{"action":"created","issue":{"url":"https://api.github.com/repos/formvalidation/support/issues/460","labels_url":"https://api.github.com/repos/formvalidation/support/issues/460/labels{/name}","comments_url":"https://api.github.com/repos/formvalidation/support/issues/460/comments","events_url":"https://api.github.com/repos/formvalidation/support/issues/460/events","html_url":"https://github.com/formvalidation/support/issues/460","id":128368279,"number":460,"title":"validation shows at the bottom of screen","user":{"login":"amucino","id":13330689,"avatar_url":"https://avatars.githubusercontent.com/u/13330689?v=3","gravatar_id":"","url":"https://api.github.com/users/amucino","html_url":"https://github.com/amucino","followers_url":"https://api.github.com/users/amucino/followers","following_url":"https://api.github.com/users/amucino/following{/other_user}","gists_url":"https://api.github.com/users/amucino/gists{/gist_id}","starred_url":"https://api.github.com/users/amucino/starred{/owner}{/repo}","subscriptions_url":"https://api.github.com/users/amucino/subscriptions","organizations_url":"https://api.github.com/users/amucino/orgs","repos_url":"https://api.github.com/users/amucino/repos","events_url":"https://api.github.com/users/amucino/events{/privacy}","received_events_url":"https://api.github.com/users/amucino/received_events","type":"User","site_admin":false},"labels":[],"state":"closed","locked":false,"assignee":null,"milestone":null,"comments":0,"created_at":"2016-01-24T02:48:33Z","updated_at":"2016-01-24T02:57:29Z","closed_at":"2016-01-24T02:57:29Z","body":"I added a date validation to a date field, but this happens to any field. The validation works but the message instead of showing right under the field name is showing at the bottom of the screen. All the include files are in place, It has something to do with the code inside this particular form. If I take the same page, remove the form and add a new one in its place it shows up fine. I can't really do that because it has over 50 fields and redoing it would take forever, perhaps you can shed some light on what could cause this issue. \r\n\r\n--- here is my page code--\r\n\r\n```\r\n\r\n\r\n<!DOCTYPE html>\r\n\r\n<!--#BlueDot Include files-->\r\n\r\n<!--#BeginBlock-->\r\n\r\n<!--#Recordsets include-->\r\n\r\n\r\n\r\n<!--#Total Admin alert-->\r\n\r\n\r\n<!--#Total Alerts count-->\r\n\r\n\r\n<!--#Reminders overdue count-->\r\n\r\n\r\n\r\n<!--#Repeat steps overdue count-->\r\n\r\n\r\n\r\n<!--#Questionnaire view-->\r\n\r\n\r\n<!--#Questionnaire ALL count-->\r\n\r\n\r\n<!--#Questionnaire mine count-->\r\n\r\n\r\n<!--#Questionnaire Questionnairegroupusers-->\r\n\r\n\r\n<head>\r\n<!--#head includes-->\r\n<!--#Bootstrap -->\r\n<link href=\"../../includes/css/bootstrap.min.css\" rel=\"stylesheet\">\r\n<link href=\"../../includes/font-awesome/css/font-awesome.css\" rel=\"stylesheet\">\r\n\r\n<!-- Morris -->\r\n<link href=\"../../includes/css/plugins/morris/morris-0.4.3.min.css\" rel=\"stylesheet\">\r\n\r\n<!-- Gritter -->\r\n<link href=\"../../includes/js/plugins/gritter/jquery.gritter.css\" rel=\"stylesheet\">\r\n<link href=\"../../includes/css/animate.css\" rel=\"stylesheet\">\r\n<link href=\"../../includes/css/style.css\" rel=\"stylesheet\"> \r\n\r\n<!-- icheck -->\r\n<link href=\"../../includes/css/plugins/awesome-bootstrap-checkbox/awesome-bootstrap-checkbox.css\" rel=\"stylesheet\">\r\n<link href=\"../../includes/css/plugins/iCheck/custom.css\" rel=\"stylesheet\">\r\n\r\n<!-- Toast -->\r\n<link href=\"../../includes/css/plugins/toastr/toastr.min.css\" rel=\"stylesheet\">\r\n\r\n<!-- Forms validation -->\r\n<link rel=\"stylesheet\" href=\"../../includes/formvalidation/dist/css/formValidation.min.css\">\r\n\r\n<!-- Date picker validation -->\r\n<link href=\"../../includes/css/plugins/datapicker/datepicker3.css\" rel=\"stylesheet\">\r\n<link href=\"../../includes/css/plugins/clockpicker/clockpicker.css\" rel=\"stylesheet\">\r\n<link rel=\"stylesheet\" type=\"text/css\" href=\"../../includes/css/plugins/datapicker/datepicker.min.css\">\r\n<link rel=\"stylesheet\" type=\"text/css\" href=\"../../includes/css/plugins/datapicker/datepicker3.css\">\r\n<link href=\"../../includes/css/plugins/daterangepicker/daterangepicker-bs3.css\" rel=\"stylesheet\">\r\n\r\n<!-- Data tables -->\r\n<link href=\"../../includes/css/plugins/dataTables/datatables.min.css\" rel=\"stylesheet\">\r\n\r\n<!-- Data Tables -->\r\n<link href=\"../../includes/css/plugins/dataTables/datatables.min.css\" rel=\"stylesheet\">\r\n\r\n \r\n<script type=\"text/JavaScript\">\r\nfunction MM_openBrWindow(theURL,winName,features) { //v2.0\r\n  window.open(theURL,winName,features);\r\n}\r\n//-->\r\n</script>\r\n\r\n\t\t\r\n\r\n\r\n<script type=\"text/JavaScript\">\r\nfunction MM_openBrWindow(theURL,winName,features) { //v2.0\r\n  window.open(theURL,winName,features);\r\n}\r\n//-->\r\n</script>\r\n\r\n\r\n\r\n<script type=\"text/javascript\">\r\nfunction WAAddError(formElement,errorMsg,focusIt,stopIt)  {\r\n  if (document.WAFV_Error)  {\r\n\t  document.WAFV_Error += \"\\n\" + errorMsg;\r\n  }\r\n  else  {\r\n    document.WAFV_Error = errorMsg;\r\n  }\r\n  if (!document.WAFV_InvalidArray)  {\r\n    document.WAFV_InvalidArray = new Array();\r\n  }\r\n  document.WAFV_InvalidArray[document.WAFV_InvalidArray.length] = formElement;\r\n  if (focusIt && !document.WAFV_Focus)  {\r\n\tdocument.WAFV_Focus = focusIt;\r\n  }\r\n\r\n  if (stopIt == 1)  {\r\n\tdocument.WAFV_Stop = true;\r\n  }\r\n  else if (stopIt == 2)  {\r\n\tformElement.WAFV_Continue = true;\r\n  }\r\n  else if (stopIt == 3)  {\r\n\tformElement.WAFV_Stop = true;\r\n\tformElement.WAFV_Continue = false;\r\n  }\r\n}\r\n</script>\r\n\r\n<script type=\"text/javascript\">\r\n\r\nfunction makeLowercase() {\r\ndocument.form1.outstring.value = document.form1.instring.value.toLowerCase();\r\n}\r\n\r\n\r\n//-->\r\n</script>\r\n\r\n\r\n\r\n\r\n<script>\r\nfunction MyPopUpWin(url, width, height) {\r\n    var leftPosition, topPosition;\r\n    //Allow for borders.\r\n    leftPosition = (window.screen.width / 2) - ((width / 2) + 10);\r\n    //Allow for title and status bars.\r\n    topPosition = (window.screen.height / 2) - ((height / 2) + 50);\r\n    //Open the window.\r\n    window.open(url, \"Window2\",\r\n    \"status=no,height=\" + height + \",width=\" + width + \",resizable=yes,left=\"\r\n    + leftPosition + \",top=\" + topPosition + \",screenX=\" + leftPosition + \",screenY=\"\r\n    + topPosition + \",toolbar=no,menubar=no,scrollbars=no,location=no,directories=no\");\r\n}\r\n </script>\r\n \r\n <script>\r\nfunction MyPopUpWin2(url, width, height) {\r\n    var leftPosition, topPosition;\r\n    //Allow for borders.\r\n    leftPosition = (window.screen.width / 2) - ((width / 2) + 10);\r\n    //Allow for title and status bars.\r\n    topPosition = (window.screen.height / 2) - ((height / 2) + 50);\r\n    //Open the window.\r\n    window.open(url, \"Window2\",\r\n    \"status=no,height=\" + height + \",width=\" + width + \",resizable=yes,left=\"\r\n    + leftPosition + \",top=\" + topPosition + \",screenX=\" + leftPosition + \",screenY=\"\r\n    + topPosition + \",toolbar=no,menubar=no,scrollbars=yes,location=no,directories=no\");\r\n}\r\n\r\n  </script>\r\n  \r\n  \r\n\t<link href=\"../../includes/css/plugins/awesome-bootstrap-checkbox/awesome-bootstrap-checkbox.css\" rel=\"stylesheet\">\r\n    <link href=\"../../includes/css/plugins/iCheck/custom.css\" rel=\"stylesheet\">\r\n     <link href=\"../../includes/css/plugins/datapicker/datepicker3.css\" rel=\"stylesheet\">\r\n     <link href=\"../../includes/css/plugins/daterangepicker/daterangepicker-bs3.css\" rel=\"stylesheet\">\r\n</head>\r\n\r\n<!--#Body-->\r\n<body>\r\n<div id=\"wrapper\">\r\n<nav class=\"navbar-default navbar-static-side\" role=\"navigation\">\r\n<div class=\"sidebar-collapse\">\r\n\r\n<!--#Left menu-->        \r\n<nav class=\"navbar-default navbar-static-side\" role=\"navigation\">\r\n<div class=\"sidebar-collapse\">\r\n          <ul class=\"nav metismenu\" id=\"side-menu\">\r\n                <li class=\"nav-header\">\r\n                  <div class=\"dropdown profile-element\"><img src=\"../../imgs/BlueDot_logo_transp.png\" class=\"img-responsive\" alt=\"Placeholder image\"></div>\r\n                  <div class=\"logo-element\">\r\n                      BlueDot\r\n                  </div>\r\n                </li>\r\n                 <li class=\"active\">\r\n                    <a href=\"../default.asp\"><i class=\"fa fa-dashboard\"></i> <span class=\"nav-label\">Dashboard</span></a>\r\n                    \r\n                </li>\r\n                \r\n                             <li >\r\n                        <a href=\"#\"><i class=\"fa fa-folder-open\"></i> <span class=\"nav-label\">Files</span><span class=\"fa arrow\"></span></a>\r\n                        <ul class=\"nav nav-second-level collapse\">\r\n                            \r\n                            <li>\r\n                                <a href=\"#\">Questionnaire<span class=\"fa arrow\"></span></a>\r\n                                <ul class=\"nav nav-third-level\">\r\n                                    <li>\r\n                                        <a href=\"../qnr/IndexNewcontact.asp\">New contact</a>\r\n                                    </li>\r\n                                    <li>\r\n                                        <a href=\"../qnr/EmailQnrexistingsearch.asp\">Existing contact</a>\r\n                                    </li>\r\n\t\t\t\t\t\t\t\t</ul>\r\n                            </li>\r\n                            \r\n                        <li><a href=\"../contacts/searchviewsearchcontacts.asp\">Contacts</a></li>\r\n                        \r\n                        <li><a href=\"../cases/searchviewsearchcases.asp\">Cases</a></li>\r\n                        \r\n                        <li><a href=\"../employers/searchviewsearchemployers.asp\">Employers</a></li>\r\n                        \r\n                        <li><a href=\"../billing/index.asp\">Billing</a></li>\r\n                        \r\n                        <li><a href=\"../RegionalCenters/Index.asp\">Regional Centers</a></li>\r\n                        \r\n                        <li ><a href=\"../Agents/Index.asp\">Agents</a></li>\r\n\t\t\t\t\t\t\r\n                        </ul>\r\n                    </li>\r\n                    \r\n                   \r\n                    <li>\r\n                        <a href=\"#\"><i class=\"fa fa-envelope\"></i> <span class=\"nav-label\">Messages</span><span class=\"fa arrow\"></span></a>\r\n                        <ul class=\"nav nav-second-level collapse\">\r\n   \t\t\t\t\t\t<li><a href=\"../inbox/index.asp\">Inbox</a></li>\r\n                        <li><a href=\"../inbox/outbox.asp\">Outbox</a></li>\r\n                        </ul>\r\n                    </li>\r\n                    \r\n                 <li class=\"active\">\r\n                        <a href=\"#\"><i class=\"fa fa-bar-chart-o\"></i> <span class=\"nav-label\">Reports</span><span class=\"fa arrow\"></span></a>\r\n                        <ul class=\"nav nav-second-level collapse\">\r\n                            <li>\r\n                                <a href=\"#\">Basic<span class=\"fa arrow\"></span></a>\r\n                                <ul class=\"nav nav-third-level\">\r\n                                    <li>\r\n                                        <a href=\"../reports/basic_contacts_index.asp\">Contacts</a>\r\n                                    </li>\r\n                                    <li >\r\n                                        <a href=\"../reports/basic_cases_index.asp\">Cases</a>\r\n                                    </li>\r\n                                    <li>\r\n                                        <a href=\"../reports/basic_employers_index.asp\">Employers</a>\r\n                                    </li>\r\n                                    <li>\r\n                                        <a href=\"../reports/basic_billing_index.asp\">Billing</a>\r\n                                    </li>\r\n\r\n                                </ul>\r\n                            </li>\r\n\t\t\t\t\t\t<li class=\"active\"><a href=\"../reports/Indexbyuser.asp\">Advanced</a></li>\r\n                        </ul>\r\n                    </li>\r\n                    \r\n                   <li >\r\n                    <a href=\"#\"><i class=\"fa fa-wrench\"></i> <span class=\"nav-label\">Tools</span><span class=\"fa arrow\"></span></a>\r\n                    <ul class=\"nav nav-second-level collapse\">\r\n                        <li><a href=\"../Tools/blankforms.asp\">Blank forms</a></li>\r\n                        <li><a href=\"../Tools/relatedlinks.asp\">Useful links</a></li>\r\n                        <li><a href=\"../Calendar/index.asp\">Calendar</a></li>\r\n                    </ul>\r\n                </li>\r\n                  \r\n               \r\n                <li>\r\n                    <a href=\"#\"><i class=\"fa fa-male\"></i> <span class=\"nav-label\">User Settings</span><span class=\"fa arrow\"></span></a>\r\n                    <ul class=\"nav nav-second-level collapse\">\r\n                    \r\n                        <li><a href=\"../Tools/index.asp\">User preferences</a></li>\r\n                        <li><a href=\"../updatepassword.asp\">Change password</a></li>\r\n                    </ul>\r\n                </li>\r\n                \r\n                 <li>\r\n                    <a href=\"#\"><i class=\"fa fa-support\"></i> <span class=\"nav-label\">Support</span><span class=\"fa arrow\"></span></a>\r\n                    <ul class=\"nav nav-second-level collapse\">\r\n                        <li> <a href=\"javascript:;\" onClick=\"MyPopUpWin2('https://bluedotcloud.zendesk.com/hc/en-us',1280, 800)\">Help center</a> </li>\r\n                        <li> <a href=\"javascript:;\" onClick=\"MyPopUpWin('https://www.bluedotcloud.com/BDotBT/index.html',1300, 800)\">Learning center</a> </li>\r\n\r\n\t\t\t\t\t</ul>\r\n                </li>\r\n              \r\n\r\n          </ul>\r\n         </div>\r\n          </nav>       \r\n</div>\r\n</nav>\r\n\r\n<div id=\"page-wrapper\" class=\"gray-bg\">\r\n\t<div class=\"row border-bottom\">\r\n   \r\n        \r\n<!-- Top bar -->\r\n<!--#Navigation bar-->\r\n<nav class=\"navbar navbar-static-top white-bg\" role=\"navigation\" style=\"margin-bottom: 0\">\r\n        <div class=\"navbar-header\">\r\n            <a class=\"navbar-minimalize minimalize-styl-2 btn btn-primary \" href=\"#\"><i class=\"fa fa-bars\"></i> </a>\r\n         \r\n        </div>\r\n            <ul class=\"nav navbar-top-links navbar-right\">\r\n               \r\n                <li>\r\n                  <span class=\"m-r-sm text-muted welcome-message\">Welcome Aleks&nbsp;Mucino</span>\r\n                </li>\r\n                \r\n<!--#Modal window code-->                 \r\n                \r\n                <div class=\"modal inmodal\" id=\"myModal\" tabindex=\"-1\" role=\"dialog\" aria-hidden=\"true\">\r\n                                <div class=\"modal-dialog\">\r\n                                <div class=\"modal-content animated bounceInRight\">\r\n                                        <div class=\"modal-header\">\r\n                                            <button type=\"button\" class=\"close\" data-dismiss=\"modal\"><span aria-hidden=\"true\">&times;</span><span class=\"sr-only\">Close</span></button>\r\n                                            <i class=\"fa fa-laptop modal-icon\"></i>\r\n                                            <h4 class=\"modal-title\">BlueDot Major Upgrade Announcement</h4>\r\n                                            <small class=\"font-bold\">Posted on: 1/1/2016</small>\r\n                                        </div>\r\n                                        <div class=\"modal-body\">\r\n                                            <p><h3>We Provide World Class Solutions</h3><p>BlueDot is a Technology company with over 10 years experience developing top of the line Commercial Web Applications.<br />\t\t\t\t\t\t\t  BlueDot provides the most user friendly and advanced integrated solutions for the Legal Industry.<br />\t\t\t\t\t\t\t   We specialize in providing personalized customer service, beautifully designed Web Applications and customizations to better fit your business needs.</p><h3>Customer Service at its best!</h3><p>We are well known for providing the best Customer Service experience. Personalized service is our signature, you will have one BlueDot Account Manager assigned to you. <br />\t\t\t\t\t\t\t   All requests are directed to your Account Manager who will be more than happy to take care of things for you.<br />\t\t\t\t\t\t\t   Better customer service starts with better communication. BlueDot uses ZenDesk to provide customer support.ZenDesk is a software that allows us to keep track of all support requests and to provide a better customer service experience.</p></p>\r\n                                                    <div class=\"form-group\"></div>\r\n                                        </div>\r\n                                        <div class=\"modal-footer\">\r\n                                            <button type=\"button\" class=\"btn btn-white\" data-dismiss=\"modal\">Close</button>\r\n                                            \r\n                                        </div>\r\n                                    </div>\r\n                                </div>\r\n                            </div>\r\n   <!--#Modal window code end-->                          \r\n   <!--#BlueDot announcement icon code-->\r\n                              \r\n\t\t\t\t\t <li class=\"dropdown\">\r\n                    <a class=\"dropdown-toggle count-info\" data-toggle=\"dropdown\" href=\"#\">\r\n                        <i class=\"fa fa-rss\"></i>  \r\n                        <span class=\"label label-warning\">\r\n                      1\r\n                      </span>\r\n                    </a>\r\n                    <ul class=\"dropdown-menu dropdown-alerts\">\r\n                        <li>\r\n                            <a href=\"#\">\r\n                                <div>\r\n                                    <i class=\"fa fa-envelope\" data-toggle=\"modal\" data-target=\"#myModal\" >&nbsp;&nbsp;BlueDot Major Upgrade Announcement</i>  \r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                    </ul>\r\n                </li>\r\n                \r\n   <!--#Inbox icon code-->\r\n                \r\n                <li class=\"dropdown\">\r\n                    <a class=\"dropdown-toggle count-info\" data-toggle=\"dropdown\" href=\"#\">\r\n                        <i class=\"fa fa-envelope\"></i> \r\n\t\t\t\t\t\t<span class=\"label label-warning\">\r\n\t\t\t\t\t\t\t2<br/>\r\n                     \t\t\r\n                        </span>\r\n                   </a>\r\n                    <ul class=\"dropdown-menu dropdown-alerts\">\r\n                        <li>\r\n                            <a href=\"../inbox/index.asp\">\r\n  \t\t\t\t\t\t\t<div>\r\n                                    <i class=\"fa fa-envelope fa-fw\"></i> You have \r\n\t\t\t\t\t\t\t\t\t2<br/>\r\n                     \t\t\t    items in your inbox\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                    </ul>\r\n                </li>\r\n                \r\n <!--#Alerts icon code-->\r\n\r\n                <li class=\"dropdown\">\r\n                    <a class=\"dropdown-toggle count-info\" data-toggle=\"dropdown\" href=\"#\">\r\n                       <i class=\"fa fa-bell\"></i>  <span class=\"label label-danger\">114</span>\r\n                    </a>\r\n                    <ul class=\"dropdown-menu dropdown-alerts\">\r\n                       \r\n                        <li>\r\n                            <a href=\"../remindersoverdue.asp\">\r\n                                <div>\r\n                                    <i class=\"fa fa-bell fa-fw\"></i> You have 17 overdue reminders\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                        <li class=\"divider\"></li>\r\n                        <li>\r\n                            <a href=\"../stepsoverdue.asp\">\r\n                                <div>\r\n                                    <i class=\"fa fa-bell fa-fw\"></i> You have 88 overdue process steps\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                            \r\n                    </ul>\r\n                </li>\r\n                <!--#Alerts icon code end-->\r\n\r\n<!--#Calendar icon code-->\r\n\r\n                <li class=\"dropdown\">\r\n                    <a class=\"dropdown-toggle count-info\" data-toggle=\"dropdown\" href=\"#\">\r\n                       <i class=\"fa fa-calendar\"></i>  <span class=\"label label-danger\"></span>\r\n                    </a>\r\n                    <ul class=\"dropdown-menu dropdown-alerts\">\r\n                       \r\n                        <li>\r\n                            <a href=\"../calendar/Add.asp\">\r\n                                <div>\r\n                                    <i class=\"fa fa-calendar fa-fw\"></i>&nbsp;&nbsp;Add an appointment\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                        <li class=\"divider\"></li>\r\n                        <li>\r\n                            <a href=\"../calendar/MyCalendar.asp?guestid=\">\r\n                                <div>\r\n                                    <i class=\"fa fa-calendar fa-fw\"></i>&nbsp;&nbsp;View my calendar\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                            \r\n                    </ul>\r\n                </li>\r\n<!--#Calendar icon code end-->\r\n  \r\n\r\n<!--#BDays icon code-->\r\n\r\n                <li class=\"dropdown\">\r\n                    <a class=\"dropdown-toggle count-info\" data-toggle=\"dropdown\" href=\"#\">\r\n                       <i class=\"fa fa-birthday-cake\"></i>   <span class=\"label label-warning\">0</span>\r\n                    </a>\r\n                    <ul class=\"dropdown-menu dropdown-alerts\">\r\n                       \r\n                        <li>\r\n                            <a href=\"../bdays.asp\">\r\n                                <div>\r\n                                    <i class=\"fa fa-birthday-cake fa-fw\"></i>&nbsp;&nbsp;View today's birthdays\r\n                                </div>\r\n                            </a>\r\n                        </li>\r\n                                             \r\n                    </ul>\r\n                </li>\r\n<!--#BDays icon code end-->\r\n\r\n\r\n                <li>\r\n                    <a href=\"../../signout.asp\">\r\n                        <i class=\"fa fa-sign-out\"></i> Log out\r\n                    </a>\r\n                </li>\r\n                <li>\r\n                    <a class=\"right-sidebar-toggle\">\r\n                        <i class=\"fa fa-tasks\"></i>\r\n                    </a>\r\n                </li>\r\n            </ul>\r\n\r\n        </nav>\r\n\r\n\t\r\n\t</div>\r\n<!-- Breadcrumbs navigation -->       \r\n<div class=\"row wrapper border-bottom white-bg page-heading\">\r\n\t<div class=\"col-lg-10\">\r\n\t\t<h2>Advanced</h2>\r\n\t\t\t<ol class=\"breadcrumb\">\r\n\t\t\t\t<li><a href=\"../default.asp\">Home</a></li>\r\n\t\t\t\t<li >Reports</li>\r\n                <li class=\"active\"><strong><a href=\"Indexbyuser.asp\">Advanced</a></strong></li>\r\n                <li class=\"active\"><strong>Contacts</strong></li>\r\n\t\t\t</ol>\r\n\t</div>\r\n</div>\r\n<!-- Breadcrumbs navigation end -->\r\n<!-- Content -->\r\n<div class=\"wrapper wrapper-content animated fadeInRight\">\r\n<form action=\"rp_byuser_02_results.asp\" method=\"post\" target=\"_blank\" class=\"form-horizontal\" id=\"form1\"> \r\n     <div class=\"row\">\r\n      <div class=\"col-lg-12\">\r\n        <div class=\"ibox float-e-margins\">\r\n          <div class=\"ibox-title\">\r\n            <h5>Contacts            </h5>\r\n          </div>\r\n          <div class=\"ibox-content\">\r\n            <table class=\"table table-striped\">\r\n              <thead>\r\n                <tr>\r\n                  <th width=\"10%\">Include</th>\r\n                  <th width=\"21%\">Field</th>\r\n                  <th width=\"69%\">Value</th>\r\n                  </tr>\r\n              </thead>\r\n              <tbody>\r\n                  <tr >\r\n                  <td colspan=\"3\" class=\"alert-warning\" >Case file information</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkuser\" type=\"checkbox\" id=\"chkuser\" form=\"form1\" value=\"1\" checked=\"checked\"/>\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>User</td>\r\n                    <td><select name=\"user\" class=\"form-control m-b\" id=\"user\" form=\"form1\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"1713\">Aleks&nbsp;Mucino</option>\r\n                      \r\n                      <option value=\"31176\">Amanda&nbsp;Jones</option>\r\n                      \r\n                      <option value=\"31507\">Juan&nbsp;Perez</option>\r\n                      \r\n                      <option value=\"22278\">Juana&nbsp;Jones</option>\r\n                      \r\n                      <option value=\"5001\">Maria&nbsp;Doe</option>\r\n                      \r\n                      <option value=\"30324\">Mary&nbsp;Fernandez</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkemployer\" type=\"checkbox\" id=\"chkemployer\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Employer</td>\r\n                    <td><select name=\"employer\" multiple=\"\" class=\"form-control\" id=\"employer\" form=\"form1\">\r\n                      \r\n                      <option value=\"1717\">--- Pending Association with Employer ----</option>\r\n                      \r\n                      <option value=\"22908\">Acme, Inc.</option>\r\n                      \r\n                      <option value=\"30328\">Altus</option>\r\n                      \r\n                      <option value=\"22673\">Alvaradon Inc</option>\r\n                      \r\n                      <option value=\"22455\">Amber LLC</option>\r\n                      \r\n                      <option value=\"14120\">Autopartes Perez & Lara</option>\r\n                      \r\n                      <option value=\"23781\">bb324</option>\r\n                      \r\n                      <option value=\"30707\">Blasmin Inc.</option>\r\n                      \r\n                      <option value=\"15304\">BlueDot</option>\r\n                      \r\n                      <option value=\"22428\">Check Employer</option>\r\n                      \r\n                      <option value=\"22601\">Coca Cola</option>\r\n                      \r\n                      <option value=\"2040\">Coersa</option>\r\n                      \r\n                      <option value=\"30034\">Company AABC</option>\r\n                      \r\n                      <option value=\"14272\">conpusystemsnet.com</option>\r\n                      \r\n                      <option value=\"22512\">Cuarta X</option>\r\n                      \r\n                      <option value=\"2039\">Delta PC</option>\r\n                      \r\n                      <option value=\"22682\">Demo Company 1</option>\r\n                      \r\n                      <option value=\"22574\">Demo Company 2 - Commercial Division</option>\r\n                      \r\n                      <option value=\"22571\">Demo employer</option>\r\n                      \r\n                      <option value=\"22513\">DINSA</option>\r\n                      \r\n                      <option value=\"31461\">Disney</option>\r\n                      \r\n                      <option value=\"17185\">Doctor's Hospital, Inc.</option>\r\n                      \r\n                      <option value=\"30199\">Employer name</option>\r\n                      \r\n                      <option value=\"22577\">Employer number four</option>\r\n                      \r\n                      <option value=\"23777\">f</option>\r\n                      \r\n                      <option value=\"23776\">g</option>\r\n                      \r\n                      <option value=\"22292\">Gamesa</option>\r\n                      \r\n                      <option value=\"22546\">GAMESA</option>\r\n                      \r\n                      <option value=\"22478\">Gamesa</option>\r\n                      \r\n                      <option value=\"23155\">GAMESA Inc.</option>\r\n                      \r\n                      <option value=\"30259\">GT TEST</option>\r\n                      \r\n                      <option value=\"23319\">h</option>\r\n                      \r\n                      <option value=\"22897\">Honeywell Technology Solutions Labs</option>\r\n                      \r\n                      <option value=\"23317\">Hundai</option>\r\n                      \r\n                      <option value=\"22579\">Jackobson Inc.</option>\r\n                      \r\n                      <option value=\"6138\">Joe Smith Apples</option>\r\n                      \r\n                      <option value=\"2038\">Kellog's</option>\r\n                      \r\n                      <option value=\"30042\">Logitech</option>\r\n                      \r\n                      <option value=\"23362\">LSI</option>\r\n                      \r\n                      <option value=\"17544\">Mustang Engineering</option>\r\n                      \r\n                      <option value=\"31472\">Naglus LLC</option>\r\n                      \r\n                      <option value=\"30455\">NAME CIA</option>\r\n                      \r\n                      <option value=\"23570\">Name Emoloyer</option>\r\n                      \r\n                      <option value=\"22883\">Name of Employer</option>\r\n                      \r\n                      <option value=\"3732\">Nascar</option>\r\n                      \r\n                      <option value=\"30743\">NEW Company</option>\r\n                      \r\n                      <option value=\"30434\">New Employer</option>\r\n                      \r\n                      <option value=\"22712\">New Employer</option>\r\n                      \r\n                      <option value=\"22913\">new employer</option>\r\n                      \r\n                      <option value=\"22718\">New Employer Name</option>\r\n                      \r\n                      <option value=\"30499\">NEW EMPLOYER TEST</option>\r\n                      \r\n                      <option value=\"22589\">New Employer, no address</option>\r\n                      \r\n                      <option value=\"22879\">New Employere Name LLC</option>\r\n                      \r\n                      <option value=\"31452\">new empty employer</option>\r\n                      \r\n                      <option value=\"22866\">No corporate users</option>\r\n                      \r\n                      <option value=\"22888\">NRG Energy, Inc.</option>\r\n                      \r\n                      <option value=\"22893\">Paddick Laboratories, Inc.</option>\r\n                      \r\n                      <option value=\"22573\">Pedrianitls. Inc.</option>\r\n                      \r\n                      <option value=\"2104\">PRISMA INTERNATIONAL INT</option>\r\n                      \r\n                      <option value=\"6139\">Quickcopy</option>\r\n                      \r\n                      <option value=\"30706\">Red Label</option>\r\n                      \r\n                      <option value=\"2103\">Richi Copies</option>\r\n                      \r\n                      <option value=\"23228\">S-Go International,  Inc.</option>\r\n                      \r\n                      <option value=\"22572\">Saldas</option>\r\n                      \r\n                      <option value=\"23846\">Schneider Enterprise Resources</option>\r\n                      \r\n                      <option value=\"30676\">SIGMA IT</option>\r\n                      \r\n                      <option value=\"17524\">Small Business - Computers Division</option>\r\n                      \r\n                      <option value=\"22470\">Small Business - Services Division</option>\r\n                      \r\n                      <option value=\"22302\">Sol Caribe 2</option>\r\n                      \r\n                      <option value=\"22553\">Sony Corp.</option>\r\n                      \r\n                      <option value=\"22578\">SupraEmployer</option>\r\n                      \r\n                      <option value=\"22604\">Test Employer</option>\r\n                      \r\n                      <option value=\"30584\">TEST EMPLOYER</option>\r\n                      \r\n                      <option value=\"22576\">Test number tree</option>\r\n                      \r\n                      <option value=\"22575\">Test number two</option>\r\n                      \r\n                      <option value=\"22511\">Testing New Employer</option>\r\n                      \r\n                      <option value=\"1715\">TYCO</option>\r\n                      \r\n                      <option value=\"3730\">TYCO Inc.</option>\r\n                      \r\n                      <option value=\"30684\">TYREX</option>\r\n                      \r\n                      <option value=\"14118\">Volkswagen</option>\r\n                      \r\n                      <option value=\"30674\">Walmart</option>\r\n                      \r\n                      <option value=\"22454\">weqweqweq</option>\r\n                      \r\n                      <option value=\"3547\">Wilson</option>\r\n                      \r\n                      <option value=\"22453\">Wonder Atts</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Contact file information</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkstatus\" type=\"checkbox\" id=\"chkstatus\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Contact status</td>\r\n                    <td><div class=\"form-group\">\r\n                      <div class=\"col-sm-10\">\r\n                         <div class=\"i-checks\">\r\n                          <label>\r\n                            <input name=\"contact_status\" type=\"radio\" form=\"form1\" value=\"0\" checked=\"checked\" />\r\n                            Active</label>\r\n                          &nbsp;<label>\r\n                            <input name=\"contact_status\" type=\"radio\" form=\"form1\"  value=\"2\" />\r\n                            Archived </label>\r\n                          </div>\r\n                      </div>\r\n                    </div></td>\r\n                  </tr>\r\n                                    <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkgender\" type=\"checkbox\" id=\"chkgender\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Gender</td>\r\n                    <td><div class=\"form-group\">\r\n                      <div class=\"col-sm-10\">\r\n                        <div class=\"i-checks\">\r\n                          <label>\r\n                            <input name=\"gender\" type=\"radio\" form=\"form1\" value=\"0\" checked=\"checked\" />\r\n                            Male</label>\r\n                          &nbsp;<label>\r\n                            <input name=\"gender\" type=\"radio\" form=\"form1\"  value=\"2\" />\r\n                            Female </label>&nbsp;\r\n                            <label>\r\n                            <input name=\"gender\" type=\"radio\" form=\"form1\"  value=\"%\" />\r\n                            All </label>\r\n                            \r\n                          </div>\r\n                    </div>\r\n                    </div></td>\r\n                  </tr>\r\n    <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chktype\" type=\"checkbox\" id=\"chktype\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Type</td>\r\n                    <td><div class=\"form-group\">\r\n                      <div class=\"col-sm-10\">\r\n                        <div class=\"i-checks\">\r\n                          <label>\r\n                            <input name=\"contact_type\" type=\"radio\" form=\"form1\" value=\"0\" checked=\"checked\" />\r\n                            Client</label>\r\n                          &nbsp;<label>\r\n                            <input name=\"contact_type\" type=\"radio\" form=\"form1\"  value=\"2\" />\r\n                            Prospect </label>&nbsp;\r\n                            <label>\r\n                            <input name=\"contact_type\" type=\"radio\" form=\"form1\"  value=\"%\" />\r\n                            All </label>\r\n                            \r\n                          </div>\r\n                    </div>\r\n                    </div></td>\r\n                  </tr>\r\n                  \r\n                                    <tr>\r\n                                      <td><div class=\"i-checks\">\r\n                                        <label>\r\n                                          <input name=\"chkmaritalstatus\" type=\"checkbox\" id=\"chkmaritalstatus\" value=\"1\" />\r\n                                        <i></i></label>\r\n                                      </div></td>\r\n                                      <td>Marital Status</td>\r\n                                      <td><select name=\"maritalstatus\" class=\"form-control m-b\" id=\"maritalstatus\">\r\n                                        <option value=\"%\">All</option>\r\n                                        <option value=\"Single\">Single</option>\r\n                                        <option value=\"Married\">Married</option>\r\n                                        <option value=\"Divorced\">Divorced</option>\r\n                                        <option value=\"Widowed\">Widowed</option>\r\n                                      </select></td>\r\n                    </tr>\r\n                  \r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkfirstnm\" type=\"checkbox\" disabled=\"disabled\" id=\"chkfirstnm\" value=\"\" checked=\"checked\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>First Name</td>\r\n                    <td><input name=\"firstnm\" type=\"text\" class=\"form-control\" id=\"firstnm\"></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chklastnm\" type=\"checkbox\" disabled=\"disabled\" id=\"chklastnm\" value=\"\" checked=\"checked\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Last Name</td>\r\n                    <td><input name=\"lastnm\" type=\"text\" class=\"form-control\" id=\"lastnm\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmiddlenm\" type=\"checkbox\" id=\"chkmiddlenm\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Middle Name</td>\r\n                    <td><input name=\"middlenm\" type=\"text\" class=\"form-control\" id=\"middlenm\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmaidenm\" type=\"checkbox\" id=\"chkmaidenm\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Maiden Name</td>\r\n                    <td><input name=\"maidenm\" type=\"text\" class=\"form-control\" id=\"maidenm\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chktitle\" type=\"checkbox\" id=\"chktitle\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Title</td>\r\n                    <td><input name=\"title\" type=\"text\" class=\"form-control\" id=\"title\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkothernm\" type=\"checkbox\" id=\"chkothernm\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Other Names</td>\r\n                    <td><input name=\"othernm\" type=\"text\" class=\"form-control\" id=\"othernm\" /></td>\r\n                  </tr>\r\n\r\n\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkssn\" type=\"checkbox\" id=\"chkssn\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>SSN</td>\r\n                    <td><input name=\"ssn\" type=\"text\" class=\"form-control\" id=\"ssn\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaliennum\" type=\"checkbox\" id=\"chkaliennum\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Alien number</td>\r\n                    <td><input name=\"aliennum\" type=\"text\" class=\"form-control\" id=\"aliennum\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkdob\" type=\"checkbox\" id=\"chkdob\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Date of birth between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"dob_start\" type=\"text\" class=\"input-sm form-control\" id=\"dob_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"dob_end\" type=\"text\" class=\"input-sm form-control\" id=\"dob_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcitybirth\" type=\"checkbox\" id=\"chkcitybirth\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>City of Birth</td>\r\n                    <td><input name=\"citybirth\" type=\"text\" class=\"form-control\" id=\"citybirth\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkstatebirth\" type=\"checkbox\" id=\"chkstatebirth\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>State of Birth</td>\r\n                    <td><input name=\"statebirth\" type=\"text\" class=\"form-control\" id=\"statebirth\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcntrybirth\" type=\"checkbox\" id=\"chkcntrybirth\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Country of birth</td>\r\n                    <td><select name=\"countrybirth\" multiple=\"multiple\" class=\"form-control\" id=\"countrybirth\">\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chknationality\" type=\"checkbox\" id=\"chknationality\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Nationality</td>\r\n                    <td><input name=\"nationality\" type=\"text\" class=\"form-control\" id=\"nationality\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkdayphone\" type=\"checkbox\" id=\"chkdayphone\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Day Phone</td>\r\n                    <td><input name=\"dayphone\" type=\"text\" class=\"form-control\" id=\"dayphone\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcelphone\" type=\"checkbox\" id=\"chkcelphone\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Cell Phone</td>\r\n                    <td><input name=\"celphone\" type=\"text\" class=\"form-control\" id=\"celphone\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkevephone\" type=\"checkbox\" id=\"chkevephone\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Evening Phone</td>\r\n                    <td><input name=\"evephone\" type=\"text\" class=\"form-control\" id=\"evephone\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkfax\" type=\"checkbox\" id=\"chkfax\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Fax</td>\r\n                    <td><input name=\"fax\" type=\"text\" class=\"form-control\" id=\"fax\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkemail\" type=\"checkbox\" id=\"chkemail\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>email</td>\r\n                    <td><input name=\"email\" type=\"text\" class=\"form-control\" id=\"email\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkpassportcntry\" type=\"checkbox\" id=\"chkpassportcntry\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Passport Issuing Country</td>\r\n                    <td><select name=\"passportcntry\" class=\"form-control m-b\" id=\"passportcntry\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkpassportnum\" type=\"checkbox\" id=\"chkpassportnum\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Passport Number</td>\r\n                    <td><input name=\"passportnum\" type=\"text\" class=\"form-control\" id=\"passportnum\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkpassportissue\" type=\"checkbox\" id=\"chkpassportissue\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Passport Issue Date</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"passportissue_start\" type=\"text\" class=\"input-sm form-control\" id=\"passportissue_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"passportissue_end\" type=\"text\" class=\"input-sm form-control\" id=\"passportissue_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkpassportexp\" type=\"checkbox\" id=\"chkpassportexp\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Passport Expiration Date</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"passportexp_start\" type=\"text\" class=\"input-sm form-control\" id=\"passportexp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"passportexp_end\" type=\"text\" class=\"input-sm form-control\" id=\"passportexp_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmajorfld\" type=\"checkbox\" id=\"chkmajorfld\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Major field of study</td>\r\n                    <td><input name=\"majorfld\" type=\"text\" class=\"form-control\" id=\"majorfld\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkdegree\" type=\"checkbox\" id=\"chkdegree\" form=\"form1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Degree</td>\r\n                    <td><input name=\"degree\" type=\"text\" class=\"form-control\" id=\"degree\" /></td>\r\n                  </tr>\r\n                   <tr>\r\n                     <td colspan=\"3\" class=\"alert-warning\">Personal Documents</td>\r\n                   </tr>\r\n                   <tr>\r\n                     <td><div class=\"i-checks\">\r\n                       <label>\r\n                         <input name=\"chkcurstatus\" type=\"checkbox\" id=\"chkcurstatus\" form=\"form1\" value=\"1\" />\r\n                         <i></i></label>\r\n                     </div></td>\r\n                     <td>Current Status</td>\r\n                     <td><input name=\"curstatus\" type=\"text\" class=\"form-control\" id=\"curstatus\" /></td>\r\n                   </tr>\r\n                   <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkstatusexp\" type=\"checkbox\" id=\"chkstatusexp\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Current status expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"statusexp_start\" type=\"text\" class=\"input-sm form-control\" id=\"statusexp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"statusexp_end\" type=\"text\" class=\"input-sm form-control\" id=\"statusexp_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmaxstay\" type=\"checkbox\" id=\"chkmaxstay\" value=\"1\" />\r\n                        <i></i></label>\r\n                      </div></td>\r\n                    <td>Maximum stay date between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                      <input name=\"maxdate_start\" type=\"text\" class=\"input-sm form-control\" id=\"maxdate_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"maxdate_end\" type=\"text\" class=\"input-sm form-control\" id=\"maxdate_end\" value=\"\" />\r\n                      </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkI797\" type=\"checkbox\" id=\"chkI797\" value=\"1\" />\r\n                        <i></i></label>\r\n                      </div></td>\r\n                    <td>I797 expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                      <input name=\"I797_start\" type=\"text\" class=\"input-sm form-control\" id=\"I797_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"I797_end\" type=\"text\" class=\"input-sm form-control\" id=\"I797_end\" value=\"\" />\r\n                      </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkead\" type=\"checkbox\" id=\"chkead\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>EAD expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"ead_start\" type=\"text\" class=\"input-sm form-control\" id=\"ead_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"ead_end\" type=\"text\" class=\"input-sm form-control\" id=\"ead_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkap\" type=\"checkbox\" id=\"chkap\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Advance Parole expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"ap_start\" type=\"text\" class=\"input-sm form-control\" id=\"ap_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"ap_end\" type=\"text\" class=\"input-sm form-control\" id=\"ap_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkiap66\" type=\"checkbox\" id=\"chkiap66\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>IAP-66/DS-2019 expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"iap66_start\" type=\"text\" class=\"input-sm form-control\" id=\"iap66_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"iap66_end\" type=\"text\" class=\"input-sm form-control\" id=\"iap66_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkgc\" type=\"checkbox\" id=\"chkgc\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Green Card expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"gc_start\" type=\"text\" class=\"input-sm form-control\" id=\"gc_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"gc_end\" type=\"text\" class=\"input-sm form-control\" id=\"gc_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chki20\" type=\"checkbox\" id=\"chki20\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>I20 expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"i20_start\" type=\"text\" class=\"input-sm form-control\" id=\"i20_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"i20_end\" type=\"text\" class=\"input-sm form-control\" id=\"i20_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkvisaexp\" type=\"checkbox\" id=\"chkvisaexp\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Visa expiration between</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"visaexp_start\" type=\"text\" class=\"input-sm form-control\" id=\"visaexp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"visaexp_end\" type=\"text\" class=\"input-sm form-control\" id=\"visaexp_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                    <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Additional Documents</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td><div class=\"i-checks\">\r\n                        <label>\r\n                          <input name=\"chkaddoc\" type=\"checkbox\" id=\"chkaddoc\" value=\"1\" />\r\n                          <i></i></label>\r\n                      </div></td>\r\n                      <td>Document / Status</td>\r\n                      <td><div class=\"form-group\">\r\n                        <div class=\"col-sm-10\">\r\n                          <select name=\"addco\" multiple=\"multiple\" class=\"form-control\" id=\"addco\" form=\"form1\">\r\n                      \r\n                      <option value=\"203\">Advance Parole</option>\r\n                      \r\n                      <option value=\"758\">Biometric Appointment</option>\r\n                      \r\n                      <option value=\"158\">EAD</option>\r\n                      \r\n                      <option value=\"157\">Green Card</option>\r\n                      \r\n                      <option value=\"209\">I-20</option>\r\n                      \r\n                      <option value=\"9\">I-797</option>\r\n                      \r\n                      <option value=\"1\">I-94</option>\r\n                      \r\n                      <option value=\"8\">IAP-66</option>\r\n                      \r\n                      <option value=\"3\">Mexican Passport</option>\r\n                      \r\n                      <option value=\"6\">Reentry Permit</option>\r\n                      \r\n                      <option value=\"7\">Residence Card</option>\r\n                      \r\n                      <option value=\"214\">Travel date</option>\r\n                      \r\n                      <option value=\"2\">Visa</option>\r\n                      \r\n                    </select>\r\n                        </div>\r\n                      </div></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaddfiledon\" type=\"checkbox\" id=\"chkaddfiledon\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Filed on</td>\r\n                    <td> <div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"addfiledon_start\" type=\"text\" class=\"input-sm form-control\" id=\"addfiledon_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"addfiledon_end\" type=\"text\" class=\"input-sm form-control\" id=\"addfiledon_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaddapprovedon\" type=\"checkbox\" id=\"chkaddapprovedon\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Approved on</td>\r\n                    <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"addapprovedon_start\" type=\"text\" class=\"input-sm form-control\" id=\"addapprovedon_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"addapprovedon_end\" type=\"text\" class=\"input-sm form-control\" id=\"addapprovedon_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaddexpdate\" type=\"checkbox\" id=\"chkaddexpdate\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Expiration Date</td>\r\n                    <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"addexp_start\" type=\"text\" class=\"input-sm form-control\" id=\"addexp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"addexp_end\" type=\"text\" class=\"input-sm form-control\" id=\"addexp_end\" value=\"\" />\r\n                                </div></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaddsponsor\" type=\"checkbox\" id=\"chkaddsponsor\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Sponsor</td>\r\n                    <td><input name=\"addsponsor\" type=\"text\" class=\"form-control\" id=\"addsponsor\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkadddesc\" type=\"checkbox\" id=\"chkadddesc\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Description</td>\r\n                    <td><input name=\"adddesc\" type=\"text\" class=\"form-control\" id=\"adddesc\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkaddcurrent\" type=\"checkbox\" id=\"chkaddcurrent\" value=\"1\" />\r\n                        <i></i></label>\r\n                      </div></td>\r\n                    <td>Current</td>\r\n                    <td><input name=\"addcur\" type=\"text\" class=\"form-control\" id=\"addcur\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">I94 Information</td>\r\n                  </tr>\r\n                     <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chki94num\" type=\"checkbox\" id=\"chki94num\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>I94 Number</td>\r\n                    <td><input name=\"i94num\" type=\"text\" class=\"form-control\" id=\"i94num\" /></td>\r\n                  </tr>\r\n                    <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chki94arrival\" type=\"checkbox\" id=\"chki94arrival\" value=\"1\" />\r\n                           <i></i></label>\r\n                      </div></td>\r\n                       <td>Arrival Date</td>\r\n                       <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"i94arrival_start\" type=\"text\" class=\"input-sm form-control\" id=\"i94arrival_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"i94arrival_end\" type=\"text\" class=\"input-sm form-control\" id=\"i94arrival_end\" value=\"\" />\r\n                       </div></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chki94exp\" type=\"checkbox\" id=\"chki94exp\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Expiration Date</td>\r\n                       <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"i94exp_start\" type=\"text\" class=\"input-sm form-control\" id=\"i94exp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"i94exp_end\" type=\"text\" class=\"input-sm form-control\" id=\"i94exp_end\" value=\"\" />\r\n                                </div></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chki94city\" type=\"checkbox\" id=\"chki94city\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Arrival City</td>\r\n                       <td><input name=\"i94city\" type=\"text\" class=\"form-control\" id=\"i94city\" /></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chki94state\" type=\"checkbox\" id=\"chki94state\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Arrival State</td>\r\n                       <td><input name=\"i94state\" type=\"text\" class=\"form-control\" id=\"i94state\" /></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chki94departure\" type=\"checkbox\" id=\"chki94departure\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Departure State</td>\r\n                       <td><input name=\"i94departure\" type=\"text\" class=\"form-control\" id=\"i94departure\" /></td>\r\n                     </tr>\r\n                      <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Visa Information</td>\r\n                    </tr>\r\n                     <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkvisanum\" type=\"checkbox\" id=\"chkvisanum\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Visa Number</td>\r\n                    <td><input name=\"visanum\" type=\"text\" class=\"form-control\" id=\"visanum\" /></td>\r\n                  </tr>\r\n                    <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chkvisapost\" type=\"checkbox\" id=\"chkvisapost\" value=\"1\" />\r\n                           <i></i></label>\r\n                      </div></td>\r\n                       <td>Issuing Post Name</td>\r\n                       <td><input name=\"visapost\" type=\"text\" class=\"form-control\" id=\"visapost\" /></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chkvisaissue\" type=\"checkbox\" id=\"chkvisaissue\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Issue Date</td>\r\n                       <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"visaissue_start\" type=\"text\" class=\"input-sm form-control\" id=\"visaissue_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"visaissue_end\" type=\"text\" class=\"input-sm form-control\" id=\"visaissue_end\" value=\"\" />\r\n                                </div></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chkvisaexp\" type=\"checkbox\" id=\"chkvisaexp\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Expiration Date</td>\r\n                       <td><div class=\"input-daterange input-group\" id=\"datepicker\">\r\n                                    <input name=\"visaexp_start\" type=\"text\" class=\"input-sm form-control\" id=\"visaexp_start\" value=\"\"/><span class=\"input-group-addon\">to</span><input name=\"visaexp_end\" type=\"text\" class=\"input-sm form-control\" id=\"visaexp_end\" value=\"\" />\r\n                                </div></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chkvisatype\" type=\"checkbox\" id=\"chkvisatype\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Visa Type</td>\r\n                       <td><input name=\"visatype\" type=\"text\" class=\"form-control\" id=\"visatype\" /></td>\r\n                     </tr>\r\n                     <tr>\r\n                       <td><div class=\"i-checks\">\r\n                         <label>\r\n                           <input name=\"chkvisaimmstatus\" type=\"checkbox\" id=\"chkvisaimmstatus\" value=\"1\" />\r\n                           <i></i></label>\r\n                       </div></td>\r\n                       <td>Immigration Status</td>\r\n                       <td><input name=\"visaimmstatus\" type=\"text\" class=\"form-control\" id=\"visaimmstatus\" /></td>\r\n                     </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Custom fields</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom1\" type=\"checkbox\" id=\"chkcustom1\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 1</td>\r\n                    <td><input name=\"custom1\" type=\"text\" class=\"form-control\" id=\"custom1\" /></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom2\" type=\"checkbox\" id=\"chkcustom2\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 2</td>\r\n                    <td><input name=\"custom2\" type=\"text\" class=\"form-control\" id=\"custom2\" /></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom3\" type=\"checkbox\" id=\"chkcustom3\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 3</td>\r\n                    <td><input name=\"custom3\" type=\"text\" class=\"form-control\" id=\"custom3\" /></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom4\" type=\"checkbox\" id=\"chkcustom4\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 4</td>\r\n                    <td><input name=\"custom4\" type=\"text\" class=\"form-control\" id=\"custom4\" /></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom5\" type=\"checkbox\" id=\"chkcustom5\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 5</td>\r\n                    <td><input name=\"custom5\" type=\"text\" class=\"form-control\" id=\"custom5\" /></td>\r\n                    </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom6\" type=\"checkbox\" id=\"chkcustom6\" value=\"1\" />\r\n                        <i></i></label>\r\n                      </div></td>\r\n                    <td>Custom field 6</td>\r\n                    <td><input name=\"custom6\" type=\"text\" class=\"form-control\" id=\"custom6\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom7\" type=\"checkbox\" id=\"chkcustom7\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 7</td>\r\n                    <td><input name=\"custom7\" type=\"text\" class=\"form-control\" id=\"custom7\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom8\" type=\"checkbox\" id=\"chkcustom8\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 8</td>\r\n                    <td><input name=\"custom8\" type=\"text\" class=\"form-control\" id=\"custom8\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom9\" type=\"checkbox\" id=\"chkcustom9\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 9</td>\r\n                    <td><input name=\"custom9\" type=\"text\" class=\"form-control\" id=\"custom9\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom10\" type=\"checkbox\" id=\"chkcustom10\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 10</td>\r\n                    <td><input name=\"custom10\" type=\"text\" class=\"form-control\" id=\"custom10\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom11\" type=\"checkbox\" id=\"chkcustom11\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 11</td>\r\n                    <td><input name=\"custom11\" type=\"text\" class=\"form-control\" id=\"custom11\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom12\" type=\"checkbox\" id=\"chkcustom12\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 12</td>\r\n                    <td><input name=\"custom12\" type=\"text\" class=\"form-control\" id=\"custom12\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom13\" type=\"checkbox\" id=\"chkcustom13\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 13</td>\r\n                    <td><input name=\"custom13\" type=\"text\" class=\"form-control\" id=\"custom13\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom14\" type=\"checkbox\" id=\"chkcustom14\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Custom field 14</td>\r\n                    <td><input name=\"cusstom14\" type=\"text\" class=\"form-control\" id=\"cusstom14\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkcustom15\" type=\"checkbox\" id=\"chkcustom15\" value=\"1\" />\r\n                        <i></i></label>\r\n                      </div></td>\r\n                    <td>Custom field 15</td>\r\n                    <td><input name=\"custom15\" type=\"text\" class=\"form-control\" id=\"custom15\" /></td>\r\n                  </tr>\r\n                   <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Mailing Address</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailcareof\" type=\"checkbox\" id=\"chkmailcareof\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Care of</td>\r\n                    <td><input name=\"mailcareof\" type=\"text\" class=\"form-control\" id=\"mailcareof\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailstreet\" type=\"checkbox\" id=\"chkmailstreet\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Street</td>\r\n                    <td><input name=\"mailstreet\" type=\"text\" class=\"form-control\" id=\"mailstreet\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailapt\" type=\"checkbox\" id=\"chkmailapt\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Apartment</td>\r\n                    <td><input name=\"mailapt\" type=\"text\" class=\"form-control\" id=\"mailapt\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailcity\" type=\"checkbox\" id=\"chkmailcity\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>City</td>\r\n                    <td><input name=\"mailcity\" type=\"text\" class=\"form-control\" id=\"mailcity\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailstate\" type=\"checkbox\" id=\"chkmailstate\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>State</td>\r\n                    <td><input name=\"mailstate\" type=\"text\" class=\"form-control\" id=\"mailstate\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailzip\" type=\"checkbox\" id=\"chkmailzip\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Zip code</td>\r\n                    <td><input name=\"mailzip\" type=\"text\" class=\"form-control\" id=\"mailzip\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkmailcntry\" type=\"checkbox\" id=\"chkmailcntry\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Country</td>\r\n                    <td><select name=\"mailcntry\" class=\"form-control m-b\" id=\"mailcntry\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Residence Address</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkrescareof\" type=\"checkbox\" id=\"chkrescareof\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Care of</td>\r\n                    <td><input name=\"rescareof\" type=\"text\" class=\"form-control\" id=\"rescareof\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkresstreet\" type=\"checkbox\" id=\"chkresstreet\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Street</td>\r\n                    <td><input name=\"resstreet\" type=\"text\" class=\"form-control\" id=\"resstreet\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkresapt\" type=\"checkbox\" id=\"chkresapt\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Apartment</td>\r\n                    <td><input name=\"resapt\" type=\"text\" class=\"form-control\" id=\"resapt\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkrescity\" type=\"checkbox\" id=\"chkrescity\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>City</td>\r\n                    <td><input name=\"rescity\" type=\"text\" class=\"form-control\" id=\"rescity\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkrestate\" type=\"checkbox\" id=\"chkrestate\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>State</td>\r\n                    <td><input name=\"restate\" type=\"text\" class=\"form-control\" id=\"restate\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkreszip\" type=\"checkbox\" id=\"chkreszip\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Zip code</td>\r\n                    <td><input name=\"rezip\" type=\"text\" class=\"form-control\" id=\"rezip\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkrescntry\" type=\"checkbox\" id=\"chkrescntry\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Country</td>\r\n                    <td><select name=\"rescntry\" class=\"form-control m-b\" id=\"rescntry\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Abroad Address</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdcareof\" type=\"checkbox\" id=\"chkabrdcareof\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Care of</td>\r\n                    <td><input name=\"abrdcareof\" type=\"text\" class=\"form-control\" id=\"abrdcareof\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrstreet\" type=\"checkbox\" id=\"chkabrstreet\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Street</td>\r\n                    <td><input name=\"abrdstreet\" type=\"text\" class=\"form-control\" id=\"abrdstreet\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdapt\" type=\"checkbox\" id=\"chkabrdapt\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Apartment</td>\r\n                    <td><input name=\"abrdapt\" type=\"text\" class=\"form-control\" id=\"abrdapt\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdcity\" type=\"checkbox\" id=\"chkabrdcity\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>City</td>\r\n                    <td><input name=\"abrdcity\" type=\"text\" class=\"form-control\" id=\"abrdcity\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdstate\" type=\"checkbox\" id=\"chkabrdstate\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>State</td>\r\n                    <td><input name=\"abrdstate\" type=\"text\" class=\"form-control\" id=\"abrdstate\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdzip\" type=\"checkbox\" id=\"chkabrdzip\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Zip code</td>\r\n                    <td><input name=\"abrdzip\" type=\"text\" class=\"form-control\" id=\"abrdzip\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkabrdcntry\" type=\"checkbox\" id=\"chkabrdcntry\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Country</td>\r\n                    <td><select name=\"abrdcntry\" class=\"form-control m-b\" id=\"abrdcntry\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\" class=\"alert-warning\">Consulate where Visa was Issued</td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkconsulatenm\" type=\"checkbox\" id=\"chkconsulatenm\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Name</td>\r\n                    <td><input name=\"consulatenm\" type=\"text\" class=\"form-control\" id=\"consulatenm\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkconsaddress\" type=\"checkbox\" id=\"chkconsaddress\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Address</td>\r\n                    <td><input name=\"consaddress\" type=\"text\" class=\"form-control\" id=\"consaddress\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkconscity\" type=\"checkbox\" id=\"chkconscity\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>City</td>\r\n                    <td><input name=\"conscity\" type=\"text\" class=\"form-control\" id=\"conscity\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"chkconszip\" type=\"checkbox\" id=\"chkconszip\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Zip code</td>\r\n                    <td><input name=\"chkconszip\" type=\"text\" class=\"form-control\" id=\"chkconszip\" /></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td><div class=\"i-checks\">\r\n                      <label>\r\n                        <input name=\"cbkconscntry\" type=\"checkbox\" id=\"cbkconscntry\" value=\"1\" />\r\n                        <i></i></label>\r\n                    </div></td>\r\n                    <td>Country</td>\r\n                    <td><select name=\"conscntry\" class=\"form-control m-b\" id=\"conscntry\">\r\n                      <option value=\"%\">All</option>\r\n                      \r\n                      <option value=\"Afghanistan\">Afghanistan</option>\r\n                      \r\n                      <option value=\"Albania\">Albania</option>\r\n                      \r\n                      <option value=\"Algeria\">Algeria</option>\r\n                      \r\n                      <option value=\"American Samoa\">American Samoa</option>\r\n                      \r\n                      <option value=\"Andorra\">Andorra</option>\r\n                      \r\n                      <option value=\"Angola\">Angola</option>\r\n                      \r\n                      <option value=\"Anguilla\">Anguilla</option>\r\n                      \r\n                      <option value=\"Antarctica\">Antarctica</option>\r\n                      \r\n                      <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>\r\n                      \r\n                      <option value=\"Argentina\">Argentina</option>\r\n                      \r\n                      <option value=\"Armenia\">Armenia</option>\r\n                      \r\n                      <option value=\"Aruba\">Aruba</option>\r\n                      \r\n                      <option value=\"Australia\">Australia</option>\r\n                      \r\n                      <option value=\"Austria\">Austria</option>\r\n                      \r\n                      <option value=\"Azerbaijan\">Azerbaijan</option>\r\n                      \r\n                      <option value=\"Bahamas\">Bahamas</option>\r\n                      \r\n                      <option value=\"Bahrain\">Bahrain</option>\r\n                      \r\n                      <option value=\"Bangladesh\">Bangladesh</option>\r\n                      \r\n                      <option value=\"Barbados\">Barbados</option>\r\n                      \r\n                      <option value=\"Belarus\">Belarus</option>\r\n                      \r\n                      <option value=\"Belgium\">Belgium</option>\r\n                      \r\n                      <option value=\"Belize\">Belize</option>\r\n                      \r\n                      <option value=\"Benin\">Benin</option>\r\n                      \r\n                      <option value=\"Bermuda\">Bermuda</option>\r\n                      \r\n                      <option value=\"Bhutan\">Bhutan</option>\r\n                      \r\n                      <option value=\"Bolivia\">Bolivia</option>\r\n                      \r\n                      <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>\r\n                      \r\n                      <option value=\"Botswana\">Botswana</option>\r\n                      \r\n                      <option value=\"Bouvet Island\">Bouvet Island</option>\r\n                      \r\n                      <option value=\"Brazil\">Brazil</option>\r\n                      \r\n                      <option value=\"Brunei\">Brunei</option>\r\n                      \r\n                      <option value=\"Bulgaria\">Bulgaria</option>\r\n                      \r\n                      <option value=\"Burkina Faso\">Burkina Faso</option>\r\n                      \r\n                      <option value=\"Burundi\">Burundi</option>\r\n                      \r\n                      <option value=\"Cambodia\">Cambodia</option>\r\n                      \r\n                      <option value=\"Cameroon\">Cameroon</option>\r\n                      \r\n                      <option value=\"Canada\">Canada</option>\r\n                      \r\n                      <option value=\"Cape Verde\">Cape Verde</option>\r\n                      \r\n                      <option value=\"Cayman Islands\">Cayman Islands</option>\r\n                      \r\n                      <option value=\"Central African Republic\">Central African Republic</option>\r\n                      \r\n                      <option value=\"Chad\">Chad</option>\r\n                      \r\n                      <option value=\"Chile\">Chile</option>\r\n                      \r\n                      <option value=\"China\">China</option>\r\n                      \r\n                      <option value=\"Christmas Island\">Christmas Island</option>\r\n                      \r\n                      <option value=\"Colombia\">Colombia</option>\r\n                      \r\n                      <option value=\"Comoros\">Comoros</option>\r\n                      \r\n                      <option value=\"Congo\">Congo</option>\r\n                      \r\n                      <option value=\"Cook Islands\">Cook Islands</option>\r\n                      \r\n                      <option value=\"Costa Rica\">Costa Rica</option>\r\n                      \r\n                      <option value=\"Croatia (Hrvatska)\">Croatia (Hrvatska)</option>\r\n                      \r\n                      <option value=\"Cuba\">Cuba</option>\r\n                      \r\n                      <option value=\"Cyprus\">Cyprus</option>\r\n                      \r\n                      <option value=\"Czech Republic\">Czech Republic</option>\r\n                      \r\n                      <option value=\"D. R. P. Corea\">D. R. P. Corea</option>\r\n                      \r\n                      <option value=\"D.R.P. Korea\">D.R.P. Korea</option>\r\n                      \r\n                      <option value=\"Dem. Rep. of Congo (Zaire)\">Dem. Rep. of Congo (Zaire)</option>\r\n                      \r\n                      <option value=\"Denmark\">Denmark</option>\r\n                      \r\n                      <option value=\"Djibouti\">Djibouti</option>\r\n                      \r\n                      <option value=\"Dominica\">Dominica</option>\r\n                      \r\n                      <option value=\"Dominican Republic\">Dominican Republic</option>\r\n                      \r\n                      <option value=\"East Timor\">East Timor</option>\r\n                      \r\n                      <option value=\"Ecuador\">Ecuador</option>\r\n                      \r\n                      <option value=\"Egypt\">Egypt</option>\r\n                      \r\n                      <option value=\"El Salvador\">El Salvador</option>\r\n                      \r\n                      <option value=\"Equatorial Guinea\">Equatorial Guinea</option>\r\n                      \r\n                      <option value=\"Eritrea\">Eritrea</option>\r\n                      \r\n                      <option value=\"Estados Federados de Micronesia\">Estados Federados de Micronesia</option>\r\n                      \r\n                      <option value=\"Estonia\">Estonia</option>\r\n                      \r\n                      <option value=\"Ethiopia\">Ethiopia</option>\r\n                      \r\n                      <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>\r\n                      \r\n                      <option value=\"Faroe Islands\">Faroe Islands</option>\r\n                      \r\n                      <option value=\"Fiji\">Fiji</option>\r\n                      \r\n                      <option value=\"Finland\">Finland</option>\r\n                      \r\n                      <option value=\"France\">France</option>\r\n                      \r\n                      <option value=\"French Guiana\">French Guiana</option>\r\n                      \r\n                      <option value=\"French Polynesia\">French Polynesia</option>\r\n                      \r\n                      <option value=\"Gabon\">Gabon</option>\r\n                      \r\n                      <option value=\"Gambia\">Gambia</option>\r\n                      \r\n                      <option value=\"Georgia\">Georgia</option>\r\n                      \r\n                      <option value=\"Germany\">Germany</option>\r\n                      \r\n                      <option value=\"Ghana\">Ghana</option>\r\n                      \r\n                      <option value=\"Gibraltar\">Gibraltar</option>\r\n                      \r\n                      <option value=\"Greece\">Greece</option>\r\n                      \r\n                      <option value=\"Greenland\">Greenland</option>\r\n                      \r\n                      <option value=\"Grenada\">Grenada</option>\r\n                      \r\n                      <option value=\"Guadeloupe\">Guadeloupe</option>\r\n                      \r\n                      <option value=\"Guam\">Guam</option>\r\n                      \r\n                      <option value=\"Guatemala\">Guatemala</option>\r\n                      \r\n                      <option value=\"Guinea\">Guinea</option>\r\n                      \r\n                      <option value=\"Guinea - Bissao\">Guinea - Bissao</option>\r\n                      \r\n                      <option value=\"Guyana\">Guyana</option>\r\n                      \r\n                      <option value=\"Haiti\">Haiti</option>\r\n                      \r\n                      <option value=\"Honduras\">Honduras</option>\r\n                      \r\n                      <option value=\"Hong Kong SAR, PRC\">Hong Kong SAR, PRC</option>\r\n                      \r\n                      <option value=\"Hungary\">Hungary</option>\r\n                      \r\n                      <option value=\"Iceland\">Iceland</option>\r\n                      \r\n                      <option value=\"India\">India</option>\r\n                      \r\n                      <option value=\"Indonesia\">Indonesia</option>\r\n                      \r\n                      <option value=\"Iran\">Iran</option>\r\n                      \r\n                      <option value=\"Iraq\">Iraq</option>\r\n                      \r\n                      <option value=\"Ireland\">Ireland</option>\r\n                      \r\n                      <option value=\"Israel\">Israel</option>\r\n                      \r\n                      <option value=\"Italy\">Italy</option>\r\n                      \r\n                      <option value=\"Ivory Coast\">Ivory Coast</option>\r\n                      \r\n                      <option value=\"Jamaica\">Jamaica</option>\r\n                      \r\n                      <option value=\"Japan\">Japan</option>\r\n                      \r\n                      <option value=\"Jordan\">Jordan</option>\r\n                      \r\n                      <option value=\"Kazakhstan\">Kazakhstan</option>\r\n                      \r\n                      <option value=\"Kenya\">Kenya</option>\r\n                      \r\n                      <option value=\"Kiribati\">Kiribati</option>\r\n                      \r\n                      <option value=\"Kuwait\">Kuwait</option>\r\n                      \r\n                      <option value=\"Kyrgystan\">Kyrgystan</option>\r\n                      \r\n                      <option value=\"Lao\">Lao</option>\r\n                      \r\n                      <option value=\"Latvia\">Latvia</option>\r\n                      \r\n                      <option value=\"Lebanon\">Lebanon</option>\r\n                      \r\n                      <option value=\"Lesotho\">Lesotho</option>\r\n                      \r\n                      <option value=\"Letonia\">Letonia</option>\r\n                      \r\n                      <option value=\"Liberia\">Liberia</option>\r\n                      \r\n                      <option value=\"Libya\">Libya</option>\r\n                      \r\n                      <option value=\"Liechtenstein\">Liechtenstein</option>\r\n                      \r\n                      <option value=\"Lithuania\">Lithuania</option>\r\n                      \r\n                      <option value=\"Luxemburg\">Luxemburg</option>\r\n                      \r\n                      <option value=\"Macao\">Macao</option>\r\n                      \r\n                      <option value=\"Macedonia\">Macedonia</option>\r\n                      \r\n                      <option value=\"Macronesia\">Macronesia</option>\r\n                      \r\n                      <option value=\"Madagascar\">Madagascar</option>\r\n                      \r\n                      <option value=\"Malawi\">Malawi</option>\r\n                      \r\n                      <option value=\"Malaysia\">Malaysia</option>\r\n                      \r\n                      <option value=\"Maldives\">Maldives</option>\r\n                      \r\n                      <option value=\"Mali\">Mali</option>\r\n                      \r\n                      <option value=\"Malta\">Malta</option>\r\n                      \r\n                      <option value=\"Martinique\">Martinique</option>\r\n                      \r\n                      <option value=\"Mauritania\">Mauritania</option>\r\n                      \r\n                      <option value=\"Mauritius\">Mauritius</option>\r\n                      \r\n                      <option value=\"Mexico\">Mexico</option>\r\n                      \r\n                      <option value=\"Moldova\">Moldova</option>\r\n                      \r\n                      <option value=\"Monaco\">Monaco</option>\r\n                      \r\n                      <option value=\"Mongolia\">Mongolia</option>\r\n                      \r\n                      <option value=\"Montenegro\">Montenegro</option>\r\n                      \r\n                      <option value=\"Montserrat\">Montserrat</option>\r\n                      \r\n                      <option value=\"Morocco\">Morocco</option>\r\n                      \r\n                      <option value=\"Mozambique\">Mozambique</option>\r\n                      \r\n                      <option value=\"Myanmar\">Myanmar</option>\r\n                      \r\n                      <option value=\"Namibia\">Namibia</option>\r\n                      \r\n                      <option value=\"Nauru\">Nauru</option>\r\n                      \r\n                      <option value=\"Nepal\">Nepal</option>\r\n                      \r\n                      <option value=\"Netherlands\">Netherlands</option>\r\n                      \r\n                      <option value=\"Netherlands Antilles\">Netherlands Antilles</option>\r\n                      \r\n                      <option value=\"New Caledonia\">New Caledonia</option>\r\n                      \r\n                      <option value=\"New Zealand\">New Zealand</option>\r\n                      \r\n                      <option value=\"Nicaragua\">Nicaragua</option>\r\n                      \r\n                      <option value=\"Niger\">Niger</option>\r\n                      \r\n                      <option value=\"Nigeria\">Nigeria</option>\r\n                      \r\n                      <option value=\"Niue\">Niue</option>\r\n                      \r\n                      <option value=\"Norfolk Island\">Norfolk Island</option>\r\n                      \r\n                      <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>\r\n                      \r\n                      <option value=\"Norway\">Norway</option>\r\n                      \r\n                      <option value=\"Oman\">Oman</option>\r\n                      \r\n                      <option value=\"Pakistan\">Pakistan</option>\r\n                      \r\n                      <option value=\"Palau\">Palau</option>\r\n                      \r\n                      <option value=\"Panama\">Panama</option>\r\n                      \r\n                      <option value=\"Papua New Guinea\">Papua New Guinea</option>\r\n                      \r\n                      <option value=\"Paraguay\">Paraguay</option>\r\n                      \r\n                      <option value=\"Peru\">Peru</option>\r\n                      \r\n                      <option value=\"Philippines\">Philippines</option>\r\n                      \r\n                      <option value=\"Poland\">Poland</option>\r\n                      \r\n                      <option value=\"Portugal\">Portugal</option>\r\n                      \r\n                      <option value=\"Puerto Rico\">Puerto Rico</option>\r\n                      \r\n                      <option value=\"Qatar\">Qatar</option>\r\n                      \r\n                      <option value=\"RepÃºblica de las Islas Marshall\">RepÃºblica de las Islas Marshall</option>\r\n                      \r\n                      <option value=\"Romania\">Romania</option>\r\n                      \r\n                      <option value=\"Russia\">Russia</option>\r\n                      \r\n                      <option value=\"Rwanda\">Rwanda</option>\r\n                      \r\n                      <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>\r\n                      \r\n                      <option value=\"Saint Lucia\">Saint Lucia</option>\r\n                      \r\n                      <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>\r\n                      \r\n                      <option value=\"Samoa\">Samoa</option>\r\n                      \r\n                      <option value=\"San Marino\">San Marino</option>\r\n                      \r\n                      <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>\r\n                      \r\n                      <option value=\"Saudi Arabia\">Saudi Arabia</option>\r\n                      \r\n                      <option value=\"Scotland\">Scotland</option>\r\n                      \r\n                      <option value=\"Senegal\">Senegal</option>\r\n                      \r\n                      <option value=\"Serbia\">Serbia</option>\r\n                      \r\n                      <option value=\"Serbia and Montenegro\">Serbia and Montenegro</option>\r\n                      \r\n                      <option value=\"Seychelles\">Seychelles</option>\r\n                      \r\n                      <option value=\"Sierra Leone\">Sierra Leone</option>\r\n                      \r\n                      <option value=\"Singapore\">Singapore</option>\r\n                      \r\n                      <option value=\"Slovak Republic\">Slovak Republic</option>\r\n                      \r\n                      <option value=\"Slovenia\">Slovenia</option>\r\n                      \r\n                      <option value=\"Solomon Islands\">Solomon Islands</option>\r\n                      \r\n                      <option value=\"Somalia\">Somalia</option>\r\n                      \r\n                      <option value=\"South Africa\">South Africa</option>\r\n                      \r\n                      <option value=\"South Korea\">South Korea</option>\r\n                      \r\n                      <option value=\"Spain\">Spain</option>\r\n                      \r\n                      <option value=\"Sri Lanka\">Sri Lanka</option>\r\n                      \r\n                      <option value=\"St Pierre and Miquelon\">St Pierre and Miquelon</option>\r\n                      \r\n                      <option value=\"Sudan\">Sudan</option>\r\n                      \r\n                      <option value=\"Suriname\">Suriname</option>\r\n                      \r\n                      <option value=\"Swaziland\">Swaziland</option>\r\n                      \r\n                      <option value=\"Sweden\">Sweden</option>\r\n                      \r\n                      <option value=\"Switzerland\">Switzerland</option>\r\n                      \r\n                      <option value=\"Syria\">Syria</option>\r\n                      \r\n                      <option value=\"Taiwan\">Taiwan</option>\r\n                      \r\n                      <option value=\"Tajikistan\">Tajikistan</option>\r\n                      \r\n                      <option value=\"Tanzania\">Tanzania</option>\r\n                      \r\n                      <option value=\"Thailand\">Thailand</option>\r\n                      \r\n                      <option value=\"Togo\">Togo</option>\r\n                      \r\n                      <option value=\"Tonga\">Tonga</option>\r\n                      \r\n                      <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>\r\n                      \r\n                      <option value=\"Tunisia\">Tunisia</option>\r\n                      \r\n                      <option value=\"Turkey\">Turkey</option>\r\n                      \r\n                      <option value=\"Turkmeninstan\">Turkmeninstan</option>\r\n                      \r\n                      <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>\r\n                      \r\n                      <option value=\"Tuvalu\">Tuvalu</option>\r\n                      \r\n                      <option value=\"Uganda\">Uganda</option>\r\n                      \r\n                      <option value=\"Ukraine\">Ukraine</option>\r\n                      \r\n                      <option value=\"United Arab Emirates\">United Arab Emirates</option>\r\n                      \r\n                      <option value=\"United Kingdom\">United Kingdom</option>\r\n                      \r\n                      <option value=\"United States\">United States</option>\r\n                      \r\n                      <option value=\"Uruguay\">Uruguay</option>\r\n                      \r\n                      <option value=\"Uzbekistan\">Uzbekistan</option>\r\n                      \r\n                      <option value=\"Vanuatu\">Vanuatu</option>\r\n                      \r\n                      <option value=\"Vatican City State (Holy See)\">Vatican City State (Holy See)</option>\r\n                      \r\n                      <option value=\"Venezuela\">Venezuela</option>\r\n                      \r\n                      <option value=\"Vietnam\">Vietnam</option>\r\n                      \r\n                      <option value=\"Virgin Islands (British)\">Virgin Islands (British)</option>\r\n                      \r\n                      <option value=\"Virgin Islands (US)\">Virgin Islands (US)</option>\r\n                      \r\n                      <option value=\"Western Sahara\">Western Sahara</option>\r\n                      \r\n                      <option value=\"Yemen\">Yemen</option>\r\n                      \r\n                      <option value=\"Zambia\">Zambia</option>\r\n                      \r\n                      <option value=\"Zimbawe\">Zimbawe</option>\r\n                      \r\n                    </select></td>\r\n                  </tr>\r\n                  <tr>\r\n                    <td colspan=\"3\">  <button class=\"btn btn-primary\" type=\"submit\" >Go</button>&nbsp;   <a href=\"rp_byuser_02_search.asp\" class=\"btn btn-white\">Reset form</a></td>\r\n                    </tr>\r\n              </tbody>\r\n          </table>\r\n          </div>\r\n        </div>\r\n      </div>\r\n    </div> \r\n\r\n </form>\r\n </div>\r\n  <!-- footer -->\r\n<div class=\"footer\">\r\n\t<div class=\"pull-right\"><a href=\"../../terms_of_service.asp\" target=\"new\">Terms and Conditions</a> | <a href=\"../../privacy_policy.asp\" target=\"_blank\">Privacy Policy</a></div>\r\n    <div><strong>Copyright</strong> BlueDot &copy; 2015</div>\r\n</div>\r\n\r\n\r\n <!-- Content end-->\r\n</div>\r\n\r\n<div id=\"right-sidebar\">\r\n\t<div class=\"sidebar-container\">\r\n    \r\n<!-- sidebar -->\r\n<div class=\"tab-content\">\r\n\t<div id=\"tab-1\" class=\"tab-pane active\">\r\n\t\t<div>\r\n\t\t\t<div class=\"sidebar-message\">\r\n\t\t\t\t<div class=\"pull-left text-center\"></div>\r\n\t\t\t\t<div class=\"media-body\">This panel will be used in the near future and will include shotcuts to your favorite actions.</div>\r\n\t\t\t</div>\r\n\t\t</div>\r\n\t</div>\r\n</div>\r\n          \r\n\t</div>\r\n\r\n</div>\r\n</div>\r\n</div>\r\n\r\n    \r\n<!-- Bootstrap scripts -->\r\n<!-- Mainly scripts -->\r\n<script src=\"../../includes/js/jquery-2.1.1.js\"></script>\r\n<script src=\"../../includes/js/bootstrap.min.js\"></script>\r\n<script src=\"../../includes/js/plugins/metisMenu/jquery.metisMenu.js\"></script>\r\n<script src=\"../../includes/js/plugins/slimscroll/jquery.slimscroll.min.js\"></script>\r\n    \r\n<!-- Custom and plugin javascript -->\r\n<script src=\"../../includes/js/inspinia.js\"></script>\r\n<script src=\"../../includes/js/plugins/pace/pace.min.js\"></script>\r\n\r\n<!-- Forms validation scripts -->\r\n<script src=\"../../includes/formvalidation/dist/js/formValidation.min.js\"></script>\r\n<script src=\"../../includes/formvalidation/dist/js/framework/bootstrap.min.js\"></script>\r\n\r\n<!-- Date picker validation scripts -->\r\n<script src=\"../../includes/js/plugins/datapicker/bootstrap-datepicker.js\"></script>\r\n<script src=\"../../includes/js/plugins/clockpicker/clockpicker.js\"></script> \r\n\r\n<!-- iCheck -->\r\n<script src=\"../../includes/js/plugins/iCheck/icheck.min.js\"></script>\r\n <script>\r\n            $(document).ready(function () {\r\n                $('.i-checks').iCheck({\r\n                    checkboxClass: 'icheckbox_square-green',\r\n                    radioClass: 'iradio_square-green',\r\n                });\r\n            });\r\n</script> \r\n\r\n<!-- Idle Timer plugin -->\r\n<script src=\"../../includes/js/plugins/idle-timer/idle-timer.min.js\"></script>\r\n\r\n<!-- Toastr script -->\r\n\r\n<script src=\"../../includes/js/plugins/toastr/toastr.min.js\"></script>\r\n<script>\r\nvar timer;\r\n$(document).ready(function () {\r\n  // Set idle time\r\n  $(document).idleTimer(1800000);\r\n});\r\n\r\n$(document).on('idle.idleTimer', function(event, elem, obj){\r\n  toastr.options = {\r\n    \"positionClass\": \"toast-top-right\",\r\n    \"timeOut\": 300000\r\n  }\r\n\r\n  toastr.warning('You have been idle for too long, to stayed logged in please move your mouse.','Idle for too long');\r\n  $('.custom-alert').fadeIn();\r\n  $('.custom-alert-active').fadeOut();\r\n  timer = setTimeout(function() {\r\n    window.location = '../../Signout.asp';\r\n  }, 300000);\r\n});\r\n\r\n$(document).on(\"active.idleTimer\", function(event, elem, obj, triggerevent){\r\n\ttoastr.options = {\r\n    \"timeOut\": 3000\r\n  }\r\n  // function you want to fire when the user becomes active again\r\n  clearTimeout(timer);\r\n  toastr.clear();\r\n  $('.custom-alert').fadeOut();\r\n  toastr.success('Great to see you back!','You are back. ');\r\n});\r\n</script>\r\n\r\n    <!-- Date range use moment.js same as full calendar plugin -->\r\n    <script src=\"../../includes/js/plugins/fullcalendar/moment.min.js\"></script>\r\n\r\n    <!-- Date range picker -->\r\n    <script src=\"../../includes/js/plugins/daterangepicker/daterangepicker.js\"></script>\r\n\r\n    <script>\r\n        $(document).ready(function(){\r\n\r\n         \r\n            $('#data_1 .input-group.date').datepicker({\r\n                todayBtn: \"linked\",\r\n                keyboardNavigation: false,\r\n                forceParse: false,\r\n                calendarWeeks: true,\r\n                autoclose: true\r\n            });\r\n\r\n            $('#data_2 .input-group.date').datepicker({\r\n                startView: 1,\r\n                todayBtn: \"linked\",\r\n                keyboardNavigation: false,\r\n                forceParse: false,\r\n                autoclose: true,\r\n                format: \"dd/mm/yyyy\"\r\n            });\r\n\r\n            $('#data_3 .input-group.date').datepicker({\r\n                startView: 2,\r\n                todayBtn: \"linked\",\r\n                keyboardNavigation: false,\r\n                forceParse: false,\r\n                autoclose: true\r\n            });\r\n\r\n            $('#data_4 .input-group.date').datepicker({\r\n                minViewMode: 1,\r\n                keyboardNavigation: false,\r\n                forceParse: false,\r\n                autoclose: true,\r\n                todayHighlight: true\r\n            });\r\n\r\n            $('.input-daterange').datepicker({\r\n                keyboardNavigation: false,\r\n                forceParse: false,\r\n                autoclose: true\r\n            });\r\n\r\n           \r\n\r\n            $('.i-checks').iCheck({\r\n                checkboxClass: 'icheckbox_square-green',\r\n                radioClass: 'iradio_square-green'\r\n            });\r\n\r\n           \r\n              \r\n            $('input[name=\"daterange\"]').daterangepicker();\r\n\r\n            $('#reportrange span').html(moment().subtract(29, 'days').format('MMMM D, YYYY') + ' - ' + moment().format('MMMM D, YYYY'));\r\n\r\n            $('#reportrange').daterangepicker({\r\n                format: 'MM/DD/YYYY',\r\n                startDate: moment().subtract(29, 'days'),\r\n                endDate: moment(),\r\n                minDate: '01/01/2012',\r\n                maxDate: '12/31/2015',\r\n                dateLimit: { days: 60 },\r\n                showDropdowns: true,\r\n                showWeekNumbers: true,\r\n                timePicker: false,\r\n                timePickerIncrement: 1,\r\n                timePicker12Hour: true,\r\n                ranges: {\r\n                    'Today': [moment(), moment()],\r\n                    'Yesterday': [moment().subtract(1, 'days'), moment().subtract(1, 'days')],\r\n                    'Last 7 Days': [moment().subtract(6, 'days'), moment()],\r\n                    'Last 30 Days': [moment().subtract(29, 'days'), moment()],\r\n                    'This Month': [moment().startOf('month'), moment().endOf('month')],\r\n                    'Last Month': [moment().subtract(1, 'month').startOf('month'), moment().subtract(1, 'month').endOf('month')]\r\n                },\r\n                opens: 'right',\r\n                drops: 'down',\r\n                buttonClasses: ['btn', 'btn-sm'],\r\n                applyClass: 'btn-primary',\r\n                cancelClass: 'btn-default',\r\n                separator: ' to ',\r\n                locale: {\r\n                    applyLabel: 'Submit',\r\n                    cancelLabel: 'Cancel',\r\n                    fromLabel: 'From',\r\n                    toLabel: 'To',\r\n                    customRangeLabel: 'Custom',\r\n                    daysOfWeek: ['Su', 'Mo', 'Tu', 'We', 'Th', 'Fr','Sa'],\r\n                    monthNames: ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'],\r\n                    firstDay: 1\r\n                }\r\n            }, function(start, end, label) {\r\n                console.log(start.toISOString(), end.toISOString(), label);\r\n                $('#reportrange span').html(start.format('MMMM D, YYYY') + ' - ' + end.format('MMMM D, YYYY'));\r\n            });\r\n\r\n\r\n        });\r\n        \r\n\r\n\r\n    </script>    \r\n<script type='text/javascript'>//<![CDATA[ \r\n$(window).load(function(){\r\n$(document).ready(function() {\r\n\r\n\r\n    $('#dob_start')\r\n        .datepicker({\r\n\t\t\ttodayHighlight:new Date(),\r\n\t\t\tautoclose: true,    // The default value is false\r\n            format: 'mm/dd/yyyy'\r\n        })\r\n        .on('changeDate', function(e) {\r\n            // Revalidate the date field\r\n            $('#form1').formValidation('revalidateField', 'dob_start');\r\n        });\r\n\t\t\r\n\t\t    $('#dob_end')\r\n        .datepicker({\r\n\t\t\ttodayHighlight:new Date(),\r\n\t\t\tautoclose: true,    // The default value is false\r\n            format: 'mm/dd/yyyy'\r\n        })\r\n        .on('changeDate', function(e) {\r\n            // Revalidate the date field\r\n            $('#form1').formValidation('revalidateField', 'dob_end');\r\n        });\r\n\t\t\r\n\r\n    $('#form1').formValidation({\r\n        framework: 'bootstrap',\r\n        icon: {\r\n            valid: 'glyphicon glyphicon-ok',\r\n            invalid: 'glyphicon glyphicon-remove',\r\n            validating: 'glyphicon glyphicon-refresh'\r\n        },\r\n        fields: {\r\n          \r\n\t\t\t\r\n\t\t\tdob_start: {\r\n                validators: {\r\n                    date: {\r\n                        format: 'MM/DD/YYYY',\r\n                        message: 'The date is not a valid or in wrong format (mm/dd/yyyy)'\r\n                    }\r\n                }\r\n            },\r\n\t\t\t\r\n\t\t\tdob_end: {\r\n                validators: {\r\n                    date: {\r\n                        format: 'MM/DD/YYYY',\r\n                        message: 'The date is not a valid or in wrong format (mm/dd/yyyy)'\r\n                    }\r\n                }\r\n            },\r\n\t\t\t\t\t\r\n  }\r\n\t\t\r\n    });\r\n});\r\n});//]]>  \r\n\r\n</script>\r\n</body>\r\n</html>\r\n\r\n\r\n\r\n\r\n<!-- Recordset include close -->\r\n```"},"comment":{"url":"https://api.github.com/repos/formvalidation/support/issues/comments/174245056","html_url":"https://github.com/formvalidation/support/issues/460#issuecomment-174245056","issue_url":"https://api.github.com/repos/formvalidation/support/issues/460","id":174245056,"user":{"login":"amucino","id":13330689,"avatar_url":"https://avatars.githubusercontent.com/u/13330689?v=3","gravatar_id":"","url":"https://api.github.com/users/amucino","html_url":"https://github.com/amucino","followers_url":"https://api.github.com/users/amucino/followers","following_url":"https://api.github.com/users/amucino/following{/other_user}","gists_url":"https://api.github.com/users/amucino/gists{/gist_id}","starred_url":"https://api.github.com/users/amucino/starred{/owner}{/repo}","subscriptions_url":"https://api.github.com/users/amucino/subscriptions","organizations_url":"https://api.github.com/users/amucino/orgs","repos_url":"https://api.github.com/users/amucino/repos","events_url":"https://api.github.com/users/amucino/events{/privacy}","received_events_url":"https://api.github.com/users/amucino/received_events","type":"User","site_admin":false},"created_at":"2016-01-24T02:57:29Z","updated_at":"2016-01-24T02:57:29Z","body":"I found the field was missing \r\n<div class=\"form-group\">"}}