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internationalpatients.html
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<!DOCTYPE html>
<html>
<head>
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta name="author" content="phoenixhospital.com">
<link rel="icon" href="images/icon3.png" type="image/x-icon">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap-theme.min.css">
<link rel="stylesheet" href="css/internationalpatients.css">
<title>International-Patient-Services</title>
</head>
<body style="background-image: url(images/im.jpg);background-repeat: no-repeat;background-size: 100%;text-decoration: none;">
<div style="background-color: #DF691A; padding-bottom: 10px;padding-top: 10px;text-align: center;color: white;">
<header>
<a href="index.html" style="font-size: 30px;">Phoenix Hospital</a>
<a href="index.html" style="font-size: 15px;"><img src="images/logo6.jpg" width="20px" height="20px">Home</a>
<a href="register.html" target="_blank" style="font-size: 15px;">Register</a>
<a href="gallery.html" target="_blank" style="font-size: 15px;">Gallery</a>
<a href="appointment.html" target="_blank" style="font-size: 15px;">Book Appointment</a>
</header>
</div><br><br><br><br><br>
<h2 align="center">Phoenix International Hospitals</h2>
<h4 class="align-center" align="center">Talk to our International Representative</h4>
<h2 align='center'> Languages</h2>
<div class="content" align="center">
<form class="lang_dropdown_form language" id="lang_dropdown_form_language" action="/international-patient-services/" method="post" accept-charset="UTF-8">
<div>
<div class="form-item form-type-select form-item-lang-dropdown-select">
<select class="lang-dropdown-select-element form-select" id="lang-dropdown-select-language" style="width:293px" name="lang_dropdown_select"><option value="en" selected="selected">English</option><option value="fr">Français</option><option value="id">Bahasa Indonesia</option><option value="sw">Kiswahili</option><option value="ar">العربية</option></select>
</div>
<input type="hidden" name="en" value="/international-patient-services/" />
<input type="hidden" name="fr" value="/international-patient-services/fr%20-%20French" />
<input type="hidden" name="id" value="/international-patient-services/id" />
<input type="hidden" name="sw" value="/international-patient-services/sw" />
<input type="hidden" name="ar" value="/international-patient-services/ar" />
<noscript><div>
<input type="submit" id="edit-submit--2" name="op" value="Go" class="form-submit" />
</div></noscript><input type="hidden" name="form_build_id" value="form-wkQl765vAf958Gz_cvT6Ef-i2BFrTfsqTu6jHlrAJsI" />
<input type="hidden" name="form_id" value="lang_dropdown_form" />
</div>
</form>
</div>
</div>
<div id="block-international-representative-international-representative" class="block block-international-representative">
<h2 align="center">Talk to Our International Representative form</h2><br>
<form>
<table border="0" bgcolor="" align="center" cellspacing="10px">
<tbody>
<tr>
<td>First Name :</td>
<td><input type="text" placeholder="First Name" required=""></td>
</tr>
<tr>
<td>Last Name :</td>
<td><input type="text" placeholder="Last Name" required=""></td>
</tr>
<tr>
<td>Email Address :</td>
<td><input type="text" placeholder="Email Address" required=""></td>
</tr>
<tr>
<td>Phone Number :</td>
<td><input type="number" placeholder="phone number" required=""></td>
</tr>
<tr>
<td>Health Concern :</td>
<td><label for="Health concern" placeholder="Health concern"></label>
<select name="requirement" id="requirement" data-live-search="true" class="selectpicker"><option value="Health concern">Health concern*</option><option value="Accident And Emergency Medicine">Accident And Emergency Medicine</option>
</option><option value="Acupressure">Acupressure</option><option value="Ahc">Ahc</option><option value="Allergy">Allergy</option><option value="Anaesthesiology">Anaesthesiology</option><option value="Anesthesia">Anesthesia</option><option value="Anesthesia And Critical Care">Anesthesia And Critical Care</option><option value="Anesthesiology">Anesthesiology</option><option value="Arthroscopy & Sports Related Injuries">Arthroscopy & Sports Related Injuries</option><option value="Audiology">Audiology</option><option value="Bariatric (obesity) And Metabolic Surgery">Bariatric (obesity) And Metabolic Surgery</option><option value="Bariatric-minimal Access Obesity Surgery">Bariatric-minimal Access Obesity Surgery</option><option value="Biochemistry">Biochemistry</option><option value="Breast Surgery">Breast Surgery</option><option value="Cancer Surgeon">Cancer Surgeon</option><option value="Cardiac Electrophysiology">Cardiac Electrophysiology</option><option value="Cardio Thoracic And Vascular Surgery">Cardio Thoracic And Vascular Surgery</option><option value="Cardio Thoracic Surgery">Cardio Thoracic Surgery</option><option value="Cardiology">Cardiology</option><option value="Cardiothoracic And Vascular Surgery">Cardiothoracic And Vascular Surgery</option><option value="Chest Physician">Chest Physician</option><option value="Child Development And Behavioral Health">Child Development And Behavioral Health</option><option value="Clinical Biochemistry">Clinical Biochemistry</option><option value="Clinical Neuropsychology">Clinical Neuropsychology</option><option value="Clinical Psychologist">Clinical Psychologist</option><option value="Colorectal Surgeon">Colorectal Surgeon</option><option value="Colorectal Surgery">Colorectal Surgery</option><option value="Cosmetic Dentistry">Cosmetic Dentistry</option><option value="Cosmetic Surgery">Cosmetic Surgery</option><option value="Critical Care">Critical Care</option><option value="Critical Care Medicine, Sleep Medicine">Critical Care Medicine, Sleep Medicine</option><option value="Ct - Anesthesia">Ct - Anesthesia</option><option value="Dental">Dental</option><option value="Dental Implants & Cosmetic Dentistry">Dental Implants & Cosmetic Dentistry</option><option value="Dentistry & Endodontics">Dentistry & Endodontics</option><option value="Dermatology">Dermatology</option><option value="Dermatology Venereology And Leprology">Dermatology Venereology And Leprology</option><option value="Diabetes & Lifestyle Disease">Diabetes & Lifestyle Disease</option><option value="Diabetology">Diabetology</option><option value="Diabetology & Internal Medicine">Diabetology & Internal Medicine</option><option value="Diet & Nutrition">Diet & Nutrition</option><option value="Emergency Department">Emergency Department</option><option value="Emergency Medicine">Emergency Medicine</option><option value="Endocrinology">Endocrinology</option><option value="Endocrinology And Diabetology">Endocrinology And Diabetology</option><option value="Endodontics">Endodontics</option><option value="Ent">Ent</option><option value="Facial Plastic Surgery">Facial Plastic Surgery</option><option value="Faciomaxillary Surgery & Dentistry">Faciomaxillary Surgery & Dentistry</option><option value="Family Medicine">Family Medicine</option><option value="Family Physician">Family Physician</option><option value="Fetal Medicine">Fetal Medicine</option><option value="Gastro & Obesity Surgeon">Gastro & Obesity Surgeon</option><option value="Gastro Surgery">Gastro Surgery</option><option value="Gastroenterology">Gastroenterology</option><option value="General & Lap Surgery">General & Lap Surgery</option><option value="General Medicine">General Medicine</option><option value="General Medicine & Geriatics">General Medicine & Geriatics</option><option value="General Surgery">General Surgery</option><option value="General Surgery & Gasteroenterology">General Surgery & Gasteroenterology</option><option value="General Surgery & Laproscopic Surgery">General Surgery & Laproscopic Surgery</option><option value="Geriatrics">Geriatrics</option><option value="Gynaecology">Gynaecology</option><option value="Gynaecology & Ultrasonology">Gynaecology & Ultrasonology</option><option value="Haemato Oncology & Bonemarrow Transplant">Haemato Oncology & Bonemarrow Transplant</option><option value="Haemato-pathology">Haemato-pathology</option><option value="Haematology">Haematology</option><option value="Haematooncology">Haematooncology</option><option value="Head & Neck Surgeon">Head & Neck Surgeon</option><option value="Head & Neck Surgical Oncology">Head & Neck Surgical Oncology</option><option value="Hematology And Transfusion Medicine">Hematology And Transfusion Medicine</option><option value="Hepato Pancreatic Biliary Surgery">Hepato Pancreatic Biliary Surgery</option><option value="Hepato Pancreato Biliary Surgery">Hepato Pancreato Biliary Surgery</option><option value="Hepato-biliary">Hepato-biliary</option><option value="Hepatology">Hepatology</option><option value="Histopathology">Histopathology</option><option value="Homeopathy">Homeopathy</option><option value="Infectious Disease">Infectious Disease</option><option value="Infertility Specialist">Infertility Specialist</option><option value="Infertility,laproscopy And Gynecologist">Infertility,laproscopy And Gynecologist</option><option value="Intensive Care Unit">Intensive Care Unit</option><option value="Intensivist">Intensivist</option><option value="Internal Medicine">Internal Medicine</option><option value="Internal Medicine & Diabetics">Internal Medicine & Diabetics</option><option value="Interventional Cardiologist">Interventional Cardiologist</option><option value="Interventional Radiologist">Interventional Radiologist</option><option value="Laboratory Services">Laboratory Services</option><option value="Laproscopic And Robotic Surgery">Laproscopic And Robotic Surgery</option><option value="Laproscopy Surgery">Laproscopy Surgery</option><option value="Laproscopy Surgery">Laproscopy Surgery</option><option value="Laproscopy Surgery And General Surgery">Laproscopy Surgery And General Surgery</option><option value="Liver And Pancreatic Disorder">Liver And Pancreatic Disorder</option><option value="Liver Transplant">Liver Transplant</option><option value="M D Biochemistry">M D Biochemistry</option><option value="M D Microbiology">M D Microbiology</option><option value="M D Pathology">M D Pathology</option><option value="M D Pulmonary Medicine">M D Pulmonary Medicine</option><option value="M S General Surgery">M S General Surgery</option><option value="Maxillo Facial Surgeon">Maxillo Facial Surgeon</option><option value="Medical Gastroenterology">Medical Gastroenterology</option><option value="Medical Ge">Medical Ge</option><option value="Medical Oncology">Medical Oncology</option><option value="Metabolic Diseases">Metabolic Diseases</option><option value="Microbilogy">Microbilogy</option><option value="Microbiology">Microbiology</option><option value="Molecular Medicine">Molecular Medicine</option><option value="Neonatology">Neonatology</option><option value="Nephrology">Nephrology</option><option value="Neuro Surgery">Neuro Surgery</option><option value="Neurology">Neurology</option><option value="Neurology & Neuro Surgery">Neurology & Neuro Surgery</option><option value="Neuropsychiatry">Neuropsychiatry</option><option value="Neurosurgery">Neurosurgery</option><option value="Nuclear Medicine">Nuclear Medicine</option><option value="Nuclear Medicine And Pet Ct">Nuclear Medicine And Pet Ct</option><option value="Nutrition And Dietetics">Nutrition And Dietetics</option><option value="Nutrition And Weight Management">Nutrition And Weight Management</option><option value="Obesity Physician">Obesity Physician</option><option value="Obstetrics & Gynecology">Obstetrics & Gynecology</option><option value="Obstetrics And Gynaecology-infertility Managemen">Obstetrics And Gynaecology-infertility Managemen</option><option value="Obstetrics And Gynaecology-laparoscopic & Hyster">Obstetrics And Gynaecology-laparoscopic & Hyster</option><option value="Obstetrics And Gynaecology-robotic Surgery">Obstetrics And Gynaecology-robotic Surgery</option><option value="Occupational Therapy">Occupational Therapy</option><option value="Oncology">Oncology</option><option value="Opthalmology">Opthalmology</option><option value="Oral & Maxilofacial Surgery">Oral & Maxilofacial Surgery</option><option value="Orthodontics">Orthodontics</option><option value="Orthopaedic Surgeon">Orthopaedic Surgeon</option><option value="Orthopaedics">Orthopaedics</option><option value="Orthopaedics & Sports Medicine">Orthopaedics & Sports Medicine</option><option value="Orthopaedics & Traumatology">Orthopaedics & Traumatology</option><option value="Orthopaedics And Spine Surgery">Orthopaedics And Spine Surgery</option><option value="Orthopaedics And Upper Limb Surgery">Orthopaedics And Upper Limb Surgery</option><option value="Paediatric Allergy">Paediatric Allergy</option><option value="Paediatric And Congenital Cardiac Surgery">Paediatric And Congenital Cardiac Surgery</option><option value="Paediatric Cardio Thoracic Surgery">Paediatric Cardio Thoracic Surgery</option><option value="Paediatric Cardiology">Paediatric Cardiology</option><option value="Paediatric Cardiology">Paediatric Cardiology</option><option value="Paediatric Endocrinologist">Paediatric Endocrinologist</option><option value="Paediatric Endocrinology">Paediatric Endocrinology</option><option value="Paediatric Gastroenterology">Paediatric Gastroenterology</option><option value="Paediatric Haemato-oncology">Paediatric Haemato-oncology</option><option value="Paediatric Neonatology">Paediatric Neonatology</option><option value="Paediatric Nephrology">Paediatric Nephrology</option><option value="Paediatric Nephrology">Paediatric Nephrology</option><option value="Paediatric Neurology">Paediatric Neurology</option><option value="Paediatric Neurology">Paediatric Neurology</option><option value="Paediatric Opthalmology And Squint">Paediatric Opthalmology And Squint</option><option value="Paediatric Orthopaedics">Paediatric Orthopaedics</option><option value="Paediatric Pulmonology">Paediatric Pulmonology</option><option value="Paediatric Rheumatology">Paediatric Rheumatology</option><option value="Paediatric Surgery">Paediatric Surgery</option><option value="Paediatric Surgery">Paediatric Surgery</option><option value="Paediatric Urology & Surgery">Paediatric Urology & Surgery</option><option value="Paediatrics">Paediatrics</option><option value="Pain Management">Pain Management</option><option value="Pathology">Pathology</option><option value="Peadodontics ( Child Dentistry )">Peadodontics ( Child Dentistry )</option><option value="Pediatric Cardiac Surgery">Pediatric Cardiac Surgery</option><option value="Periodontia">Periodontia</option><option value="Periodontist And Implantologist">Periodontist And Implantologist</option><option value="Peripheral Vascular Surgery">Peripheral Vascular Surgery</option><option value="Physical Medicine & Rehabilitation">Physical Medicine & Rehabilitation</option><option value="Physician">Physician</option><option value="Physician & Diabetologist">Physician & Diabetologist</option><option value="Physiotherapy">Physiotherapy</option><option value="Physiotherapy & Rehabilitation">Physiotherapy & Rehabilitation</option><option value="Plastic And Cosmetic Surgery">Plastic And Cosmetic Surgery</option><option value="Plastic Surgery">Plastic Surgery</option><option value="Podiatry">Podiatry</option><option value="Proctology">Proctology</option><option value="Prosthodontics & Implants">Prosthodontics & Implants</option><option value="Psychiatry">Psychiatry</option><option value="Psychology">Psychology</option><option value="Pulmonology">Pulmonology</option><option value="Radiation Oncology">Radiation Oncology</option><option value="Radiodiagnosis">Radiodiagnosis</option><option value="Radiology">Radiology</option><option value="Radiology & Pet-ct">Radiology & Pet-ct</option><option value="Renal Transplant Surgeon">Renal Transplant Surgeon</option><option value="Resident Physicians">Resident Physicians</option><option value="Respiratory Allergy And Sleep Medicine">Respiratory Allergy And Sleep Medicine</option><option value="Respiratory Medicine">Respiratory Medicine</option><option value="Rheumatology">Rheumatology</option><option value="Robotic Surgery">Robotic Surgery</option><option value="Sexual Medicine">Sexual Medicine</option><option value="Sleep Medicine">Sleep Medicine</option><option value="Special Physiotherapy">Special Physiotherapy</option><option value="Speech Language And Hearing Science">Speech Language And Hearing Science</option><option value="Spine Surgery">Spine Surgery</option><option value="Sports Medicine">Sports Medicine</option><option value="Surgical">Surgical</option><option value="Surgical Gastroenterology">Surgical Gastroenterology</option><option value="Surgical Oncology">Surgical Oncology</option><option value="Thyroid, Diabetes & Hormone Disorder">Thyroid, Diabetes & Hormone Disorder</option><option value="Transfusion Medicine">Transfusion Medicine</option><option value="Transplant Surgery & Surgical Gastro">Transplant Surgery & Surgical Gastro</option><option value="Trauma Surgery">Trauma Surgery</option><option value="Uro Oncology">Uro Oncology</option><option value="Urogynaecology">Urogynaecology</option><option value="Urology">Urology</option><option value="Vascular &endovascular Surgery">Vascular &endovascular Surgery</option><option value="Vascular Surgery">Vascular Surgery</option><option value="Yoga Therapist">Yoga Therapist</option>
</td>
</tr>
<tr>
<td>Gender :</td>
<td>
<input type="radio" name="r1" required="">Male
<input type="radio" name="r1" required="">Female
</td>
</tr>
<tr>
<td>
I am enquiring from* :
</td>
<td>
<select name="country" id="country" data-live-search="true" class="selectpicker">
<option value="">I am enquiring from *</option>
<option value="Afganistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua & Barbuda">Antigua & Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire">Bonaire</option>
<option value="Bosnia & Herzegovina">Bosnia & Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Ter">British Indian Ocean Ter</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Canary Islands">Canary Islands</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Channel Islands">Channel Islands</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos Island">Cocos Island</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote DIvoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaco">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor">East Timor</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Ter">French Southern Ter</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Great Britain">Great Britain</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Hawaii">Hawaii</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea North">Korea North</option>
<option value="Korea Sout">Korea South</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malaysia">Malaysia</option>
<option value="Malawi">Malawi</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Midway Islands">Midway Islands</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Nambia">Nambia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherland Antilles">Netherland Antilles</option>
<option value="Netherlands">Netherlands (Holland, Europe)</option>
<option value="Nevis">Nevis</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau Island">Palau Island</option>
<option value="Palestine">Palestine</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Phillipines">Philippines</option>
<option value="Pitcairn Island">Pitcairn Island</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Montenegro">Republic of Montenegro</option>
<option value="Republic of Serbia">Republic of Serbia</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="St Barthelemy">St Barthelemy</option>
<option value="St Eustatius">St Eustatius</option>
<option value="St Helena">St Helena</option>
<option value="St Kitts-Nevis">St Kitts-Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="St Maarten">St Maarten</option>
<option value="St Pierre & Miquelon">St Pierre & Miquelon</option>
<option value="St Vincent & Grenadines">St Vincent & Grenadines</option>
<option value="Saipan">Saipan</option>
<option value="Samoa">Samoa</option>
<option value="Samoa American">Samoa American</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome & Principe">Sao Tome & Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Tahiti">Tahiti</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad & Tobago">Trinidad & Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks & Caicos Is">Turks & Caicos Is</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Erimates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States of America">United States of America</option>
<option value="Uraguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City State">Vatican City State</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands (Brit)">Virgin Islands (Brit)</option>
<option value="Virgin Islands (USA)">Virgin Islands (USA)</option>
<option value="Wake Island">Wake Island</option>
<option value="Wallis & Futana Is">Wallis & Futana Is</option>
<option value="Yemen">Yemen</option>
<option value="Zaire">Zaire</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</td>
</tr>
<tr>
<td>
Preferred location :
</td>
<td>
<select name="preferred_location" id="preferred_location" data-live-search="true" class="selectpicker">
<option value="">Preferred location *</option>
<option value="Ahmedabad">Ahmedabad</option>
<option value="Bengaluru">Bengaluru</option>
<option value="Chennai">Chennai</option>
<option value="Delhi">Delhi</option>
<option value="Mumbai">Mumbai</option>
<option value="Hyderabad">Hyderabad</option>
<option value="Kolkata">Kolkata</option>
</select>
</td>
</tr>
<tr>
<td colspan="2" align="center"><input type="submit" id="button"></td>
</tr>
</tbody>
</table>
</form><br>
<footer>
<div class="w-80">
<div class="footer-box">
<h2>Services</h2>
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</div>
<div class="footer-box">
<h2>Aboutr us</h2>
<a href="#">COMPANY OVERVIEW</a>
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<div class="footer-box">
<h2>Contact us</h2>
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</div>
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</div>
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</html>