
<div style="margin-bottom: -37px">
<label>Please select from the dropdown</label>
<span class="required">*</span><br>
<select data-val="true" data-val-number="The field MarketingSource must be a number." data-val-required="The MarketingSource field is required." id="marketingSource" name="MarketingSource">
<option value="">< Select Option ></option>
<option value="1">Advertisement</option>
<option value="200006">Biz Community</option>
<option value="200007">Business Day website</option>
<option value="200016">Curata</option>
<option value="200013">ED Focus email</option>
<option value="200002">Email Campaign</option>
<option value="200000">Email Enquiry</option>
<option value="200003">Email Vibrant</option>
<option value="2">Employer Referral</option>
<option value="3">External Referral</option>
<option value="100000001">Facebook</option>
<option value="200004">Google AdWords</option>
<option value="200011">Google Search</option>
<option value="200008">HR Works</option>
<option value="200009">Human Capital Review</option>
<option value="200001">Leader.co.za</option>
<option value="10">Other</option>
<option value="4">Partner</option>
<option value="200015">Referral Website</option>
<option value="200014">Rocketseed Signature</option>
<option value="6">Seminar</option>
<option value="200005">Telephone</option>
<option value="7">Trade Show</option>
<option value="100000002">Twitter</option>
<option value="100000000">US</option>
<option value="200012">USB</option>
<option value="200010">Walk-in</option>
<option value="8">Web - General</option>
<option value="30">Web - News Section</option>
<option value="31">Web - Views Section</option>
<option value="9">Word of Mouth</option>
</select>
<br><span class="info"> if other, please specify</span><br>
<input value="" id="MarketingSourceOther" name="MarketingSourceOther" type="text" autocomplete="off">
</div>
<br>
<br>
</fieldset>
<fieldset class="executiveContainer" style="margin-top: 12px;" "="">
<legend>What made you decide on USB Executive Development for your studies?</legend>
<div>
<label>Please select from the dropdown</label>
<span class=" required">*</span><br>
<select data-val="true" data-val-number="The field MarketingReason must be a number." data-val-required="The MarketingReason field is required." id="marketingReason" name="MarketingReason">
<option value="">< Select Option ></option>
<option value="10">Attended Information Session</option>
<option value="9">Career Progression/Change</option>
<option value="2">Competitive Fees</option>
<option value="5">Geographical Location</option>
<option value="6">Good Reputation</option>
<option value="8">High Quality of Students</option>
<option value="1">International Accreditation</option>
<option value="11">Other</option>
<option value="3">Recommended by Alumni</option>
<option value="7">Recommended by Employer</option>
<option value="4">You are an Alumnus of the University</option>
</select>
<br><span class="info"> if other, please specify</span><br>
<input value="" id="MarketingReasonOther" name="MarketingReasonOther" type="text" autocomplete="off">
</div>
</fieldset>
</div>
</div>
<div id="socialMedia">
<div id="socialMediaSection">
<fieldset class="socialMediaContainer" style="margin-top: 12px;">
<legend>Which of the following social media networks do you use?</legend>
<div>
<label for="usesTwitter">Twitter</label>
<input type="checkbox" id="usesTwitter" name="usesTwitter" value="true">
<span class="info"> Twitter username: @</span>
<input value="" id="TwitterUsername" name="TwitterUsername" type="text" autocomplete="off">
</div>
<div class="facebook" style="padding-bottom:16px;">
<label for="usesFacebook">Facebook</label>
<input type="checkbox" id="usesFacebook" name="usesFacebook" value="true">
</div>
<div>
<label for="usesLinkedIn">LinkedIn</label>
<input type="checkbox" id="usesLinkedIn" name="usesLinkedIn" value="true">
</div>
</fieldset>
</div>
</div>
<div id="newsletter">
<div id="newsLetterSection">
<div class="contactInfoNavigateButton">
<input type="submit" class="navigateButton marketingButton" value="Next">
</div>
</div>
</div>
</div>
<div id="paymentInfo" style="display: none;">
<!-- Layout -->
<div id="paymentInfoSection">
<br>
<fieldset class="paymentSection">
<legend>Payment Responsibility</legend>
<div>
<input id="paymentResponsibilityType" name="paymentResponsibilityType" type="hidden" value="< Select Option >">
<label>Please select from the dropdown</label>
<span class="required">*</span><br>
<select data-val="true" data-val-required="The Payment Responsibility field is required." id="payment" name="PaymentResponsibility">
<option value="">< Select Option ></option>
<option value="95db86ee-0936-e511-80c8-005056b8008e">Company</option>
<option value="97db86ee-0936-e511-80c8-005056b8008e">Department</option>
<option value="99db86ee-0936-e511-80c8-005056b8008e">Self</option>
<option value="9bdb86ee-0936-e511-80c8-005056b8008e">Sponsored</option>
</select>
<span>For more information about other payment options, please click <a href="/PaymentOptions" target="_blank" style="color: #a91d39">here.</a></span>
<br>
<input value="" data-val="true" data-val-required="The Payment Policy field is required." id="isPaymentPolicy" name="isPaymentPolicy" type="hidden">
<input type="checkbox" id="PaymentPolicy" value="false">I agree to USB-ED Payment, Cancellation and Postponement Policy, click
<a href="https://usb-ed.com/content/uploads/2020/OE-Payment-Terms-Cancellation-and-Postponement-Policy.pdf" target="_blank" style="color:red !important;">here</a> to view. <br><br>
</div>
<br>
<div class="companyContainer" style="display: none;">
<input data-val="true" data-val-required="The IsCompanyResponsibility field is required." id="isCompanyResponsibility" name="IsCompanyResponsibility" type="hidden" value="False">
<input data-val="true" data-val-required="The IsSelf field is required." id="isSelf" name="IsSelf" type="hidden" value="False">
<h2 id="paymentCompanyHeading" style="padding-bottom: 12px;">Company:</h2>
<label>Copy of purchase order or letter from sponsor</label><br>
<div style="margin-top:3px;">
<label for="fileuploadCompanyPurchaseOrder" class="custom-file-upload">Select file...</label>
<input id="fileuploadCompanyPurchaseOrder" type="file" name="files[]">
<span style="vertical-align: top" id="upload_CompanyPurchaseOrder"></span> <progress style="display: none" class="progress-bar" id="companyPurchaseOrderUploadProgress"></progress>
<span style="vertical-align: top" id="companyPurchaseOrderUploadResult"></span>
</div>
<table>
<tbody>
<tr>
<td><label for="PaymentContactName">First name</label><span class="required">*</span> </td>
<td><input value="" id="PaymentContactName" name="PaymentContactName" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentContactSurname">Surname</label><span class="required">*</span> </td>
<td><input value="" id="PaymentContactSurname" name="PaymentContactSurname" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentContactNumber">Contact Number</label><span class="required">*</span></td>
<td><input value="" id="PaymentContactNumber" name="PaymentContactNumber" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentContactEmail">Contact Email</label><span class="required">*</span></td>
<td><input value="" id="PaymentContactEmail" name="PaymentContactEmail" type="text" autocomplete="off"></td>
</tr>
<tr>
<td>
<label id="paymentCompanyLabel">Name of Company</label><span class="required">*</span>
</td>
<td><input value="" id="PaymentContactCompanyName" name="PaymentContactCompanyName" type="text" autocomplete="off"></td>
</tr>
</tbody>
</table>
<h2 id="paymentCompanyAddressHeading">Company Address:</h2>
<table>
<tbody>
<tr>
<td>
<label>Country</label><span class="required">*</span>
</td>
<td class="countryPayment"><select data-val="true" data-val-required="The Country field is required." id="paymentCountries" name="PaymentPostalCountry">
<option value="6723b8f9-0736-e511-80c8-005056b8008e">Afghanistan</option>
<option value="ff24b8f9-0736-e511-80c8-005056b8008e">South Africa</option>
<option value="6923b8f9-0736-e511-80c8-005056b8008e">Aland Islands</option>
<option value="6b23b8f9-0736-e511-80c8-005056b8008e">Albania</option>
<option value="6d23b8f9-0736-e511-80c8-005056b8008e">Algeria</option>
<option value="6f23b8f9-0736-e511-80c8-005056b8008e">American Samoa</option>
<option value="7123b8f9-0736-e511-80c8-005056b8008e">Andorra</option>
<option value="7323b8f9-0736-e511-80c8-005056b8008e">Angola</option>
<option value="7523b8f9-0736-e511-80c8-005056b8008e">Anguilla</option>
<option value="7723b8f9-0736-e511-80c8-005056b8008e">Antarctica</option>
<option value="7923b8f9-0736-e511-80c8-005056b8008e">Antigua and Barbuda</option>
<option value="7b23b8f9-0736-e511-80c8-005056b8008e">Argentina</option>
<option value="7d23b8f9-0736-e511-80c8-005056b8008e">Armenia</option>
<option value="7f23b8f9-0736-e511-80c8-005056b8008e">Aruba</option>
<option value="8123b8f9-0736-e511-80c8-005056b8008e">Australia</option>
<option value="8323b8f9-0736-e511-80c8-005056b8008e">Austria</option>
<option value="8523b8f9-0736-e511-80c8-005056b8008e">Azerbaijan</option>
<option value="8723b8f9-0736-e511-80c8-005056b8008e">Bahamas</option>
<option value="8923b8f9-0736-e511-80c8-005056b8008e">Bahrain</option>
<option value="8b23b8f9-0736-e511-80c8-005056b8008e">Bangladesh</option>
<option value="8d23b8f9-0736-e511-80c8-005056b8008e">Barbados</option>
<option value="8f23b8f9-0736-e511-80c8-005056b8008e">Belarus</option>
<option value="9123b8f9-0736-e511-80c8-005056b8008e">Belgium</option>
<option value="9323b8f9-0736-e511-80c8-005056b8008e">Belize</option>
<option value="9523b8f9-0736-e511-80c8-005056b8008e">Benin</option>
<option value="9723b8f9-0736-e511-80c8-005056b8008e">Bermuda</option>
<option value="9923b8f9-0736-e511-80c8-005056b8008e">Bhutan</option>
<option value="9b23b8f9-0736-e511-80c8-005056b8008e">Bolivia</option>
<option value="9d23b8f9-0736-e511-80c8-005056b8008e">Bonaire, Sint Eustatius and SABA</option>
<option value="9f23b8f9-0736-e511-80c8-005056b8008e">Bosnia and Herzegovina</option>
<option value="a123b8f9-0736-e511-80c8-005056b8008e">Botswana</option>
<option value="a323b8f9-0736-e511-80c8-005056b8008e">Bouvet Island</option>
<option value="a523b8f9-0736-e511-80c8-005056b8008e">Brazil</option>
<option value="a723b8f9-0736-e511-80c8-005056b8008e">British Indian Ocean Territory</option>
<option value="a923b8f9-0736-e511-80c8-005056b8008e">Brunei Darussalam</option>
<option value="ab23b8f9-0736-e511-80c8-005056b8008e">Bulgaria</option>
<option value="ad23b8f9-0736-e511-80c8-005056b8008e">Burkina Faso</option>
<option value="af23b8f9-0736-e511-80c8-005056b8008e">Burundi</option>
<option value="b123b8f9-0736-e511-80c8-005056b8008e">Cambodia</option>
<option value="b323b8f9-0736-e511-80c8-005056b8008e">Cameroon</option>
<option value="b523b8f9-0736-e511-80c8-005056b8008e">Canada</option>
<option value="b723b8f9-0736-e511-80c8-005056b8008e">Cape Verde</option>
<option value="b923b8f9-0736-e511-80c8-005056b8008e">Cayman Islands</option>
<option value="bb23b8f9-0736-e511-80c8-005056b8008e">Central African Republic</option>
<option value="bd23b8f9-0736-e511-80c8-005056b8008e">Chad</option>
<option value="bf23b8f9-0736-e511-80c8-005056b8008e">Chile</option>
<option value="c123b8f9-0736-e511-80c8-005056b8008e">China</option>
<option value="c323b8f9-0736-e511-80c8-005056b8008e">Christmas Island</option>
<option value="c523b8f9-0736-e511-80c8-005056b8008e">Cocos (Keeling) Islands</option>
<option value="c723b8f9-0736-e511-80c8-005056b8008e">Colombia</option>
<option value="c923b8f9-0736-e511-80c8-005056b8008e">Comoros</option>
<option value="cb23b8f9-0736-e511-80c8-005056b8008e">Congo</option>
<option value="cd23b8f9-0736-e511-80c8-005056b8008e">Cook Islands</option>
<option value="cf23b8f9-0736-e511-80c8-005056b8008e">Costa Rica</option>
<option value="d123b8f9-0736-e511-80c8-005056b8008e">Croatia</option>
<option value="d323b8f9-0736-e511-80c8-005056b8008e">Cuba</option>
<option value="d523b8f9-0736-e511-80c8-005056b8008e">Curacao</option>
<option value="d723b8f9-0736-e511-80c8-005056b8008e">Cyprus</option>
<option value="d923b8f9-0736-e511-80c8-005056b8008e">Czech Republic</option>
<option value="db23b8f9-0736-e511-80c8-005056b8008e">Democratic Republic of the Congo</option>
<option value="dd23b8f9-0736-e511-80c8-005056b8008e">Denmark</option>
<option value="df23b8f9-0736-e511-80c8-005056b8008e">Djibouti</option>
<option value="e123b8f9-0736-e511-80c8-005056b8008e">Dominica</option>
<option value="e323b8f9-0736-e511-80c8-005056b8008e">Dominican Republic</option>
<option value="e523b8f9-0736-e511-80c8-005056b8008e">Ecuador</option>
<option value="e723b8f9-0736-e511-80c8-005056b8008e">Egypt</option>
<option value="e923b8f9-0736-e511-80c8-005056b8008e">El Salvador</option>
<option value="eb23b8f9-0736-e511-80c8-005056b8008e">Equatorial Guinea</option>
<option value="ed23b8f9-0736-e511-80c8-005056b8008e">Eritrea</option>
<option value="ef23b8f9-0736-e511-80c8-005056b8008e">Estonia</option>
<option value="f123b8f9-0736-e511-80c8-005056b8008e">Ethiopia</option>
<option value="f323b8f9-0736-e511-80c8-005056b8008e">Falkland Islands</option>
<option value="f523b8f9-0736-e511-80c8-005056b8008e">Faroe Islands</option>
<option value="f723b8f9-0736-e511-80c8-005056b8008e">Fiji</option>
<option value="f923b8f9-0736-e511-80c8-005056b8008e">Finland</option>
<option value="fb23b8f9-0736-e511-80c8-005056b8008e">France</option>
<option value="fd23b8f9-0736-e511-80c8-005056b8008e">French Guiana</option>
<option value="ff23b8f9-0736-e511-80c8-005056b8008e">French Polynesia</option>
<option value="0124b8f9-0736-e511-80c8-005056b8008e">French Southern Territories</option>
<option value="0324b8f9-0736-e511-80c8-005056b8008e">Gabon</option>
<option value="0524b8f9-0736-e511-80c8-005056b8008e">Gambia</option>
<option value="0724b8f9-0736-e511-80c8-005056b8008e">Georgia</option>
<option value="0924b8f9-0736-e511-80c8-005056b8008e">Germany</option>
<option value="0b24b8f9-0736-e511-80c8-005056b8008e">Ghana</option>
<option value="0d24b8f9-0736-e511-80c8-005056b8008e">Gibraltar</option>
<option value="0f24b8f9-0736-e511-80c8-005056b8008e">Greece</option>
<option value="1124b8f9-0736-e511-80c8-005056b8008e">Greenland</option>
<option value="1324b8f9-0736-e511-80c8-005056b8008e">Grenada</option>
<option value="1524b8f9-0736-e511-80c8-005056b8008e">Guadeloupe</option>
<option value="1724b8f9-0736-e511-80c8-005056b8008e">Guam</option>
<option value="1924b8f9-0736-e511-80c8-005056b8008e">Guatemala</option>
<option value="1b24b8f9-0736-e511-80c8-005056b8008e">Guernsey</option>
<option value="1d24b8f9-0736-e511-80c8-005056b8008e">Guinea</option>
<option value="1f24b8f9-0736-e511-80c8-005056b8008e">Guinea-Bissau</option>
<option value="2124b8f9-0736-e511-80c8-005056b8008e">Guyana</option>
<option value="2324b8f9-0736-e511-80c8-005056b8008e">Haiti</option>
<option value="2524b8f9-0736-e511-80c8-005056b8008e">Heard Island And Mcdonald Islands</option>
<option value="2724b8f9-0736-e511-80c8-005056b8008e">Holy See</option>
<option value="2924b8f9-0736-e511-80c8-005056b8008e">Honduras</option>
<option value="2b24b8f9-0736-e511-80c8-005056b8008e">Hong Kong</option>
<option value="2d24b8f9-0736-e511-80c8-005056b8008e">Hungary</option>
<option value="2f24b8f9-0736-e511-80c8-005056b8008e">Iceland</option>
<option value="3124b8f9-0736-e511-80c8-005056b8008e">India</option>
<option value="3324b8f9-0736-e511-80c8-005056b8008e">Indonesia</option>
<option value="3524b8f9-0736-e511-80c8-005056b8008e">Iran (Islamic Republic of)</option>
<option value="3724b8f9-0736-e511-80c8-005056b8008e">Iraq</option>
<option value="3924b8f9-0736-e511-80c8-005056b8008e">Ireland</option>
<option value="3b24b8f9-0736-e511-80c8-005056b8008e">Isle Of Man</option>
<option value="3d24b8f9-0736-e511-80c8-005056b8008e">Israel</option>
<option value="3f24b8f9-0736-e511-80c8-005056b8008e">Italy</option>
<option value="4124b8f9-0736-e511-80c8-005056b8008e">Ivory Coast</option>
<option value="4324b8f9-0736-e511-80c8-005056b8008e">Jamaica</option>
<option value="4524b8f9-0736-e511-80c8-005056b8008e">Japan</option>
<option value="4724b8f9-0736-e511-80c8-005056b8008e">Jordan</option>
<option value="4924b8f9-0736-e511-80c8-005056b8008e">Kazakhstan</option>
<option value="4b24b8f9-0736-e511-80c8-005056b8008e">Kenya</option>
<option value="4d24b8f9-0736-e511-80c8-005056b8008e">Kiribati</option>
<option value="4f24b8f9-0736-e511-80c8-005056b8008e">Korea, Democratic People's Rep. (North Korea)</option>
<option value="5124b8f9-0736-e511-80c8-005056b8008e">Korea, Republic of (South Korea)</option>
<option value="5324b8f9-0736-e511-80c8-005056b8008e">Kuwait</option>
<option value="5524b8f9-0736-e511-80c8-005056b8008e">Kyrgyzstan</option>
<option value="5724b8f9-0736-e511-80c8-005056b8008e">Lao, People's Democratic Republic</option>
<option value="5924b8f9-0736-e511-80c8-005056b8008e">Latvia</option>
<option value="5b24b8f9-0736-e511-80c8-005056b8008e">Lebanon</option>
<option value="5d24b8f9-0736-e511-80c8-005056b8008e">Lesotho</option>
<option value="5f24b8f9-0736-e511-80c8-005056b8008e">Liberia</option>
<option value="6124b8f9-0736-e511-80c8-005056b8008e">Libya</option>
<option value="6324b8f9-0736-e511-80c8-005056b8008e">Liechtenstein</option>
<option value="6524b8f9-0736-e511-80c8-005056b8008e">Lithuania</option>
<option value="6724b8f9-0736-e511-80c8-005056b8008e">Luxembourg</option>
<option value="6924b8f9-0736-e511-80c8-005056b8008e">Macau</option>
<option value="6b24b8f9-0736-e511-80c8-005056b8008e">Macedonia, Rep. of</option>
<option value="6d24b8f9-0736-e511-80c8-005056b8008e">Madagascar</option>
<option value="6f24b8f9-0736-e511-80c8-005056b8008e">Malawi</option>
<option value="7124b8f9-0736-e511-80c8-005056b8008e">Malaysia</option>
<option value="7324b8f9-0736-e511-80c8-005056b8008e">Maldives</option>
<option value="7524b8f9-0736-e511-80c8-005056b8008e">Mali</option>
<option value="7724b8f9-0736-e511-80c8-005056b8008e">Malta</option>
<option value="7924b8f9-0736-e511-80c8-005056b8008e">Marshall Islands</option>
<option value="7b24b8f9-0736-e511-80c8-005056b8008e">Martinique</option>
<option value="7d24b8f9-0736-e511-80c8-005056b8008e">Mauritania</option>
<option value="7f24b8f9-0736-e511-80c8-005056b8008e">Mauritius</option>
<option value="8124b8f9-0736-e511-80c8-005056b8008e">Mayotte</option>
<option value="8324b8f9-0736-e511-80c8-005056b8008e">Mexico</option>
<option value="8524b8f9-0736-e511-80c8-005056b8008e">Micronesia, Federal States of</option>
<option value="8724b8f9-0736-e511-80c8-005056b8008e">Moldova, Republic of</option>
<option value="8924b8f9-0736-e511-80c8-005056b8008e">Monaco</option>
<option value="8b24b8f9-0736-e511-80c8-005056b8008e">Mongolia</option>
<option value="8d24b8f9-0736-e511-80c8-005056b8008e">Montenegro</option>
<option value="8f24b8f9-0736-e511-80c8-005056b8008e">Montserrat</option>
<option value="9124b8f9-0736-e511-80c8-005056b8008e">Morocco</option>
<option value="9324b8f9-0736-e511-80c8-005056b8008e">Mozambique</option>
<option value="9524b8f9-0736-e511-80c8-005056b8008e">Myanmar, Burma</option>
<option value="9724b8f9-0736-e511-80c8-005056b8008e">Namibia</option>
<option value="9924b8f9-0736-e511-80c8-005056b8008e">Nauru</option>
<option value="9b24b8f9-0736-e511-80c8-005056b8008e">Nepal</option>
<option value="9d24b8f9-0736-e511-80c8-005056b8008e">Netherlands</option>
<option value="9f24b8f9-0736-e511-80c8-005056b8008e">New Caledonia</option>
<option value="a124b8f9-0736-e511-80c8-005056b8008e">New Zealand</option>
<option value="a324b8f9-0736-e511-80c8-005056b8008e">Nicaragua</option>
<option value="a524b8f9-0736-e511-80c8-005056b8008e">Niger</option>
<option value="a724b8f9-0736-e511-80c8-005056b8008e">Nigeria</option>
<option value="a924b8f9-0736-e511-80c8-005056b8008e">Niue</option>
<option value="ab24b8f9-0736-e511-80c8-005056b8008e">Norfolk Island</option>
<option value="ad24b8f9-0736-e511-80c8-005056b8008e">Northern Mariana Islands</option>
<option value="af24b8f9-0736-e511-80c8-005056b8008e">Norway</option>
<option value="b124b8f9-0736-e511-80c8-005056b8008e">Oman</option>
<option value="b324b8f9-0736-e511-80c8-005056b8008e">Pakistan</option>
<option value="b524b8f9-0736-e511-80c8-005056b8008e">Palau</option>
<option value="b724b8f9-0736-e511-80c8-005056b8008e">Palestinian territories</option>
<option value="b924b8f9-0736-e511-80c8-005056b8008e">Panama</option>
<option value="bb24b8f9-0736-e511-80c8-005056b8008e">Papua New Guinea</option>
<option value="bd24b8f9-0736-e511-80c8-005056b8008e">Paraguay</option>
<option value="bf24b8f9-0736-e511-80c8-005056b8008e">Peru</option>
<option value="c124b8f9-0736-e511-80c8-005056b8008e">Philippines</option>
<option value="c324b8f9-0736-e511-80c8-005056b8008e">Pitcairn Island</option>
<option value="c524b8f9-0736-e511-80c8-005056b8008e">Poland</option>
<option value="c724b8f9-0736-e511-80c8-005056b8008e">Portugal</option>
<option value="c924b8f9-0736-e511-80c8-005056b8008e">Puerto Rico</option>
<option value="cb24b8f9-0736-e511-80c8-005056b8008e">Qatar</option>
<option value="cd24b8f9-0736-e511-80c8-005056b8008e">Reunion Island</option>
<option value="cf24b8f9-0736-e511-80c8-005056b8008e">Romania</option>
<option value="d124b8f9-0736-e511-80c8-005056b8008e">Russian Federation</option>
<option value="d324b8f9-0736-e511-80c8-005056b8008e">Rwanda</option>
<option value="d524b8f9-0736-e511-80c8-005056b8008e">Saint Barthelemy</option>
<option value="d724b8f9-0736-e511-80c8-005056b8008e">Saint Helena</option>
<option value="d924b8f9-0736-e511-80c8-005056b8008e">Saint Kitts and Nevis</option>
<option value="db24b8f9-0736-e511-80c8-005056b8008e">Saint Lucia</option>
<option value="dd24b8f9-0736-e511-80c8-005056b8008e">Saint Martin (French Part)</option>
<option value="df24b8f9-0736-e511-80c8-005056b8008e">Saint Pierre And Miquelon</option>
<option value="e124b8f9-0736-e511-80c8-005056b8008e">Saint Vincent and the Grenadines</option>
<option value="e324b8f9-0736-e511-80c8-005056b8008e">Samoa</option>
<option value="e524b8f9-0736-e511-80c8-005056b8008e">San Marino</option>
<option value="e724b8f9-0736-e511-80c8-005056b8008e">Sao Tome and Principe</option>
<option value="e924b8f9-0736-e511-80c8-005056b8008e">Saudi Arabia</option>
<option value="eb24b8f9-0736-e511-80c8-005056b8008e">Senegal</option>
<option value="ed24b8f9-0736-e511-80c8-005056b8008e">Serbia</option>
<option value="ef24b8f9-0736-e511-80c8-005056b8008e">Seychelles</option>
<option value="f124b8f9-0736-e511-80c8-005056b8008e">Sierra Leone</option>
<option value="f324b8f9-0736-e511-80c8-005056b8008e">Singapore</option>
<option value="f524b8f9-0736-e511-80c8-005056b8008e">Sint Maarten (Dutch part)</option>
<option value="f724b8f9-0736-e511-80c8-005056b8008e">Slovakia (Slovak Republic)</option>
<option value="f924b8f9-0736-e511-80c8-005056b8008e">Slovenia</option>
<option value="fb24b8f9-0736-e511-80c8-005056b8008e">Solomon Islands</option>
<option value="fd24b8f9-0736-e511-80c8-005056b8008e">Somalia</option>
<option value="0125b8f9-0736-e511-80c8-005056b8008e">South Georgia And The South Sandwich Islands</option>
<option value="0325b8f9-0736-e511-80c8-005056b8008e">South Sudan</option>
<option value="0525b8f9-0736-e511-80c8-005056b8008e">Spain</option>
<option value="0725b8f9-0736-e511-80c8-005056b8008e">Sri Lanka</option>
<option value="0925b8f9-0736-e511-80c8-005056b8008e">Sudan</option>
<option value="0b25b8f9-0736-e511-80c8-005056b8008e">Suriname</option>
<option value="0d25b8f9-0736-e511-80c8-005056b8008e">Svalbard And Jan Mayen Islands</option>
<option value="0f25b8f9-0736-e511-80c8-005056b8008e">Swaziland</option>
<option value="1125b8f9-0736-e511-80c8-005056b8008e">Sweden</option>
<option value="1325b8f9-0736-e511-80c8-005056b8008e">Switzerland</option>
<option value="1525b8f9-0736-e511-80c8-005056b8008e">Syria, Syrian Arab Republic</option>
<option value="1725b8f9-0736-e511-80c8-005056b8008e">Taiwan (Republic of China)</option>
<option value="1925b8f9-0736-e511-80c8-005056b8008e">Tajikistan</option>
<option value="1b25b8f9-0736-e511-80c8-005056b8008e">Tanzania</option>
<option value="1d25b8f9-0736-e511-80c8-005056b8008e">Thailand</option>
<option value="1f25b8f9-0736-e511-80c8-005056b8008e">Timor-Leste (East Timor)</option>
<option value="2125b8f9-0736-e511-80c8-005056b8008e">Togo</option>
<option value="2325b8f9-0736-e511-80c8-005056b8008e">Tokelau</option>
<option value="2525b8f9-0736-e511-80c8-005056b8008e">Tonga</option>
<option value="2725b8f9-0736-e511-80c8-005056b8008e">Trinidad and Tobago</option>
<option value="2925b8f9-0736-e511-80c8-005056b8008e">Tunisia</option>
<option value="2b25b8f9-0736-e511-80c8-005056b8008e">Turkey</option>
<option value="2d25b8f9-0736-e511-80c8-005056b8008e">Turkmenistan</option>
<option value="2f25b8f9-0736-e511-80c8-005056b8008e">Turks and Caicos Islands</option>
<option value="3125b8f9-0736-e511-80c8-005056b8008e">Tuvalu</option>
<option value="3325b8f9-0736-e511-80c8-005056b8008e">Uganda</option>
<option value="3525b8f9-0736-e511-80c8-005056b8008e">Ukraine</option>
<option value="3725b8f9-0736-e511-80c8-005056b8008e">United Arab Emirates</option>
<option value="3925b8f9-0736-e511-80c8-005056b8008e">United Kingdom</option>
<option value="3b25b8f9-0736-e511-80c8-005056b8008e">United States</option>
<option value="3d25b8f9-0736-e511-80c8-005056b8008e">Uruguay</option>
<option value="3f25b8f9-0736-e511-80c8-005056b8008e">Uzbekistan</option>
<option value="4125b8f9-0736-e511-80c8-005056b8008e">Vanuatu</option>
<option value="4325b8f9-0736-e511-80c8-005056b8008e">Vatican City State (Holy See)</option>
<option value="4525b8f9-0736-e511-80c8-005056b8008e">Venezuela</option>
<option value="4725b8f9-0736-e511-80c8-005056b8008e">Vietnam</option>
<option value="4925b8f9-0736-e511-80c8-005056b8008e">Virgin Islands (British)</option>
<option value="4b25b8f9-0736-e511-80c8-005056b8008e">Virgin Islands (U.S.)</option>
<option value="4d25b8f9-0736-e511-80c8-005056b8008e">Wallis and Futuna Islands</option>
<option value="4f25b8f9-0736-e511-80c8-005056b8008e">Western Sahara</option>
<option value="5125b8f9-0736-e511-80c8-005056b8008e">Yemen</option>
<option value="5325b8f9-0736-e511-80c8-005056b8008e">Zambia</option>
<option value="5525b8f9-0736-e511-80c8-005056b8008e">Zimbabwe</option>
</select></td>
</tr>
</tbody>
</table>
<div id="paymentPostalContainer">
<table>
<tbody>
<tr class="paymentPostal-SA" style="display: none;">
<td><label></label><span class="required" style="position:relative;left:92%;">*</span></td>
<td><input value="" class="meduimText" id="paymentPostalAfrigisId" name="PaymentPostalCode" type="text" autocomplete="off"></td>
<td style="position: relative;left:6px;">
<input id="paymentPostalDistribution" type="button" value="Search">
</td>
</tr>
<tr class="paymentPostal-SA" style="display: none;">
<td></td>
<td class="companyAddressFields1">
<select name="PaymentPostalAfrigis" id="paymentDistributionAreaList"></select>
</td>
</tr>
<tr class="paymentPostal-SA" style="display: none;">
<td>
<label>Province</label>
</td>
<td class="PostalSA"><select id="paymentProvinces" name="PaymentProvince">
<option value="0cb9d57a-0b36-e511-80c8-005056b8008e">Eastern Cape</option>
<option value="b3f1821e-0b36-e511-80c8-005056b8008e">Free State</option>
<option value="cc02d25f-0a36-e511-80c8-005056b8008e">Gauteng</option>
<option value="fb05831e-0b36-e511-80c8-005056b8008e">Kwazulu-Natal</option>
<option value="4e0dd25f-0a36-e511-80c8-005056b8008e">Limpopo</option>
<option value="e60bd25f-0a36-e511-80c8-005056b8008e">Mpumalanga</option>
<option value="ccc1d57a-0b36-e511-80c8-005056b8008e">Northern Cape</option>
<option value="780bd25f-0a36-e511-80c8-005056b8008e">North West</option>
<option value="1ac7d57a-0b36-e511-80c8-005056b8008e">Western Cape</option>
</select></td>
</tr>
<tr class="paymentPostal-SA" style="display: none;">
<td>
<label>Street / Post Box</label><span class="required">*</span>
</td>
<td class="PostalSA"><input value="" id="PaymentPostalStreet1" name="PaymentPostalStreet1" type="text" autocomplete="off"></td>
</tr>
<tr class="paymentPostal-SA" style="display: none;">
<td>
<label></label>
</td>
<td><input value="" id="PaymentPostalStreet2" name="PaymentPostalStreet2" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentPostalSuburb">Suburb</label></td>
<td><input value="" id="paymentPostalSuburb" name="PaymentPostalSuburb" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentPostalCity">City / Town</label></td>
<td><input value="" id="paymentPostalCity" name="PaymentPostalCity" type="text" autocomplete="off"></td>
</tr>
<tr>
<td><label for="PaymentPostalCode">Postal Code</label></td>
<td><input value="" id="paymentPostalCode" name="PaymentPostalCode" type="text" autocomplete="off"></td>
</tr>
</tbody>
</table>
</div>
<table border="0" id="companyConsent" style="display: none;">
<tbody>
<tr>
<td colspan="3" style="padding-top:14px;padding-bottom:5px;">
<span class="required">*</span>
<span><b>Consent for Release of Information (PoPi Act)</b><br>
</span>
<span>I give my consent that information regarding my enrolment, academic records and/or awards may be released to my Company.</span><br>
<span>I understand that the purpose of the disclosure of the information is to assist with the monitoring of my progress and the implementation of the necessary actions to support my development.</span>
</td>
</tr>
<tr>
<td>
<div class="selector radio" style="padding-bottom: 5px;">
<label> <input data-val="true" data-val-required="The Consent field is required." id="Consent" name="Consent" type="radio" value="True"> Yes<span></span>
</label>
</div>
<div class="selector radio">
<label> <input id="Consent" name="Consent" type="radio" value="False"> No<span></span>
</label>
</div>
<table>
<tbody>
<tr>
</tr>
<tr>
</tr>
</tbody>
</table>
</td>
<td> </td>
<td> </td>
</tr>
</tbody>
</table>
<div class="paymentPostal-nonSA">
<table>
<tbody>
<tr>
<td><label for="PaymentSelectedCountry">Country</label></td>
<td class="countryPayment"><input value="" id="paymentCountry" name="PaymentSelectedCountry" readonly="readonly" type="text" autocomplete="off"></td>
</tr>
</tbody>
</table>
</div>
</div>
</fieldset>
<input id="navigateButton" type="submit" class="navigateButton paymentInfoButton" value="Submit" style="display: none;">
<input id="mainSubmitButton" class="navigateButton" type="submit" value="Submit">
</div>
<script type="text/javascript">
var paymentVal = $("#payment option:selected").text();
//alert(paymentVal);
if (paymentVal == "Company") {
$('#companyConsent').show();
} else {
$('#companyConsent').hide();
$("#Consent").prop("checked", false);
}
$(function() {
$("#paymentResponsibilityType").val($("#payment>option:selected").text());
if ($("#paymentCountries")) {
resolvePaymentCountries();
}
$("#paymentCountries").change(function() {
resolvePaymentCountries();
//set province to empty string if international
//if ($("#payment>option:selected").text() !== "South Africa" || $("#payment>option:selected").text() !== "")
//{
// //Internation Company address
// paymentProvinces
// $("#payment>option:selected").va('0cb9d57a-0b36-e511-80c8-005056b8908e');
//}
});
if ($("#payment>option:selected").text() != undefined && $("#payment>option:selected").text() == "Self") {
$("#paymentResponsibilityType").val($("#payment>option:selected").text());
$("#isCompanyResponsibility").val(false);
$("#isSelf").val(true);
}
$("#payment").change(function() {
var paymentVal = $("#payment option:selected").text();
//alert(paymentVal);
if (paymentVal == "Company" || paymentVal == "Sponsored" || paymentVal == "Department") {
$('#companyConsent').show();
} else {
$('#companyConsent').hide();
$("#Consent").prop("checked", false);
}
$("#paymentResponsibilityType").val("");
if ($("#payment>option:selected").text() != undefined && $("#payment>option:selected").text() == "Self") {
$("#paymentResponsibilityType").val($("#payment>option:selected").text());
$("#isCompanyResponsibility").val(false);
$("#isSelf").val(true);
} else if ($("#payment>option:selected").text() != undefined && $("#payment>option:selected").text() == "Company") {
$("#paymentCompanyLabel").text("Name of Company");
$("#paymentCompanyHeading").text("Company:");
$("#paymentCompanyAddressHeading").text("Company Address:");
$("#isCompanyResponsibility").val(true);
$("#isSelf").val(false);
} else if ($("#payment>option:selected").text() != undefined && $("#payment>option:selected").text() == "Department") {
$("#paymentCompanyHeading").text("Department:");
$("#paymentCompanyAddressHeading").text("Department Address:");
$("#isCompanyResponsibility").val(true);
$("#isSelf").val(false);
} else if ($("#payment>option:selected").text() != undefined && $("#payment>option:selected").text() == "Sponsored") {
$("#paymentCompanyLabel").text("Name of Sponsor");
$("#paymentCompanyHeading").text("Sponsor:");
$("#paymentCompanyAddressHeading").text("Sponsor Address:");
$("#isCompanyResponsibility").val(true);
$("#isSelf").val(false);
}
});
$("#paymentPostalDistribution").click(function() {
var searchCriteria = $("#paymentPostalAfrigisId").val();
if (!searchCriteria) {
alert("Please enter Postal Code");
return;
}
$.ajax({
type: "POST",
dataType: "json",
url: "ApplicationForm/GetDistributionAreas?query=" + searchCriteria,
data: {
"query": searchCriteria
},
contentType: 'application/json; charset=utf-8',
error: function(x, e) {
alert("An error occurred while trying to load the data. Please try again later or contact your service administrator.");
},
success: function(data) {
populatePaymentDistributionAreas(data);
}
});
});
$("#paymentDistributionAreaList").change(function() {
var selectedArea = $("#paymentDistributionAreaList option:selected").text();
var area = selectedArea.split(',');
if (area.length === 1) {
return false;
}
$("#paymentPostalSuburb").val(area[0]);
$("#paymentPostalCity").val(area[1]);
$("#paymentPostalCode").val(area[2]);
});
});
resolvePaymentCountries = function() {
var selectedText = $("#paymentCountries option:selected").text();
if (selectedText == "South Africa") {
$("#paymentPostalContainer").show(500);
$(".paymentPostal-nonSA").hide();
$(".paymentPostal-SA").show();
$("#paymentPostalSuburb").attr("readonly", true);
$("#paymentPostalCity").attr("readonly", true);
$("#paymentPostalCode").attr("readonly", true);
} else if (selectedText != "") {
//$("#nationality").val(selectedText);
$("#paymentPostalContainer").show(500);
$(".paymentPostal-nonSA").show();
$(".paymentPostal-SA").hide();
$("#paymentPostalSuburb").attr("readonly", false);
$("#paymentPostalCity").attr("readonly", false);
$("#paymentPostalCode").attr("readonly", false);
} else {
$("#paymentPostalContainer").hide(500);
}
$("#paymentCountry").val(selectedText);
$("#paymentSelectedCountry").val(selectedText);
};
populatePaymentDistributionAreas = function(areas) {
if (areas.length > 0) {
if ($('#paymentDistributionAreaList').length >= 0) {
$('#paymentDistributionAreaList')[0].options.length = 0;
}
var options = $("#paymentDistributionAreaList");
$.each(areas, function() {
options.append(new Option(this.Text, this.Value));
});
} else {
alert(
"The address search returned no results for your query. Check the spelling and try filling in your town or city which will return the broadest search. Remember to fill in either the one or the other, for instance, do not supply BOTH suburb AND city."
);
}
};
var paymentVal = $("#payment option:selected").text();
//alert(paymentVal);
if (paymentVal == "Company") {
$('#companyConsent').show();
} else {
$('#companyConsent').hide();
}
</script>
</div>
</div>
<div id="dialog" style="display: none;">
<strong class="message"></strong>
</div>
<div id="progressDialog" style="display: none;">
<strong class="message"></strong>
<img class="progress">
</div>
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</section>
</main>
</form>Text Content
SHORT COURSE APPLICATION FORM
*
--------------------------------------------------------------------------------
Have you studied at USB-ED before or saved an incomplete application?
Enter your email address to search for a previously added/saved application.
E-mail address
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application
APPLICATION
Please have the following on hand before you begin the application process:
Electronic copies of:
* ID/Passport
* Matric certificate/AO level OR Abridged CV
Continue to the application process
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Current Employment
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Industry
< Select Option > Agriculture and Environmental Science Business Management and
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Qualification Type *
< Select Option > Grade 12 Certificate, Diploma B Degree Post Graduate, Honours
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if other, please specify
Qualification Field
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Copy of Qualifications
Copy of Identity document *
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Select file...
Copy of CV document
Select file...
Field of Study
Course: Women in Leadership
Course start date: 12 Apr 2023
Personal Information
Please enter correct date format for year. eg 1900 or later
E-mail address *
Surname *
On completion of your studies, the following name will be displayed on your
certificate. This is a read only display. Please make any changes in the surname
and first name fields. Please check spacing and punctuation.
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First Names *
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Initials *
Title *
< Select Option > 2nd Lieutenant Adjudant Adjudant-General Advocate Archbishop
Archbishop Emeritus Baron Baroness Bishop Brigadier Brigadier General Brother
Candidate Candidate Officer Captain Captain (SA Navy) Chaplain Chief Justice
Colonel Commandant Commandant-General Commander Commodore Constable Corporal
Countess Director General Doctor/Docter Dr Right Honourable Dr The Honourable
Earl Eminence Ensign Father Field-Cornet Field-Marshal General Governor
Governor-General Honourable Judge Judge President Lady Lance-Corporal Lieutenant
Lieutenant-Colonel Lieutenant-Commander Lieutenant-General Lord Madame Maj-Genl
Major Major-General Midshipman Minister Miss Mr Mrs Ms Mx Pastor President
Prince Princess Private Prof Dr Professor Rear-Admiral Reverand 2nd Lieutenant
Reverend Right Honourable Senator Adjudant Sergeant Sergeant-Major Sir Sister
Sub-Lieutenant Adjudant-General The Honourable Advocate Archbishop Unknown
Archbishop Emeritus Vise-Admiral Baron Warrant Officer Baroness Bishop Brigadier
Brigadier General Brother Candidate Candidate Officer Captain Captain (SA Navy)
Chaplain Chief Justice Colonel Commandant Commandant-General Commander Commodore
Constable Corporal Countess Director General Doctor/Docter Dr Right Honourable
Dr The Honourable Earl Eminence Ensign Father Field-Cornet Field-Marshal General
Governor Governor-General Honourable Judge Judge President Lady Lance-Corporal
Lieutenant Lieutenant-Colonel Lieutenant-Commander Lieutenant-General Lord
Madame Maj-Genl Major Major-General Midshipman Minister Miss Mr Mrs Ms Mx Pastor
President Prince Princess Private Prof Dr Professor Rear-Admiral Reverand
Reverend Right Honourable Senator Sergeant Sergeant-Major Sir Sister
Sub-Lieutenant The Honourable Unknown Vise-Admiral Warrant Officer 2nd
Lieutenant Adjudant Adjudant-General Advocate Archbishop Archbishop Emeritus
Baron Baroness Bishop Brigadier Brigadier General Brother Candidate Candidate
Officer Captain Captain (SA Navy) Chaplain Chief Justice Colonel Commandant
Commandant-General Commander Commodore Constable Corporal Countess Director
General Doctor/Docter Dr Right Honourable Dr The Honourable Earl Eminence Ensign
Father Field-Cornet Field-Marshal General Governor Governor-General Honourable
Judge Judge President Lady Lance-Corporal Lieutenant Lieutenant-Colonel
Lieutenant-Commander Lieutenant-General Lord Madame Maj-Genl Major Major-General
Midshipman Minister Miss Mr Mrs Ms Mx Pastor President Prince Princess Private
Prof Dr Professor Rear-Admiral Reverand Reverend Right Honourable Senator
Sergeant Sergeant-Major Sir Sister Sub-Lieutenant The Honourable Unknown
Vise-Admiral Warrant Officer
Gender *
< Select Option > Female Male Non Binary Female Male Non Binary Female Male Non
Binary
Nationality *
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Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei
Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde
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Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany
Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey
Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Holy See
Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of)
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Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau
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States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco
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Reunion Island Romania Russian Federation Rwanda Saint Barthelemy Saint Helena
Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre And
Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe
Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten
(Dutch part) Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South
Georgia And The South Sandwich Islands South Sudan Spain Sri Lanka Sudan
Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syria,
Syrian Arab Republic Taiwan (Republic of China) Tajikistan Tanzania Thailand
Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
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See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and
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