{"id":25,"date":"2022-07-26T07:02:40","date_gmt":"2022-07-26T07:02:40","guid":{"rendered":"https:\/\/www.bcn-bhilai.com\/index.php\/apply-online\/"},"modified":"2022-08-01T11:14:47","modified_gmt":"2022-08-01T11:14:47","slug":"apply-online","status":"publish","type":"page","link":"https:\/\/bcn-bhilai.com\/apply-online\/","title":{"rendered":"APPLY ONLINE"},"content":{"rendered":"<div id='av_section_1'  class='avia-section av-av_section-e72984d7d38aa3d67d084c0697520518 main_color avia-section-default avia-no-border-styling  avia-builder-el-0  avia-builder-el-no-sibling  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-25'><div class='entry-content-wrapper clearfix'>\n<div class='flex_column av-av_one_full-a961ec8c42a44a397321d1a2224da3ca av_one_full  avia-builder-el-1  avia-builder-el-no-sibling  first flex_column_div '     ><section  class='av_textblock_section av-l6anmklh-d3fa84085730d5bd5405c2956e824383'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><div id=\"iphorm-outer-66336b4333d47\" class=\"iphorm-outer iphorm-outer-1 iphorm-uniform-theme-aristo iphorm-theme-light-light\" >\r\n    <script type=\"text\/javascript\">\r\n            jQuery(document).ready(function($) {\r\n                        $('#iphorm-66336b4333d47').iPhorm({\"id\":1,\"uniqueId\":\"66336b4333d47\",\"PHPSESSID\":\"bjg9a5dnjbcejoqufanaefgljb\",\"useAjax\":true,\"successMessageTimeout\":10,\"clElementIds\":[],\"clDependentElementIds\":[],\"centerFancybox\":true,\"centerFancyboxSpeed\":true});\r\n                        if ($.isFunction($.fn.qtip)) {\r\n                $('.iphorm-tooltip-hover', iPhorm.instance.$form).qtip({\r\n                    style: {\r\n                        classes: 'qtip-plain qtip-shadow qtip-rounded'\r\n                    },\r\n                    position: {\r\n                        my: 'left center',\r\n                        at: 'right center'\r\n                    }\r\n                });\r\n                $('.iphorm-tooltip-click', iPhorm.instance.$form).qtip({\r\n                    style: {\r\n                        classes: 'qtip-plain qtip-shadow qtip-rounded'\r\n                    },\r\n                    position: {\r\n                        my: 'left center',\r\n                        at: 'right center'\r\n                    },\r\n                    show: {\r\n                        event: 'focus'\r\n                    },\r\n                    hide: {\r\n                        event: 'unfocus'\r\n                    }\r\n                });\r\n                $('.iphorm-tooltip-icon-hover', iPhorm.instance.$form).qtip({\r\n                    style: {\r\n                        classes: 'qtip-plain qtip-shadow qtip-rounded'\r\n                    },\r\n                    position: {\r\n                        my: 'left center',\r\n                        at: 'right center'\r\n                    },\r\n                    content: {\r\n                        text: function (api) {\r\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\r\n                        }\r\n                    }\r\n                });\r\n                $('.iphorm-tooltip-icon-click', iPhorm.instance.$form).qtip({\r\n                    style: {\r\n                        classes: 'qtip-plain qtip-shadow qtip-rounded'\r\n                    },\r\n                    position: {\r\n                        my: 'left center',\r\n                        at: 'right center'\r\n                    },\r\n                    show: {\r\n                        event: 'click'\r\n                    },\r\n                    hide: {\r\n                        event: 'unfocus'\r\n                    },\r\n                    content: {\r\n                        text: function (api) {\r\n                            return $(this).find('.iphorm-tooltip-icon-content').html();\r\n                        }\r\n                    }\r\n                });\r\n                $('.iphorm-labels-inside > .iphorm-element-spacer > label').hover(function () {\r\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('show');\r\n                }, function () {\r\n                    $(this).siblings('.iphorm-input-wrap').find('.iphorm-tooltip-hover').qtip('hide');\r\n                });\r\n            }\r\n                                    if ($.isFunction($.fn.uniform)) {\r\n                $('select, input:checkbox, input:radio', iPhorm.instance.$form).uniform({context: iPhorm.instance.$form, selectAutoWidth: false});\r\n            }\r\n                        if ($.isFunction($.fn.inFieldLabels)) {\r\n                $('.iphorm-labels-inside:not(.iphorm-element-wrap-recaptcha) > .iphorm-element-spacer > label', iPhorm.instance.$form).inFieldLabels();\r\n            }\r\n                            if ($.isFunction($.fn.datepicker)) {\r\n                                            if (!$('#iphorm-jqueryui-theme').length) {\r\n                            var themeUrl = iphormL10n.plugin_url + '\/js\/jqueryui\/themes\/smoothness\/jquery-ui-1.8.24.custom.css';\r\n                            $('head').append('<link id=\"iphorm-jqueryui-theme\" rel=\"stylesheet\" href=\"' + themeUrl + '\" type=\"text\/css\" \/>');\r\n                        }\r\n                                                        }\r\n                        $('.iphorm-group-row > div:last-child:not(:first-child)', iPhorm.instance.$form).add('.iphorm-group-row:last-child', iPhorm.instance.$form).addClass('last-child');\r\n                    });\r\n    <\/script>\r\n    <form id=\"iphorm-66336b4333d47\" class=\"iphorm iphorm-form-1\" action=\"\/wp-json\/wp\/v2\/pages\/25#iphorm-66336b4333d47\" method=\"post\" enctype=\"multipart\/form-data\">\r\n        <div class=\"iphorm-inner iphorm-inner-1\" >\r\n            <input type=\"hidden\" name=\"iphorm_id\" value=\"1\" \/>\r\n            <input type=\"hidden\" name=\"iphorm_uid\" value=\"66336b4333d47\" \/>\r\n            <input type=\"hidden\" name=\"form_url\" value=\"https:\/\/bcn-bhilai.com\/wp-json\/wp\/v2\/pages\/25\" \/>\r\n            <input type=\"hidden\" name=\"referring_url\" value=\"\" \/>\r\n            <input type=\"hidden\" name=\"post_id\" value=\"\" \/>\r\n            <input type=\"hidden\" name=\"post_title\" value=\"\" \/>\r\n                            <h3 class=\"iphorm-title\" >Online Admission Form<\/h3>\r\n                                                                        <div class=\"iphorm-success-message iphorm-hidden\" ><\/div>\r\n                                        <div class=\"iphorm-elements iphorm-elements-1 iphorm-clearfix\" >\r\n                <div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_1-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_1-element-spacer\">\r\n                    <label for=\"iphorm_1_1_66336b4333d47\" >\r\n                Name                                     <span class=\"iphorm-required\">(required)<\/span>\r\n                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_1-input-wrap\" >\r\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_1_1\" id=\"iphorm_1_1_66336b4333d47\" type=\"text\" name=\"iphorm_1_1\" title=\"Full Name as in School Record\" value=\"\" style='width: 250px;' \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-group-wrap iphorm_1_20-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\">\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-date iphorm_1_3-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-date iphorm_1_3-element-spacer\">\r\r\n        \r\n            <label >\r\r\n                Date of Birth\r\n                \r\n                \r\n            <\/label>\r\r\n        \r\n        <div id=\"iphorm_1_3_66336b4333d47\" class=\"iphorm-input-wrap iphorm-input-wrap-date iphorm_1_3-input-wrap\" >\r\r\n        \t<div class=\"iphorm-clearfix\">\r\r\n                <div class=\"iphorm-input-wrap-date-select-wrap\">\r\r\n                    \r\n                    \r\n                    \r\n                    <select id=\"iphorm_1_3_66336b4333d47_day\" name=\"iphorm_1_3[day]\" class=\"iphorm_1_3-input-day\" >\r\r\n                        <option value=\"\">Day<\/option>\r\n                        \r\n                            <option value=\"1\" >1<\/option>\r\r\n                        \r\n                            <option value=\"2\" >2<\/option>\r\r\n                        \r\n                            <option value=\"3\" >3<\/option>\r\r\n                        \r\n                            <option value=\"4\" >4<\/option>\r\r\n                        \r\n                            <option value=\"5\" >5<\/option>\r\r\n                        \r\n                            <option value=\"6\" >6<\/option>\r\r\n                        \r\n                            <option value=\"7\" >7<\/option>\r\r\n                        \r\n                            <option value=\"8\" >8<\/option>\r\r\n                        \r\n                            <option value=\"9\" >9<\/option>\r\r\n                        \r\n                            <option value=\"10\" >10<\/option>\r\r\n                        \r\n                            <option value=\"11\" >11<\/option>\r\r\n                        \r\n                            <option value=\"12\" >12<\/option>\r\r\n                        \r\n                            <option value=\"13\" >13<\/option>\r\r\n                        \r\n                            <option value=\"14\" >14<\/option>\r\r\n                        \r\n                            <option value=\"15\" >15<\/option>\r\r\n                        \r\n                            <option value=\"16\" >16<\/option>\r\r\n                        \r\n                            <option value=\"17\" >17<\/option>\r\r\n                        \r\n                            <option value=\"18\" >18<\/option>\r\r\n                        \r\n                            <option value=\"19\" >19<\/option>\r\r\n                        \r\n                            <option value=\"20\" >20<\/option>\r\r\n                        \r\n                            <option value=\"21\" >21<\/option>\r\r\n                        \r\n                            <option value=\"22\" >22<\/option>\r\r\n                        \r\n                            <option value=\"23\" >23<\/option>\r\r\n                        \r\n                            <option value=\"24\" >24<\/option>\r\r\n                        \r\n                            <option value=\"25\" >25<\/option>\r\r\n                        \r\n                            <option value=\"26\" >26<\/option>\r\r\n                        \r\n                            <option value=\"27\" >27<\/option>\r\r\n                        \r\n                            <option value=\"28\" >28<\/option>\r\r\n                        \r\n                            <option value=\"29\" >29<\/option>\r\r\n                        \r\n                            <option value=\"30\" >30<\/option>\r\r\n                        \r\n                            <option value=\"31\" >31<\/option>\r\r\n                        \r\n                    <\/select>\r\r\n                    \r\n                    <select id=\"iphorm_1_3_66336b4333d47_month\" name=\"iphorm_1_3[month]\" class=\"iphorm_1_3-input-month\" >\r\r\n                        <option value=\"\">Month<\/option>\r\n                        \r\n                            <option value=\"1\" >January<\/option>\r\r\n                        \r\n                            <option value=\"2\" >February<\/option>\r\r\n                        \r\n                            <option value=\"3\" >March<\/option>\r\r\n                        \r\n                            <option value=\"4\" >April<\/option>\r\r\n                        \r\n                            <option value=\"5\" >May<\/option>\r\r\n                        \r\n                            <option value=\"6\" >June<\/option>\r\r\n                        \r\n                            <option value=\"7\" >July<\/option>\r\r\n                        \r\n                            <option value=\"8\" >August<\/option>\r\r\n                        \r\n                            <option value=\"9\" >September<\/option>\r\r\n                        \r\n                            <option value=\"10\" >October<\/option>\r\r\n                        \r\n                            <option value=\"11\" >November<\/option>\r\r\n                        \r\n                            <option value=\"12\" >December<\/option>\r\r\n                        \r\n                    <\/select>\r\r\n                    \r\n                    <select id=\"iphorm_1_3_66336b4333d47_year\" name=\"iphorm_1_3[year]\" class=\"iphorm_1_3-input-year\" >\r\r\n                        <option value=\"\">Year<\/option>\r\n                        \r\n                            \r\n                                <option value=\"2028\" >2028<\/option>\r\r\n                            \r\n                                <option value=\"2027\" >2027<\/option>\r\r\n                            \r\n                                <option value=\"2026\" >2026<\/option>\r\r\n                            \r\n                                <option value=\"2025\" >2025<\/option>\r\r\n                            \r\n                                <option value=\"2024\" >2024<\/option>\r\r\n                            \r\n                                <option value=\"2023\" >2023<\/option>\r\r\n                            \r\n                                <option value=\"2022\" >2022<\/option>\r\r\n                            \r\n                                <option value=\"2021\" >2021<\/option>\r\r\n                            \r\n                                <option value=\"2020\" >2020<\/option>\r\r\n                            \r\n                                <option value=\"2019\" >2019<\/option>\r\r\n                            \r\n                                <option value=\"2018\" >2018<\/option>\r\r\n                            \r\n                                <option value=\"2017\" >2017<\/option>\r\r\n                            \r\n                                <option value=\"2016\" >2016<\/option>\r\r\n                            \r\n                                <option value=\"2015\" >2015<\/option>\r\r\n                            \r\n                                <option value=\"2014\" >2014<\/option>\r\r\n                            \r\n                                <option value=\"2013\" >2013<\/option>\r\r\n                            \r\n                                <option value=\"2012\" >2012<\/option>\r\r\n                            \r\n                                <option value=\"2011\" >2011<\/option>\r\r\n                            \r\n                                <option value=\"2010\" >2010<\/option>\r\r\n                            \r\n                                <option value=\"2009\" >2009<\/option>\r\r\n                            \r\n                                <option value=\"2008\" >2008<\/option>\r\r\n                            \r\n                                <option value=\"2007\" >2007<\/option>\r\r\n                            \r\n                                <option value=\"2006\" >2006<\/option>\r\r\n                            \r\n                                <option value=\"2005\" >2005<\/option>\r\r\n                            \r\n                                <option value=\"2004\" >2004<\/option>\r\r\n                            \r\n                                <option value=\"2003\" >2003<\/option>\r\r\n                            \r\n                                <option value=\"2002\" >2002<\/option>\r\r\n                            \r\n                                <option value=\"2001\" >2001<\/option>\r\r\n                            \r\n                                <option value=\"2000\" >2000<\/option>\r\r\n                            \r\n                                <option value=\"1999\" >1999<\/option>\r\r\n                            \r\n                                <option value=\"1998\" >1998<\/option>\r\r\n                            \r\n                                <option value=\"1997\" >1997<\/option>\r\r\n                            \r\n                                <option value=\"1996\" >1996<\/option>\r\r\n                            \r\n                                <option value=\"1995\" >1995<\/option>\r\r\n                            \r\n                                <option value=\"1994\" >1994<\/option>\r\r\n                            \r\n                                <option value=\"1993\" >1993<\/option>\r\r\n                            \r\n                                <option value=\"1992\" >1992<\/option>\r\r\n                            \r\n                                <option value=\"1991\" >1991<\/option>\r\r\n                            \r\n                                <option value=\"1990\" >1990<\/option>\r\r\n                            \r\n                                <option value=\"1989\" >1989<\/option>\r\r\n                            \r\n                                <option value=\"1988\" >1988<\/option>\r\r\n                            \r\n                                <option value=\"1987\" >1987<\/option>\r\r\n                            \r\n                                <option value=\"1986\" >1986<\/option>\r\r\n                            \r\n                                <option value=\"1985\" >1985<\/option>\r\r\n                            \r\n                                <option value=\"1984\" >1984<\/option>\r\r\n                            \r\n                                <option value=\"1983\" >1983<\/option>\r\r\n                            \r\n                                <option value=\"1982\" >1982<\/option>\r\r\n                            \r\n                                <option value=\"1981\" >1981<\/option>\r\r\n                            \r\n                                <option value=\"1980\" >1980<\/option>\r\r\n                            \r\n                                <option value=\"1979\" >1979<\/option>\r\r\n                            \r\n                                <option value=\"1978\" >1978<\/option>\r\r\n                            \r\n                                <option value=\"1977\" >1977<\/option>\r\r\n                            \r\n                                <option value=\"1976\" >1976<\/option>\r\r\n                            \r\n                                <option value=\"1975\" >1975<\/option>\r\r\n                            \r\n                                <option value=\"1974\" >1974<\/option>\r\r\n                            \r\n                                <option value=\"1973\" >1973<\/option>\r\r\n                            \r\n                                <option value=\"1972\" >1972<\/option>\r\r\n                            \r\n                                <option value=\"1971\" >1971<\/option>\r\r\n                            \r\n                                <option value=\"1970\" >1970<\/option>\r\r\n                            \r\n                                <option value=\"1969\" >1969<\/option>\r\r\n                            \r\n                                <option value=\"1968\" >1968<\/option>\r\r\n                            \r\n                                <option value=\"1967\" >1967<\/option>\r\r\n                            \r\n                                <option value=\"1966\" >1966<\/option>\r\r\n                            \r\n                                <option value=\"1965\" >1965<\/option>\r\r\n                            \r\n                                <option value=\"1964\" >1964<\/option>\r\r\n                            \r\n                                <option value=\"1963\" >1963<\/option>\r\r\n                            \r\n                                <option value=\"1962\" >1962<\/option>\r\r\n                            \r\n                                <option value=\"1961\" >1961<\/option>\r\r\n                            \r\n                                <option value=\"1960\" >1960<\/option>\r\r\n                            \r\n                                <option value=\"1959\" >1959<\/option>\r\r\n                            \r\n                                <option value=\"1958\" >1958<\/option>\r\r\n                            \r\n                                <option value=\"1957\" >1957<\/option>\r\r\n                            \r\n                                <option value=\"1956\" >1956<\/option>\r\r\n                            \r\n                                <option value=\"1955\" >1955<\/option>\r\r\n                            \r\n                                <option value=\"1954\" >1954<\/option>\r\r\n                            \r\n                                <option value=\"1953\" >1953<\/option>\r\r\n                            \r\n                                <option value=\"1952\" >1952<\/option>\r\r\n                            \r\n                                <option value=\"1951\" >1951<\/option>\r\r\n                            \r\n                                <option value=\"1950\" >1950<\/option>\r\r\n                            \r\n                                <option value=\"1949\" >1949<\/option>\r\r\n                            \r\n                                <option value=\"1948\" >1948<\/option>\r\r\n                            \r\n                                <option value=\"1947\" >1947<\/option>\r\r\n                            \r\n                                <option value=\"1946\" >1946<\/option>\r\r\n                            \r\n                                <option value=\"1945\" >1945<\/option>\r\r\n                            \r\n                                <option value=\"1944\" >1944<\/option>\r\r\n                            \r\n                                <option value=\"1943\" >1943<\/option>\r\r\n                            \r\n                                <option value=\"1942\" >1942<\/option>\r\r\n                            \r\n                                <option value=\"1941\" >1941<\/option>\r\r\n                            \r\n                                <option value=\"1940\" >1940<\/option>\r\r\n                            \r\n                                <option value=\"1939\" >1939<\/option>\r\r\n                            \r\n                                <option value=\"1938\" >1938<\/option>\r\r\n                            \r\n                                <option value=\"1937\" >1937<\/option>\r\r\n                            \r\n                                <option value=\"1936\" >1936<\/option>\r\r\n                            \r\n                                <option value=\"1935\" >1935<\/option>\r\r\n                            \r\n                                <option value=\"1934\" >1934<\/option>\r\r\n                            \r\n                                <option value=\"1933\" >1933<\/option>\r\r\n                            \r\n                                <option value=\"1932\" >1932<\/option>\r\r\n                            \r\n                                <option value=\"1931\" >1931<\/option>\r\r\n                            \r\n                                <option value=\"1930\" >1930<\/option>\r\r\n                            \r\n                                <option value=\"1929\" >1929<\/option>\r\r\n                            \r\n                                <option value=\"1928\" >1928<\/option>\r\r\n                            \r\n                                <option value=\"1927\" >1927<\/option>\r\r\n                            \r\n                                <option value=\"1926\" >1926<\/option>\r\r\n                            \r\n                                <option value=\"1925\" >1925<\/option>\r\r\n                            \r\n                                <option value=\"1924\" >1924<\/option>\r\r\n                            \r\n                                <option value=\"1923\" >1923<\/option>\r\r\n                            \r\n                                <option value=\"1922\" >1922<\/option>\r\r\n                            \r\n                                <option value=\"1921\" >1921<\/option>\r\r\n                            \r\n                                <option value=\"1920\" >1920<\/option>\r\r\n                            \r\n                                <option value=\"1919\" >1919<\/option>\r\r\n                            \r\n                                <option value=\"1918\" >1918<\/option>\r\r\n                            \r\n                                <option value=\"1917\" >1917<\/option>\r\r\n                            \r\n                                <option value=\"1916\" >1916<\/option>\r\r\n                            \r\n                                <option value=\"1915\" >1915<\/option>\r\r\n                            \r\n                                <option value=\"1914\" >1914<\/option>\r\r\n                            \r\n                                <option value=\"1913\" >1913<\/option>\r\r\n                            \r\n                                <option value=\"1912\" >1912<\/option>\r\r\n                            \r\n                                <option value=\"1911\" >1911<\/option>\r\r\n                            \r\n                                <option value=\"1910\" >1910<\/option>\r\r\n                            \r\n                                <option value=\"1909\" >1909<\/option>\r\r\n                            \r\n                                <option value=\"1908\" >1908<\/option>\r\r\n                            \r\n                                <option value=\"1907\" >1907<\/option>\r\r\n                            \r\n                                <option value=\"1906\" >1906<\/option>\r\r\n                            \r\n                                <option value=\"1905\" >1905<\/option>\r\r\n                            \r\n                                <option value=\"1904\" >1904<\/option>\r\r\n                            \r\n                                <option value=\"1903\" >1903<\/option>\r\r\n                            \r\n                                <option value=\"1902\" >1902<\/option>\r\r\n                            \r\n                                <option value=\"1901\" >1901<\/option>\r\r\n                            \r\n                                <option value=\"1900\" >1900<\/option>\r\r\n                            \r\n                        \r\n                    <\/select>\r\r\n                <\/div>\r\r\n                \r\n                    <input type=\"hidden\" class=\"iphorm-datepicker\" name=\"iphorm_datepicker_iphorm_1_3_66336b4333d47\" value=\"\" \/>\r\r\n                    <div class=\"iphorm-datepicker-icon\"><\/div>\r\r\n                    <script type=\"text\/javascript\">\r\r\n                    jQuery(document).ready(function ($) {\r\r\n                        iPhorm.instance.addDatepicker('iphorm_1_3_66336b4333d47', {\r\r\n                            minDate: new Date(1900, 1 - 1, 1),\r\r\n                            maxDate: new Date(2028, 12 - 1, 31)\r\r\n                        });\r\r\n                    });\r\r\n                    <\/script>\r\r\n                \r\n            <\/div>\r\r\n            \r\n        <\/div>\r\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>\r\n    <\/div>\r\r\n<\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_4-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_4-element-spacer\">\r\n                    <label for=\"iphorm_1_4_66336b4333d47\" >\r\n                Age                                    <span class=\"iphorm-required\">(required)<\/span>\r\n                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_4-input-wrap\" >\r\n            <select class=\"iphorm-element-select iphorm-tooltip iphorm-tooltip-hover iphorm_1_4\" name=\"iphorm_1_4\" id=\"iphorm_1_4_66336b4333d47\" title=\"Select your age\" >\r\n                                    <option value=\"1\" >1<\/option>\r\n                                    <option value=\"2\" >2<\/option>\r\n                                    <option value=\"3\" >3<\/option>\r\n                                    <option value=\"4\" >4<\/option>\r\n                                    <option value=\"5\" >5<\/option>\r\n                                    <option value=\"6\" >6<\/option>\r\n                                    <option value=\"7\" >7<\/option>\r\n                                    <option value=\"8\" >8<\/option>\r\n                                    <option value=\"9\" >9<\/option>\r\n                                    <option value=\"10\" >10<\/option>\r\n                                    <option value=\"11\" >11<\/option>\r\n                                    <option value=\"12\" >12<\/option>\r\n                                    <option value=\"13\" >13<\/option>\r\n                                    <option value=\"14\" >14<\/option>\r\n                                    <option value=\"15\" >15<\/option>\r\n                                    <option value=\"16\" >16<\/option>\r\n                                    <option value=\"17\" >17<\/option>\r\n                                    <option value=\"18\" >18<\/option>\r\n                                    <option value=\"19\" >19<\/option>\r\n                                    <option value=\"20\" >20<\/option>\r\n                                    <option value=\"21\" >21<\/option>\r\n                                    <option value=\"22\" >22<\/option>\r\n                                    <option value=\"23\" >23<\/option>\r\n                                    <option value=\"24\" >24<\/option>\r\n                                    <option value=\"25\" >25<\/option>\r\n                                    <option value=\"26\" >26<\/option>\r\n                                    <option value=\"27\" >27<\/option>\r\n                                    <option value=\"28\" >28<\/option>\r\n                                    <option value=\"29\" >29<\/option>\r\n                                    <option value=\"30\" >30<\/option>\r\n                                    <option value=\"31\" >31<\/option>\r\n                                    <option value=\"32\" >32<\/option>\r\n                                    <option value=\"33\" >33<\/option>\r\n                                    <option value=\"34\" >34<\/option>\r\n                                    <option value=\"35\" >35<\/option>\r\n                                    <option value=\"36\" >36<\/option>\r\n                                    <option value=\"37\" >37<\/option>\r\n                                    <option value=\"38\" >38<\/option>\r\n                                    <option value=\"39\" >39<\/option>\r\n                                    <option value=\"40\" >40<\/option>\r\n                                    <option value=\"41\" >41<\/option>\r\n                                    <option value=\"42\" >42<\/option>\r\n                                    <option value=\"43\" >43<\/option>\r\n                                    <option value=\"44\" >44<\/option>\r\n                                    <option value=\"45\" >45<\/option>\r\n                                    <option value=\"46\" >46<\/option>\r\n                                    <option value=\"47\" >47<\/option>\r\n                                    <option value=\"48\" >48<\/option>\r\n                                    <option value=\"49\" >49<\/option>\r\n                                    <option value=\"50\" >50<\/option>\r\n                                    <option value=\"\" ><\/option>\r\n                            <\/select>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n<\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_22-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_5-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_5-element-spacer\">\r\n                    <label for=\"iphorm_1_5_66336b4333d47\" >\r\n                Gender                                    <span class=\"iphorm-required\">(required)<\/span>\r\n                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_5-input-wrap\" >\r\n            <select class=\"iphorm-element-select iphorm-tooltip iphorm-tooltip-hover iphorm_1_5\" name=\"iphorm_1_5\" id=\"iphorm_1_5_66336b4333d47\" title=\"Select your gender\" >\r\n                                    <option value=\"Male\" >Male<\/option>\r\n                                    <option value=\"Female\" >Female<\/option>\r\n                                    <option value=\"Other\" >Other<\/option>\r\n                            <\/select>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n<\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_6-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_6-element-spacer\">\r\n                    <label for=\"iphorm_1_6_66336b4333d47\" >\r\n                Height                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_6-input-wrap\" >\r\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_1_6\" id=\"iphorm_1_6_66336b4333d47\" type=\"text\" name=\"iphorm_1_6\" title=\"In feet\" value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_7-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_7-element-spacer\">\r\n                    <label for=\"iphorm_1_7_66336b4333d47\" >\r\n                Weight                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_7-input-wrap\" >\r\n            <input class=\"iphorm-element-text iphorm-tooltip iphorm-tooltip-hover iphorm_1_7\" id=\"iphorm_1_7_66336b4333d47\" type=\"text\" name=\"iphorm_1_7\" title=\"In KG\" value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_24-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_8-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_8-element-spacer\">\r\n                    <label for=\"iphorm_1_8_66336b4333d47\" >\r\n                Marital Status                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_8-input-wrap\" >\r\n            <select class=\"iphorm-element-select  iphorm_1_8\" name=\"iphorm_1_8\" id=\"iphorm_1_8_66336b4333d47\"  >\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>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n<\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_9-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_9-element-spacer\">\r\n                    <label for=\"iphorm_1_9_66336b4333d47\" >\r\n                Nationality                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_9-input-wrap\" >\r\n            <select class=\"iphorm-element-select iphorm-tooltip iphorm-tooltip-hover iphorm_1_9\" name=\"iphorm_1_9\" id=\"iphorm_1_9_66336b4333d47\" title=\"Select Nationality\" >\r\n                                    <option value=\"Afghanistan\" >Afghanistan<\/option>\r\n                                    <option value=\"Albania\" >Albania<\/option>\r\n                                    <option value=\"Algeria\" >Algeria<\/option>\r\n                                    <option value=\"American Samoa\" >American Samoa<\/option>\r\n                                    <option value=\"Andorra\" >Andorra<\/option>\r\n                                    <option value=\"Angola\" >Angola<\/option>\r\n                                    <option value=\"Anguilla\" >Anguilla<\/option>\r\n                                    <option value=\"Antarctica\" >Antarctica<\/option>\r\n                                    <option value=\"Antigua And Barbuda\" >Antigua And Barbuda<\/option>\r\n                                    <option value=\"Argentina\" >Argentina<\/option>\r\n                                    <option value=\"Armenia\" >Armenia<\/option>\r\n                                    <option value=\"Aruba\" >Aruba<\/option>\r\n                                    <option value=\"Australia\" >Australia<\/option>\r\n                                    <option value=\"Austria\" >Austria<\/option>\r\n                                    <option value=\"Azerbaijan\" >Azerbaijan<\/option>\r\n                                    <option value=\"Bahamas\" >Bahamas<\/option>\r\n                                    <option value=\"Bahrain\" >Bahrain<\/option>\r\n                                    <option value=\"Bangladesh\" >Bangladesh<\/option>\r\n                                    <option value=\"Barbados\" >Barbados<\/option>\r\n                                    <option value=\"Belarus\" >Belarus<\/option>\r\n                                    <option value=\"Belgium\" >Belgium<\/option>\r\n                                    <option value=\"Belize\" >Belize<\/option>\r\n                                    <option value=\"Benin\" >Benin<\/option>\r\n                                    <option value=\"Bermuda\" >Bermuda<\/option>\r\n                                    <option value=\"Bhutan\" >Bhutan<\/option>\r\n                                    <option value=\"Bolivia\" >Bolivia<\/option>\r\n                                    <option value=\"Bosnia And Herzegovina\" >Bosnia And Herzegovina<\/option>\r\n                                    <option value=\"Botswana\" >Botswana<\/option>\r\n                                    <option value=\"Bouvet Island\" >Bouvet Island<\/option>\r\n                                    <option value=\"Brazil\" >Brazil<\/option>\r\n                                    <option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option>\r\n                                    <option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option>\r\n                                    <option value=\"Bulgaria\" >Bulgaria<\/option>\r\n                                    <option value=\"Burkina Faso\" >Burkina Faso<\/option>\r\n                                    <option value=\"Burundi\" >Burundi<\/option>\r\n                                    <option value=\"Cambodia\" >Cambodia<\/option>\r\n                                    <option value=\"Cameroon\" >Cameroon<\/option>\r\n                                    <option value=\"Canada\" >Canada<\/option>\r\n                                    <option value=\"Cape Verde\" >Cape Verde<\/option>\r\n                                    <option value=\"Cayman Islands\" >Cayman Islands<\/option>\r\n                                    <option value=\"Central African Republic\" >Central African Republic<\/option>\r\n                                    <option value=\"Chad\" >Chad<\/option>\r\n                                    <option value=\"Chile\" >Chile<\/option>\r\n                                    <option value=\"China\" >China<\/option>\r\n                                    <option value=\"Christmas Island\" >Christmas Island<\/option>\r\n                                    <option value=\"Cocos (Keeling) Islands\" >Cocos (Keeling) Islands<\/option>\r\n                                    <option value=\"Colombia\" >Colombia<\/option>\r\n                                    <option value=\"Comoros\" >Comoros<\/option>\r\n                                    <option value=\"Congo\" >Congo<\/option>\r\n                                    <option value=\"Congo, The Democratic Republic Of The\" >Congo, The Democratic Republic Of The<\/option>\r\n                                    <option value=\"Cook Islands\" >Cook Islands<\/option>\r\n                                    <option value=\"Costa Rica\" >Costa Rica<\/option>\r\n                                    <option value=\"Cote D'Ivoire\" >Cote D'Ivoire<\/option>\r\n                                    <option value=\"Croatia (Local Name: Hrvatska)\" >Croatia (Local Name: Hrvatska)<\/option>\r\n                                    <option value=\"Cuba\" >Cuba<\/option>\r\n                                    <option value=\"Cyprus\" >Cyprus<\/option>\r\n                                    <option value=\"Czech Republic\" >Czech Republic<\/option>\r\n                                    <option value=\"Denmark\" >Denmark<\/option>\r\n                                    <option value=\"Djibouti\" >Djibouti<\/option>\r\n                                    <option value=\"Dominica\" >Dominica<\/option>\r\n                                    <option value=\"Dominican Republic\" >Dominican Republic<\/option>\r\n                                    <option value=\"East Timor\" >East Timor<\/option>\r\n                                    <option value=\"Ecuador\" >Ecuador<\/option>\r\n                                    <option value=\"Egypt\" >Egypt<\/option>\r\n                                    <option value=\"El Salvador\" >El Salvador<\/option>\r\n                                    <option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option>\r\n                                    <option value=\"Eritrea\" >Eritrea<\/option>\r\n                                    <option value=\"Estonia\" >Estonia<\/option>\r\n                                    <option value=\"Ethiopia\" >Ethiopia<\/option>\r\n                                    <option value=\"Falkland Islands (Malvinas)\" >Falkland Islands (Malvinas)<\/option>\r\n                                    <option value=\"Faroe Islands\" >Faroe Islands<\/option>\r\n                                    <option value=\"Fiji\" >Fiji<\/option>\r\n                                    <option value=\"Finland\" >Finland<\/option>\r\n                                    <option value=\"France\" >France<\/option>\r\n                                    <option value=\"France, Metropolitan\" >France, Metropolitan<\/option>\r\n                                    <option value=\"French Guiana\" >French Guiana<\/option>\r\n                                    <option value=\"French Polynesia\" >French Polynesia<\/option>\r\n                                    <option value=\"French Southern Territories\" >French Southern Territories<\/option>\r\n                                    <option value=\"Gabon\" >Gabon<\/option>\r\n                                    <option value=\"Gambia\" >Gambia<\/option>\r\n                                    <option value=\"Georgia\" >Georgia<\/option>\r\n                                    <option value=\"Germany\" >Germany<\/option>\r\n                                    <option value=\"Ghana\" >Ghana<\/option>\r\n                                    <option value=\"Gibraltar\" >Gibraltar<\/option>\r\n                                    <option value=\"Greece\" >Greece<\/option>\r\n                                    <option value=\"Greenland\" >Greenland<\/option>\r\n                                    <option value=\"Grenada\" >Grenada<\/option>\r\n                                    <option value=\"Guadeloupe\" >Guadeloupe<\/option>\r\n                                    <option value=\"Guam\" >Guam<\/option>\r\n                                    <option value=\"Guatemala\" >Guatemala<\/option>\r\n                                    <option value=\"Guinea\" >Guinea<\/option>\r\n                                    <option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option>\r\n                                    <option value=\"Guyana\" >Guyana<\/option>\r\n                                    <option value=\"Haiti\" >Haiti<\/option>\r\n                                    <option value=\"Heard And Mc Donald Islands\" >Heard And Mc Donald Islands<\/option>\r\n                                    <option value=\"Holy See (Vatican City State)\" >Holy See (Vatican City State)<\/option>\r\n                                    <option value=\"Honduras\" >Honduras<\/option>\r\n                                    <option value=\"Hong Kong\" >Hong Kong<\/option>\r\n                                    <option value=\"Hungary\" >Hungary<\/option>\r\n                                    <option value=\"Iceland\" >Iceland<\/option>\r\n                                    <option value=\"India\" >India<\/option>\r\n                                    <option value=\"Indonesia\" >Indonesia<\/option>\r\n                                    <option value=\"Iran (Islamic Republic Of)\" >Iran (Islamic Republic Of)<\/option>\r\n                                    <option value=\"Iraq\" >Iraq<\/option>\r\n                                    <option value=\"Ireland\" >Ireland<\/option>\r\n                                    <option value=\"Israel\" >Israel<\/option>\r\n                                    <option value=\"Italy\" >Italy<\/option>\r\n                                    <option value=\"Jamaica\" >Jamaica<\/option>\r\n                                    <option value=\"Japan\" >Japan<\/option>\r\n                                    <option value=\"Jordan\" >Jordan<\/option>\r\n                                    <option value=\"Kazakhstan\" >Kazakhstan<\/option>\r\n                                    <option value=\"Kenya\" >Kenya<\/option>\r\n                                    <option value=\"Kiribati\" >Kiribati<\/option>\r\n                                    <option value=\"Korea, Democratic People's Republic Of\" >Korea, Democratic People's Republic Of<\/option>\r\n                                    <option value=\"Korea, Republic Of\" >Korea, Republic Of<\/option>\r\n                                    <option value=\"Kuwait\" >Kuwait<\/option>\r\n                                    <option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option>\r\n                                    <option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option>\r\n                                    <option value=\"Latvia\" >Latvia<\/option>\r\n                                    <option value=\"Lebanon\" >Lebanon<\/option>\r\n                                    <option value=\"Lesotho\" >Lesotho<\/option>\r\n                                    <option value=\"Liberia\" >Liberia<\/option>\r\n                                    <option value=\"Libyan Arab Jamahiriya\" >Libyan Arab Jamahiriya<\/option>\r\n                                    <option value=\"Liechtenstein\" >Liechtenstein<\/option>\r\n                                    <option value=\"Lithuania\" >Lithuania<\/option>\r\n                                    <option value=\"Luxembourg\" >Luxembourg<\/option>\r\n                                    <option value=\"Macau\" >Macau<\/option>\r\n                                    <option value=\"Macedonia, Former Yugoslav Republic Of\" >Macedonia, Former Yugoslav Republic Of<\/option>\r\n                                    <option value=\"Madagascar\" >Madagascar<\/option>\r\n                                    <option value=\"Malawi\" >Malawi<\/option>\r\n                                    <option value=\"Malaysia\" >Malaysia<\/option>\r\n                                    <option value=\"Maldives\" >Maldives<\/option>\r\n                                    <option value=\"Mali\" >Mali<\/option>\r\n                                    <option value=\"Malta\" >Malta<\/option>\r\n                                    <option value=\"Marshall Islands\" >Marshall Islands<\/option>\r\n                                    <option value=\"Martinique\" >Martinique<\/option>\r\n                                    <option value=\"Mauritania\" >Mauritania<\/option>\r\n                                    <option value=\"Mauritius\" >Mauritius<\/option>\r\n                                    <option value=\"Mayotte\" >Mayotte<\/option>\r\n                                    <option value=\"Mexico\" >Mexico<\/option>\r\n                                    <option value=\"Micronesia, Federated States Of\" >Micronesia, Federated States Of<\/option>\r\n                                    <option value=\"Moldova, Republic Of\" >Moldova, Republic Of<\/option>\r\n                                    <option value=\"Monaco\" >Monaco<\/option>\r\n                                    <option value=\"Mongolia\" >Mongolia<\/option>\r\n                                    <option value=\"Montserrat\" >Montserrat<\/option>\r\n                                    <option value=\"Morocco\" >Morocco<\/option>\r\n                                    <option value=\"Mozambique\" >Mozambique<\/option>\r\n                                    <option value=\"Myanmar\" >Myanmar<\/option>\r\n                                    <option value=\"Namibia\" >Namibia<\/option>\r\n                                    <option value=\"Nauru\" >Nauru<\/option>\r\n                                    <option value=\"Nepal\" >Nepal<\/option>\r\n                                    <option value=\"Netherlands\" >Netherlands<\/option>\r\n                                    <option value=\"Netherlands Antilles\" >Netherlands Antilles<\/option>\r\n                                    <option value=\"New Caledonia\" >New Caledonia<\/option>\r\n                                    <option value=\"New Zealand\" >New Zealand<\/option>\r\n                                    <option value=\"Nicaragua\" >Nicaragua<\/option>\r\n                                    <option value=\"Niger\" >Niger<\/option>\r\n                                    <option value=\"Nigeria\" >Nigeria<\/option>\r\n                                    <option value=\"Niue\" >Niue<\/option>\r\n                                    <option value=\"Norfolk Island\" >Norfolk Island<\/option>\r\n                                    <option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option>\r\n                                    <option value=\"Norway\" >Norway<\/option>\r\n                                    <option value=\"Oman\" >Oman<\/option>\r\n                                    <option value=\"Pakistan\" >Pakistan<\/option>\r\n                                    <option value=\"Palau\" >Palau<\/option>\r\n                                    <option value=\"Panama\" >Panama<\/option>\r\n                                    <option value=\"Papua New Guinea\" >Papua New Guinea<\/option>\r\n                                    <option value=\"Paraguay\" >Paraguay<\/option>\r\n                                    <option value=\"Peru\" >Peru<\/option>\r\n                                    <option value=\"Philippines\" >Philippines<\/option>\r\n                                    <option value=\"Pitcairn\" >Pitcairn<\/option>\r\n                                    <option value=\"Poland\" >Poland<\/option>\r\n                                    <option value=\"Portugal\" >Portugal<\/option>\r\n                                    <option value=\"Puerto Rico\" >Puerto Rico<\/option>\r\n                                    <option value=\"Qatar\" >Qatar<\/option>\r\n                                    <option value=\"Reunion\" >Reunion<\/option>\r\n                                    <option value=\"Romania\" >Romania<\/option>\r\n                                    <option value=\"Russian Federation\" >Russian Federation<\/option>\r\n                                    <option value=\"Rwanda\" >Rwanda<\/option>\r\n                                    <option value=\"Saint Kitts And Nevis\" >Saint Kitts And Nevis<\/option>\r\n                                    <option value=\"Saint Lucia\" >Saint Lucia<\/option>\r\n                                    <option value=\"Saint Vincent And The Grenadines\" >Saint Vincent And The Grenadines<\/option>\r\n                                    <option value=\"Samoa\" >Samoa<\/option>\r\n                                    <option value=\"San Marino\" >San Marino<\/option>\r\n                                    <option value=\"Sao Tome And Principe\" >Sao Tome And Principe<\/option>\r\n                                    <option value=\"Saudi Arabia\" >Saudi Arabia<\/option>\r\n                                    <option value=\"Senegal\" >Senegal<\/option>\r\n                                    <option value=\"Seychelles\" >Seychelles<\/option>\r\n                                    <option value=\"Sierra Leone\" >Sierra Leone<\/option>\r\n                                    <option value=\"Singapore\" >Singapore<\/option>\r\n                                    <option value=\"Slovakia (Slovak Republic)\" >Slovakia (Slovak Republic)<\/option>\r\n                                    <option value=\"Slovenia\" >Slovenia<\/option>\r\n                                    <option value=\"Solomon Islands\" >Solomon Islands<\/option>\r\n                                    <option value=\"Somalia\" >Somalia<\/option>\r\n                                    <option value=\"South Africa\" >South Africa<\/option>\r\n                                    <option value=\"South Georgia, South Sandwich Islands\" >South Georgia, South Sandwich Islands<\/option>\r\n                                    <option value=\"Spain\" >Spain<\/option>\r\n                                    <option value=\"Sri Lanka\" >Sri Lanka<\/option>\r\n                                    <option value=\"St. Helena\" >St. Helena<\/option>\r\n                                    <option value=\"St. Pierre And Miquelon\" >St. Pierre And Miquelon<\/option>\r\n                                    <option value=\"Sudan\" >Sudan<\/option>\r\n                                    <option value=\"Suriname\" >Suriname<\/option>\r\n                                    <option value=\"Svalbard And Jan Mayen Islands\" >Svalbard And Jan Mayen Islands<\/option>\r\n                                    <option value=\"Swaziland\" >Swaziland<\/option>\r\n                                    <option value=\"Sweden\" >Sweden<\/option>\r\n                                    <option value=\"Switzerland\" >Switzerland<\/option>\r\n                                    <option value=\"Syrian Arab Republic\" >Syrian Arab Republic<\/option>\r\n                                    <option value=\"Taiwan\" >Taiwan<\/option>\r\n                                    <option value=\"Tajikistan\" >Tajikistan<\/option>\r\n                                    <option value=\"Tanzania, United Republic Of\" >Tanzania, United Republic Of<\/option>\r\n                                    <option value=\"Thailand\" >Thailand<\/option>\r\n                                    <option value=\"Togo\" >Togo<\/option>\r\n                                    <option value=\"Tokelau\" >Tokelau<\/option>\r\n                                    <option value=\"Tonga\" >Tonga<\/option>\r\n                                    <option value=\"Trinidad And Tobago\" >Trinidad And Tobago<\/option>\r\n                                    <option value=\"Tunisia\" >Tunisia<\/option>\r\n                                    <option value=\"Turkey\" >Turkey<\/option>\r\n                                    <option value=\"Turkmenistan\" >Turkmenistan<\/option>\r\n                                    <option value=\"Turks And Caicos Islands\" >Turks And Caicos Islands<\/option>\r\n                                    <option value=\"Tuvalu\" >Tuvalu<\/option>\r\n                                    <option value=\"Uganda\" >Uganda<\/option>\r\n                                    <option value=\"Ukraine\" >Ukraine<\/option>\r\n                                    <option value=\"United Arab Emirates\" >United Arab Emirates<\/option>\r\n                                    <option value=\"United Kingdom\" >United Kingdom<\/option>\r\n                                    <option value=\"United States\" >United States<\/option>\r\n                                    <option value=\"United States Minor Outlying Islands\" >United States Minor Outlying Islands<\/option>\r\n                                    <option value=\"Uruguay\" >Uruguay<\/option>\r\n                                    <option value=\"Uzbekistan\" >Uzbekistan<\/option>\r\n                                    <option value=\"Vanuatu\" >Vanuatu<\/option>\r\n                                    <option value=\"Venezuela\" >Venezuela<\/option>\r\n                                    <option value=\"Vietnam\" >Vietnam<\/option>\r\n                                    <option value=\"Virgin Islands (British)\" >Virgin Islands (British)<\/option>\r\n                                    <option value=\"Virgin Islands (U.S.)\" >Virgin Islands (U.S.)<\/option>\r\n                                    <option value=\"Wallis And Futuna Islands\" >Wallis And Futuna Islands<\/option>\r\n                                    <option value=\"Western Sahara\" >Western Sahara<\/option>\r\n                                    <option value=\"Yemen\" >Yemen<\/option>\r\n                                    <option value=\"Yugoslavia\" >Yugoslavia<\/option>\r\n                                    <option value=\"Zambia\" >Zambia<\/option>\r\n                                    <option value=\"Zimbabwe\" >Zimbabwe<\/option>\r\n                            <\/select>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n<\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-select iphorm_1_10-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-select iphorm_1_10-element-spacer\">\r\n                    <label for=\"iphorm_1_10_66336b4333d47\" >\r\n                State                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-select iphorm_1_10-input-wrap\" >\r\n            <select class=\"iphorm-element-select iphorm-tooltip iphorm-tooltip-hover iphorm_1_10\" name=\"iphorm_1_10\" id=\"iphorm_1_10_66336b4333d47\" title=\"Select State\" >\r\n                                    <option value=\"Andaman and Nicobar Islands\" >Andaman and Nicobar Islands<\/option>\r\n                                    <option value=\"Andra Pradesh\" >Andra Pradesh<\/option>\r\n                                    <option value=\"Arunachal Pradesh\" >Arunachal Pradesh<\/option>\r\n                                    <option value=\"Assam\" >Assam<\/option>\r\n                                    <option value=\"Bihar\" >Bihar<\/option>\r\n                                    <option value=\"Chandigarh\" >Chandigarh<\/option>\r\n                                    <option value=\"Chhattisgarh\" >Chhattisgarh<\/option>\r\n                                    <option value=\"Dadar and Nagar Haveli\" >Dadar and Nagar Haveli<\/option>\r\n                                    <option value=\"Daman and Diu\" >Daman and Diu<\/option>\r\n                                    <option value=\"Delhi\" >Delhi<\/option>\r\n                                    <option value=\"Goa\" >Goa<\/option>\r\n                                    <option value=\"Gujarat\" >Gujarat<\/option>\r\n                                    <option value=\"Haryana\" >Haryana<\/option>\r\n                                    <option value=\"Himachal Pradesh\" >Himachal Pradesh<\/option>\r\n                                    <option value=\"Jammu and Kashmir\" >Jammu and Kashmir<\/option>\r\n                                    <option value=\"Jharkhand\" >Jharkhand<\/option>\r\n                                    <option value=\"Karnataka\" >Karnataka<\/option>\r\n                                    <option value=\"Kerala\" >Kerala<\/option>\r\n                                    <option value=\"Lakshadeep\" >Lakshadeep<\/option>\r\n                                    <option value=\"Madya Pradesh\" >Madya Pradesh<\/option>\r\n                                    <option value=\"Maharashtra\" >Maharashtra<\/option>\r\n                                    <option value=\"Manipur\" >Manipur<\/option>\r\n                                    <option value=\"Meghalaya\" >Meghalaya<\/option>\r\n                                    <option value=\"Mizoram\" >Mizoram<\/option>\r\n                                    <option value=\"Nagaland\" >Nagaland<\/option>\r\n                                    <option value=\"Orissa\" >Orissa<\/option>\r\n                                    <option value=\"Pondicherry\" >Pondicherry<\/option>\r\n                                    <option value=\"Punjab\" >Punjab<\/option>\r\n                                    <option value=\"Rajasthan\" >Rajasthan<\/option>\r\n                                    <option value=\"Sikkim\" >Sikkim<\/option>\r\n                                    <option value=\"Tamil Nadu\" >Tamil Nadu<\/option>\r\n                                    <option value=\"Tripura\" >Tripura<\/option>\r\n                                    <option value=\"Uttar Pradesh\" >Uttar Pradesh<\/option>\r\n                                    <option value=\"Uttaranchal\" >Uttaranchal<\/option>\r\n                                    <option value=\"West Bengal\" >West Bengal<\/option>\r\n                                    <option value=\"\" ><\/option>\r\n                            <\/select>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n<\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_26-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_12-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_12-element-spacer\">\r\n                    <label for=\"iphorm_1_12_66336b4333d47\" >\r\n                Caste                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_12-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_12\" id=\"iphorm_1_12_66336b4333d47\" type=\"text\" name=\"iphorm_1_12\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_11-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_11-element-spacer\">\r\n                    <label for=\"iphorm_1_11_66336b4333d47\" >\r\n                Religion                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_11-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_11\" id=\"iphorm_1_11_66336b4333d47\" type=\"text\" name=\"iphorm_1_11\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_28-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-textarea iphorm_1_14-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-textarea iphorm_1_14-element-spacer\">\r\n                    <label for=\"iphorm_1_14_66336b4333d47\" >\r\n                Present Address                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-textarea iphorm_1_14-input-wrap\" >\r\n            <textarea class=\"iphorm-element-textarea  iphorm_1_14\" id=\"iphorm_1_14_66336b4333d47\" name=\"iphorm_1_14\"   rows=\"5\" cols=\"25\"><\/textarea>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-textarea iphorm_1_13-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-textarea iphorm_1_13-element-spacer\">\r\n                    <label for=\"iphorm_1_13_66336b4333d47\" >\r\n                Permanent Address                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-textarea iphorm_1_13-input-wrap\" >\r\n            <textarea class=\"iphorm-element-textarea  iphorm_1_13\" id=\"iphorm_1_13_66336b4333d47\" name=\"iphorm_1_13\"   rows=\"5\" cols=\"25\"><\/textarea>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_30-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_15-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_15-element-spacer\">\r\n                    <label for=\"iphorm_1_15_66336b4333d47\" >\r\n                Telephone No.                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_15-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_15\" id=\"iphorm_1_15_66336b4333d47\" type=\"text\" name=\"iphorm_1_15\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_16-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_16-element-spacer\">\r\n                    <label for=\"iphorm_1_16_66336b4333d47\" >\r\n                Mobile No.                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_16-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_16\" id=\"iphorm_1_16_66336b4333d47\" type=\"text\" name=\"iphorm_1_16\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_17-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_17-element-spacer\">\r\n                    <label for=\"iphorm_1_17_66336b4333d47\" >\r\n                Email address                                    <span class=\"iphorm-required\">(required)<\/span>\r\n                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_17-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_17\" id=\"iphorm_1_17_66336b4333d47\" type=\"text\" name=\"iphorm_1_17\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_32-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-3cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_19-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_19-element-spacer\">\r\n                    <label for=\"iphorm_1_19_66336b4333d47\" >\r\n                Annual Income                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_19-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_19\" id=\"iphorm_1_19_66336b4333d47\" type=\"text\" name=\"iphorm_1_19\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_18-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_18-element-spacer\">\r\n                    <label for=\"iphorm_1_18_66336b4333d47\" >\r\n                Father\/Mother Occupation                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_18-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_18\" id=\"iphorm_1_18_66336b4333d47\" type=\"text\" name=\"iphorm_1_18\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_34-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-5cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-html iphorm_1_37-element-wrap iphorm-clearfix\">\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-html iphorm_1_37-element-spacer\">\r\n        <h4>Secondary School<\/h4>    <\/div>\r\n<\/div>\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_36-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_36-element-spacer\">\r\n                    <label for=\"iphorm_1_36_66336b4333d47\" >\r\n                Institution\/University                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_36-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_36\" id=\"iphorm_1_36_66336b4333d47\" type=\"text\" name=\"iphorm_1_36\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_38-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_38-element-spacer\">\r\n                    <label for=\"iphorm_1_38_66336b4333d47\" >\r\n                Year of Passing                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_38-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_38\" id=\"iphorm_1_38_66336b4333d47\" type=\"text\" name=\"iphorm_1_38\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_39-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_39-element-spacer\">\r\n                    <label for=\"iphorm_1_39_66336b4333d47\" >\r\n                Percentage                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_39-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_39\" id=\"iphorm_1_39_66336b4333d47\" type=\"text\" name=\"iphorm_1_39\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_40-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_40-element-spacer\">\r\n                    <label for=\"iphorm_1_40_66336b4333d47\" >\r\n                Medium of language                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_40-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_40\" id=\"iphorm_1_40_66336b4333d47\" type=\"text\" name=\"iphorm_1_40\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_41-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-5cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-html iphorm_1_64-element-wrap iphorm-clearfix\">\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-html iphorm_1_64-element-spacer\">\r\n        <h4>Higher Education<h4>    <\/div>\r\n<\/div>\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_43-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_43-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_43-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_43\" id=\"iphorm_1_43_66336b4333d47\" type=\"text\" name=\"iphorm_1_43\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_44-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_44-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_44-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_44\" id=\"iphorm_1_44_66336b4333d47\" type=\"text\" name=\"iphorm_1_44\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_45-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_45-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_45-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_45\" id=\"iphorm_1_45_66336b4333d47\" type=\"text\" name=\"iphorm_1_45\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_46-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_46-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_46-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_46\" id=\"iphorm_1_46_66336b4333d47\" type=\"text\" name=\"iphorm_1_46\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_47-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-5cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-html iphorm_1_65-element-wrap iphorm-clearfix\">\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-html iphorm_1_65-element-spacer\">\r\n        <h4>Graduation (If Any)<h4>    <\/div>\r\n<\/div>\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_49-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_49-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_49-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_49\" id=\"iphorm_1_49_66336b4333d47\" type=\"text\" name=\"iphorm_1_49\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_50-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_50-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_50-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_50\" id=\"iphorm_1_50_66336b4333d47\" type=\"text\" name=\"iphorm_1_50\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_51-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_51-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_51-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_51\" id=\"iphorm_1_51_66336b4333d47\" type=\"text\" name=\"iphorm_1_51\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_52-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_52-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_52-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_52\" id=\"iphorm_1_52_66336b4333d47\" type=\"text\" name=\"iphorm_1_52\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_53-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-5cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-html iphorm_1_66-element-wrap iphorm-clearfix\">\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-html iphorm_1_66-element-spacer\">\r\n        <h4>Others (If Any)<\/h4>    <\/div>\r\n<\/div>\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_55-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_55-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_55-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_55\" id=\"iphorm_1_55_66336b4333d47\" type=\"text\" name=\"iphorm_1_55\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_56-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_56-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_56-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_56\" id=\"iphorm_1_56_66336b4333d47\" type=\"text\" name=\"iphorm_1_56\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_57-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_57-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_57-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_57\" id=\"iphorm_1_57_66336b4333d47\" type=\"text\" name=\"iphorm_1_57\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><div class=\"iphorm-element-wrap iphorm-element-wrap-text iphorm_1_58-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-text iphorm_1_58-element-spacer\">\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-text iphorm_1_58-input-wrap\" >\r\n            <input class=\"iphorm-element-text  iphorm_1_58\" id=\"iphorm_1_58_66336b4333d47\" type=\"text\" name=\"iphorm_1_58\"  value=\"\"  \/>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div><\/div><\/div><\/div><div class=\"iphorm-group-wrap iphorm_1_59-group-wrap iphorm-clearfix iphorm-labels-above iphorm-group-style-plain iphorm-group-alignment-proportional\" >\r\n    <div class=\"iphorm-group-elements\" >\r\n                <div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\"><div class=\"iphorm-element-wrap iphorm-element-wrap-textarea iphorm_1_61-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-textarea iphorm_1_61-element-spacer\">\r\n                    <label for=\"iphorm_1_61_66336b4333d47\" >\r\n                Other Extra-Curricular Activities                                            <\/label>\r\n                <div class=\"iphorm-input-wrap iphorm-input-wrap-textarea iphorm_1_61-input-wrap\" >\r\n            <textarea class=\"iphorm-element-textarea  iphorm_1_61\" id=\"iphorm_1_61_66336b4333d47\" name=\"iphorm_1_61\"   rows=\"5\" cols=\"25\"><\/textarea>\r\n                    <\/div>\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>    <\/div>\r\n    <\/div>\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-captcha iphorm_1_62-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-required\" >\r\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-captcha iphorm_1_62-element-spacer\">\r\r\n        \r\n            <label for=\"iphorm_1_62_66336b4333d47\" >\r\r\n                Type the characters\r\n                \r\n                    <span class=\"iphorm-required\">(required)<\/span>\r\r\n                \r\n                \r\n            <\/label>\r\r\n        \r\n        <div class=\"iphorm-input-wrap iphorm-input-wrap-captcha iphorm_1_62-input-wrap\" >\r\r\n            <input class=\"iphorm-element-captcha  iphorm_1_62\" id=\"iphorm_1_62_66336b4333d47\" type=\"text\" name=\"iphorm_1_62\"  value=\"\"  \/>\r\r\n            \r\n        <\/div>\r\r\n        <div class=\"iphorm-captcha-image-wrap iphorm-clearfix iphorm_1_62-captcha-image-wrap\" >\r\r\n            <div class=\"ifb-captcha-image-inner\">\r\r\n                <img decoding=\"async\" id=\"iphorm-captcha-image-iphorm_1_62_66336b4333d47\" class=\"iphorm-captcha-image\" src=\"https:\/\/bcn-bhilai.com\/wp-content\/plugins\/iphorm-form-builder\/includes\/captcha.php?c=eyJ1bmlxSWQiOiI2NjMzNmI0MzMzZDQ3IiwidG1wRGlyIjoiXC90bXBcLyIsIm9wdGlvbnMiOnsibGVuZ3RoIjoiMyIsIndpZHRoIjoiMTE1IiwiaGVpZ2h0IjoiNDAiLCJiZ0NvbG91ciI6IiNGRkZGRkYiLCJ0ZXh0Q29sb3VyIjoiIzIyMjIyMiIsImZvbnQiOiJUeXBpc3QudHRmIiwibWluRm9udFNpemUiOiIxMiIsIm1heEZvbnRTaXplIjoiMTkiLCJtaW5BbmdsZSI6IjAiLCJtYXhBbmdsZSI6IjIwIn19&amp;t=1714645827.2284\" alt=\"\" \/>\r\r\n            <\/div>\r\r\n        <\/div>\r\r\n\r\r\n        <script type=\"text\/javascript\">\r\r\n        jQuery(document).ready(function ($) {\r\r\n            $('#iphorm-captcha-image-iphorm_1_62_66336b4333d47').hover(function () {\r\r\n                $(this).stop().fadeTo('slow', '0.3');\r\r\n            }, function () {\r\r\n                $(this).stop().fadeTo('slow', '1.0');\r\r\n            }).click(function () {\r\r\n                var newSrc = $(this).attr('src').replace(\/&t=.+\/, '&t=' + new Date().getTime());\r\r\n                $(this).attr('src', newSrc);\r\r\n            });\r\r\n        });\r\r\n        <\/script>\r\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>\r\n    <\/div>\r\r\n<\/div><\/div><div class=\"iphorm-group-row iphorm-clearfix iphorm-group-row-2cols\">\r\n<div class=\"iphorm-element-wrap iphorm-element-wrap-file iphorm_1_63-element-wrap iphorm-clearfix iphorm-labels-above iphorm-element-optional\" >\r\r\n    <div class=\"iphorm-element-spacer iphorm-element-spacer-file iphorm_1_63-element-spacer\">\r\r\n        \r\n            <label >\r\r\n                File upload \r\n                \r\n                \r\n            <\/label>\r\r\n        \r\n        <div class=\"iphorm-input-outer-wrap iphorm_1_63-input-outer-wrap\" >\r\r\n            \r\n                    \r\n                        <div class=\"iphorm-input-wrap iphorm-input-wrap-file iphorm-clearfix iphorm_1_63-input-wrap\" >\r\r\n                            <span class=\"iphorm-element-file-inner\"><input class=\"iphorm-element-file  iphorm_1_63\" type=\"file\" name=\"iphorm_1_63[]\"  tabindex=\"-1\" \/><\/span>\r\r\n                        <\/div>\r\r\n                    \r\n                    \r\n                        \r\n                        <div class=\"iphorm-hidden iphorm-add-another-upload iphorm_1_63-add-another-upload iphorm-clearfix\">\r\r\n                            <span class=\"iphorm-add-another-upload-button\">Upload another<\/span>\r\r\n                        <\/div>\r\r\n                        <script type=\"text\/javascript\">\r\r\n                        jQuery(document).ready(function ($) {\r\r\n                            $('.iphorm_1_63-add-another-upload', iPhorm.instance.$form).show().find('span').click(function (e) {\r\r\n                                var $newFileElement = $('<div class=\"iphorm-input-wrap iphorm-input-wrap-file iphorm-clearfix iphorm_1_63-input-wrap\"><span class=\"iphorm-element-file-inner\"><input class=\"iphorm-element-file  iphorm_1_63\" type=\"file\" name=\"iphorm_1_63[]\"  tabindex=\"-1\" \/><\/span><\/div>');\r\r\n                                $('.iphorm_1_63-input-outer-wrap .iphorm-input-wrap:last').after($newFileElement);\r\r\n                                $newFileElement.addClass('iphorm-add-another-file-wrap').show();\r\r\n\r\r\n                                \r\n                                if ($.isFunction($.fn.uniform)) {\r\r\n                                    $newFileElement.find('input:file').uniform({\r\r\n                                        fileDefaultHtml: 'No file selected',\r\r\n                                        fileButtonHtml: 'Browse...'\r\r\n                                    });\r\r\n                                }\r\r\n                                \r\n                            });\r\r\n                        });\r\r\n                        <\/script>\r\r\n                \r\n            \r\n            \r\n                <script type=\"text\/javascript\">\r\r\n                jQuery(document).ready(function ($) {\r\r\n                    if ($.isFunction($.fn.uniform)) {\r\r\n                        $('.iphorm_1_63-element-wrap input:file', iPhorm.instance.$form).uniform({\r\r\n                        \tfileDefaultHtml: 'No file selected',\r\r\n                        \tfileButtonHtml: 'Browse...'\r\r\n                        });\r\r\n                    }\r\r\n                });\r\r\n                <\/script>\r\r\n            \r\n            <script type=\"text\/javascript\">\r\r\n            jQuery(document).ready(function ($) {\r\r\n              \t$('.iphorm_1_63-input-wrap', iPhorm.instance.$form).show();\r\r\n            });\r\r\n            <\/script>\r\r\n            \r\n                <div id=\"iphorm_1_63_66336b4333d47-swfupload\" class=\"iphorm-swfupload\">\r\r\n                \t<div class=\"iphorm-clearfix\">\r\r\n                        <div id=\"iphorm_1_63_66336b4333d47-file-queue\" class=\"iphorm-file-queue iphorm-clearfix\"><\/div>\r\r\n                        <div id=\"iphorm_1_63_66336b4333d47-file-queue-errors\" class=\"iphorm-queue-errors iphorm-hidden\"><\/div>\r\r\n                        <div class=\"iphorm-swfupload-browse-wrap iphorm-clearfix\">\r\r\n                            <div class=\"iphorm-swfupload-browse\" id=\"iphorm_1_63_66336b4333d47-browse\">Browse...\r\n                                <div class=\"iphorm-swfupload-object\" id=\"iphorm_1_63_66336b4333d47-object\"><\/div>\r\r\n                            <\/div>\r\r\n                        <\/div>\r\r\n                    <\/div>\r\r\n                <\/div>\r\r\n                <script type=\"text\/javascript\">\r\r\n                jQuery(document).ready(function ($) {\r\r\n                    iPhorm.instance.addUploader({\r\r\n                        id: 63,\r\r\n                        name: 'iphorm_1_63',\r\r\n                        uniqueId: 'iphorm_1_63_66336b4333d47',\r\r\n                        fileTypes: '*.jpg; *.jpeg; *.png; *.gif; *.pdf; *.docx; *.doc',\r\r\n                        fileTypesDescription: 'Allowed Files',\r\r\n                        fileSizeLimit : \"10485760B\",\r\r\n                        fileUploadLimit : 0\r\n                    });\r\r\n                });\r\r\n                <\/script>\r\r\n            \r\n                <p class=\"iphorm-description\" >Please upload 10th mark sheet, 12th  Mark sheet, others and a recent passport size photograph, Multiple file can be uploaded, Maximum size 10MB<\/p>\r\n\r\n        <\/div>\r\r\n        \r\n<div class=\"iphorm-errors-wrap iphorm-hidden\" >\r\r\n    \r\n<\/div>\r\n    <\/div>\r\r\n<\/div><\/div><\/div><\/div><div class=\"iphorm-hidden\">\r\n    <label>This field should be left blank<input type=\"text\" name=\"iphorm_1_0\" \/><\/label>\r\n<\/div>                <div class=\"iphorm-submit-wrap iphorm-submit-wrap-1 iphorm-clearfix\" >\r\n                    <div class=\"iphorm-submit-input-wrap iphorm-submit-input-wrap-1\" >\r\n                        <button class=\"iphorm-submit-element\" type=\"submit\" name=\"iphorm_submit\" ><span ><em >Submit<\/em><\/span><\/button>\r\n                    <\/div>\r\n                    <div class=\"iphorm-loading-wrap\"><span class=\"iphorm-loading\">Please wait...<\/span><\/div>\r\n                <\/div>\r\n            <\/div>\r\n                            <div>\r\n                   \r\n                <\/div>\r\n                                        <div class=\"iphom-upload-progress-wrap\">\r\n                    <div class=\"iphorm-upload-progress-bar-wrap\">\r\n                        <div class=\"iphorm-upload-progress-bar\"><\/div>\r\n                    <\/div>\r\n                    <div class=\"iphorm-upload-info iphorm-clearfix\">\r\n                        <div class=\"iphorm-upload-filename\"><\/div>\r\n                        <div class=\"iphorm-upload-error\"><\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                                <\/div>\r\n            <\/form>\r\n    <script type=\"text\/javascript\">\r\n    <!--\r\n    jQuery('#iphorm-outer-66336b4333d47 script').remove();\r\n    \/\/-->\r\n    <\/script>\r\n<\/div><\/p>\n<\/div><\/section><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":18,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>APPLY ONLINE - Bethany College of Nursing, Durg, Chhattisgarh, India<\/title>\n<meta name=\"description\" content=\"At Bethany College, we understand how important it is for you to earn a quality, affordable education in a welcoming academic environment.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bcn-bhilai.com\/apply-online\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"APPLY ONLINE - Bethany College of Nursing, Durg, Chhattisgarh, India\" \/>\n<meta property=\"og:description\" content=\"At Bethany College, we understand how important it is for you to earn a quality, affordable education in a welcoming academic environment.\" \/>\n<meta property=\"og:url\" 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