{"id":660,"date":"2022-11-05T00:12:05","date_gmt":"2022-11-05T00:12:05","guid":{"rendered":"https:\/\/canadamama.ca\/?page_id=660"},"modified":"2023-03-28T23:31:32","modified_gmt":"2023-03-28T23:31:32","slug":"lead","status":"publish","type":"page","link":"https:\/\/canadamama.ca\/en\/lead\/","title":{"rendered":"New customer"},"content":{"rendered":"<div class=\"wp-block-columns lead-form-container is-layout-flex wp-container-core-columns-layout-1 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Dear customers, for a more detailed consideration of your question - please fill out this form. Personal information provided by Users is confidential and will not be disclosed.<\/p>\n\n\n\n<details class=\"wp-block-mamaduka-toggles wp-block-toggles\"><summary>What is this form for?<\/summary><div class=\"wp-block-toggles__content\">\n<p>We consult with you by all available methods: WhatsApp, Google Meet, Zoom or a direct phone call. However, to accompany the client and during the initial familiarization phase, we retain the ability to keep you in the loop.<\/p>\n<\/div><\/details>\n\n\n\n<details class=\"wp-block-mamaduka-toggles wp-block-toggles\"><summary>Why is it important to fill out the data in its entirety?<\/summary><div class=\"wp-block-toggles__content\">\n<p>We can tell you about your chances of getting a visa to Canada almost immediately, before negotiations begin. And also, prepare the necessary information about what can be improved or what other options are possible.<\/p>\n<\/div><\/details>\n\n\n\n<details class=\"wp-block-mamaduka-toggles wp-block-toggles\"><summary>Can I delete the data after the consultation?<\/summary><div class=\"wp-block-toggles__content\">\n<p>Yes. We can delete your personal information upon request.<\/p>\n<\/div><\/details>\n\n\n\n<details class=\"wp-block-mamaduka-toggles wp-block-toggles\"><summary>Customer portal<\/summary><div class=\"wp-block-toggles__content\">\n<p>We have prepared a convenient functionality for our customers. By filling in your information, you will get access to your personal profile. There you will find a section with frequently asked questions, videos, a customer memo when traveling to Canada, contracts, invoices, appointment calendars, and other opportunities to interact with us. This approach enables us to provide a high level of service and resolve all issues in a timely manner, even if your trip is scheduled in half a year.<\/p>\n<\/div><\/details>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"padding-bottom:var(--wp--preset--spacing--80)\">\n<div class=\"lead-form\">\n\t<form role=\"form\" id=\"lead-form\" accept-charset=\"utf-8\" action=\"https:\/\/crm.canadamama.ca\/index.php\/collect_leads\/save\" method=\"post\" data-trp-original-action=\"https:\/\/crm.canadamama.ca\/index.php\/collect_leads\/save\">\n\t\t<input id=\"company_name\" name=\"company_name\" required=\"required\" type=\"text\" placeholder=\"Last name\">\n\t\t<div class=\"required-info\">\n\t\t\t<div class=\"field w50 left\"><input id=\"first_name\" name=\"first_name\" required=\"required\" type=\"text\" placeholder=\" \"><label for=\"first_name\">Name *<\/label><\/div>\n\t\t\t<div class=\"field w50 right\"><input id=\"last_name\" name=\"last_name\" required=\"required\" type=\"text\" placeholder=\" \"><label for=\"last_name\">Surname *<\/label><\/div>\n\t\t\t<div class=\"field w50 left\"><input id=\"email\" autocomplete=\"off\" name=\"email\" required=\"required\" type=\"email\" placeholder=\" \"><label for=\"email\">Email *<\/label><\/div>\n\t\t\t<div class=\"field w50 right with-hint\">\n\t\t\t\t<input id=\"phone\" name=\"phone\" required=\"required\" type=\"tel\" placeholder=\" \">\n\t\t\t\t<label for=\"phone\">Phone number *<\/label>\n\t\t\t\t<div class=\"hint\">Specify a contact phone number in international format. For example: +1234567890<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"field w50 country-select left\">\n\t\t\t\t<input id=\"country\" name=\"country\" required=\"required\" type=\"text\" placeholder=\" \">\n\t\t\t\t<div id=\"country-select\" class=\"country-select-container\">\n\t\t\t\t\t<div id=\"csif\" class=\"input-field\">Host country *<\/div>\n\t\t\t\t\t<div class=\"close\"><\/div>\n\t\t\t\t\t<ul id=\"cssw\" class=\"pick-list\">\n\t\t\t\t\t\t<li data-value=\"af\"><span class=\"flag flag-af\"><\/span> Afghanistan<\/li>\n\t\t\t\t\t\t<li data-value=\"ax\"><span class=\"flag flag-ax\"><\/span> \u00c5land Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"al\"><span class=\"flag flag-al\"><\/span> Albania<\/li>\n\t\t\t\t\t\t<li data-value=\"dz\"><span class=\"flag flag-dz\"><\/span> Algeria<\/li>\n\t\t\t\t\t\t<li data-value=\"as\"><span class=\"flag flag-as\"><\/span> American Samoa<\/li>\n\t\t\t\t\t\t<li data-value=\"ad\"><span class=\"flag flag-ad\"><\/span> Andorra<\/li>\n\t\t\t\t\t\t<li data-value=\"ao\"><span class=\"flag flag-ao\"><\/span> Angola<\/li>\n\t\t\t\t\t\t<li data-value=\"ai\"><span class=\"flag flag-ai\"><\/span> Anguilla<\/li>\n\t\t\t\t\t\t<li data-value=\"aq\"><span class=\"flag flag-aq\"><\/span> Antarctica<\/li>\n\t\t\t\t\t\t<li data-value=\"ag\"><span class=\"flag flag-ag\"><\/span> Antigua and Barbuda<\/li>\n\t\t\t\t\t\t<li data-value=\"ar\"><span class=\"flag flag-ar\"><\/span> Argentina<\/li>\n\t\t\t\t\t\t<li data-value=\"am\"><span class=\"flag flag-am\"><\/span> Armenia<\/li>\n\t\t\t\t\t\t<li data-value=\"aw\"><span class=\"flag flag-aw\"><\/span> Aruba<\/li>\n\t\t\t\t\t\t<li data-value=\"au\"><span class=\"flag flag-au\"><\/span> Australia<\/li>\n\t\t\t\t\t\t<li data-value=\"at\"><span class=\"flag flag-at\"><\/span> Austria<\/li>\n\t\t\t\t\t\t<li data-value=\"az\"><span class=\"flag flag-az\"><\/span> Azerbaijan<\/li>\n\t\t\t\t\t\t<li data-value=\"bs\"><span class=\"flag flag-bs\"><\/span> The Bahamas<\/li>\n\t\t\t\t\t\t<li data-value=\"bh\"><span class=\"flag flag-bh\"><\/span> Bahrain<\/li>\n\t\t\t\t\t\t<li data-value=\"bd\"><span class=\"flag flag-bd\"><\/span> Bangladesh<\/li>\n\t\t\t\t\t\t<li data-value=\"bb\"><span class=\"flag flag-bb\"><\/span> Barbados<\/li>\n\t\t\t\t\t\t<li data-value=\"by\"><span class=\"flag flag-by\"><\/span> Belarus<\/li>\n\t\t\t\t\t\t<li data-value=\"be\"><span class=\"flag flag-be\"><\/span> Belgium<\/li>\n\t\t\t\t\t\t<li data-value=\"bz\"><span class=\"flag flag-bz\"><\/span> Belize<\/li>\n\t\t\t\t\t\t<li data-value=\"bj\"><span class=\"flag flag-bj\"><\/span> Benin<\/li>\n\t\t\t\t\t\t<li data-value=\"bm\"><span class=\"flag flag-bm\"><\/span> Bermuda<\/li>\n\t\t\t\t\t\t<li data-value=\"bt\"><span class=\"flag flag-bt\"><\/span> Bhutan<\/li>\n\t\t\t\t\t\t<li data-value=\"bo\"><span class=\"flag flag-bo\"><\/span> Bolivia<\/li>\n\t\t\t\t\t\t<li data-value=\"ba\"><span class=\"flag flag-ba\"><\/span> Bosnia and Herzegovina<\/li>\n\t\t\t\t\t\t<li data-value=\"bw\"><span class=\"flag flag-bw\"><\/span> Botswana<\/li>\n\t\t\t\t\t\t<li data-value=\"bv\"><span class=\"flag flag-bv\"><\/span> Bouvet Island<\/li>\n\t\t\t\t\t\t<li data-value=\"br\"><span class=\"flag flag-br\"><\/span> Brazil<\/li>\n\t\t\t\t\t\t<li data-value=\"io\"><span class=\"flag flag-io\"><\/span> British Indian Ocean Territory<\/li>\n\t\t\t\t\t\t<li data-value=\"bn\"><span class=\"flag flag-bn\"><\/span> Brunei Darussalam<\/li>\n\t\t\t\t\t\t<li data-value=\"bg\"><span class=\"flag flag-bg\"><\/span> Bulgaria<\/li>\n\t\t\t\t\t\t<li data-value=\"bf\"><span class=\"flag flag-bf\"><\/span> Burkina Faso<\/li>\n\t\t\t\t\t\t<li data-value=\"bi\"><span class=\"flag flag-bi\"><\/span> Burundi<\/li>\n\t\t\t\t\t\t<li data-value=\"kh\"><span class=\"flag flag-kh\"><\/span> Cambodia<\/li>\n\t\t\t\t\t\t<li data-value=\"cm\"><span class=\"flag flag-cm\"><\/span> Cameroon<\/li>\n\t\t\t\t\t\t<li data-value=\"ca\"><span class=\"flag flag-ca\"><\/span> Canada<\/li>\n\t\t\t\t\t\t<li data-value=\"cv\"><span class=\"flag flag-cv\"><\/span> Cape Verde<\/li>\n\t\t\t\t\t\t<li data-value=\"ky\"><span class=\"flag flag-ky\"><\/span> Cayman Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"cf\"><span class=\"flag flag-cf\"><\/span> Central African Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"td\"><span class=\"flag flag-td\"><\/span> Chad<\/li>\n\t\t\t\t\t\t<li data-value=\"cl\"><span class=\"flag flag-cl\"><\/span> Chile<\/li>\n\t\t\t\t\t\t<li data-value=\"cn\"><span class=\"flag flag-cn\"><\/span> China<\/li>\n\t\t\t\t\t\t<li data-value=\"cx\"><span class=\"flag flag-cx\"><\/span> Christmas Island<\/li>\n\t\t\t\t\t\t<li data-value=\"cc\"><span class=\"flag flag-cc\"><\/span> Coconut Islands (Keeling)<\/li>\n\t\t\t\t\t\t<li data-value=\"co\"><span class=\"flag flag-co\"><\/span> Colombia<\/li>\n\t\t\t\t\t\t<li data-value=\"km\"><span class=\"flag flag-km\"><\/span> Comoros<\/li>\n\t\t\t\t\t\t<li data-value=\"cg\"><span class=\"flag flag-cg\"><\/span> Congo<\/li>\n\t\t\t\t\t\t<li data-value=\"cd\"><span class=\"flag flag-cd\"><\/span> Democratic Republic of Congo<\/li>\n\t\t\t\t\t\t<li data-value=\"ck\"><span class=\"flag flag-ck\"><\/span> Cook Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"cr\"><span class=\"flag flag-cr\"><\/span> Costa Rica<\/li>\n\t\t\t\t\t\t<li data-value=\"ci\"><span class=\"flag flag-ci\"><\/span> C\u00f4te d'Ivoire<\/li>\n\t\t\t\t\t\t<li data-value=\"hr\"><span class=\"flag flag-hr\"><\/span> Croatia<\/li>\n\t\t\t\t\t\t<li data-value=\"cu\"><span class=\"flag flag-cu\"><\/span> Cuba<\/li>\n\t\t\t\t\t\t<li data-value=\"cy\"><span class=\"flag flag-cy\"><\/span> Cyprus<\/li>\n\t\t\t\t\t\t<li data-value=\"cz\"><span class=\"flag flag-cz\"><\/span> Czech Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"dk\"><span class=\"flag flag-dk\"><\/span> Denmark<\/li>\n\t\t\t\t\t\t<li data-value=\"dj\"><span class=\"flag flag-dj\"><\/span> Djibouti<\/li>\n\t\t\t\t\t\t<li data-value=\"dm\"><span class=\"flag flag-dm\"><\/span> Dominica<\/li>\n\t\t\t\t\t\t<li data-value=\"do\"><span class=\"flag flag-do\"><\/span> Dominican Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"ec\"><span class=\"flag flag-ec\"><\/span> Ecuador<\/li>\n\t\t\t\t\t\t<li data-value=\"eg\"><span class=\"flag flag-eg\"><\/span> Egypt<\/li>\n\t\t\t\t\t\t<li data-value=\"sv\"><span class=\"flag flag-sv\"><\/span> Salvador<\/li>\n\t\t\t\t\t\t<li data-value=\"gq\"><span class=\"flag flag-gq\"><\/span> Equatorial Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"er\"><span class=\"flag flag-er\"><\/span> Eritrea<\/li>\n\t\t\t\t\t\t<li data-value=\"ee\"><span class=\"flag flag-ee\"><\/span> Estonia<\/li>\n\t\t\t\t\t\t<li data-value=\"et\"><span class=\"flag flag-et\"><\/span> Ethiopia<\/li>\n\t\t\t\t\t\t<li data-value=\"fk\"><span class=\"flag flag-fk\"><\/span> Falkland Islands (Malvinas)<\/li>\n\t\t\t\t\t\t<li data-value=\"fo\"><span class=\"flag flag-fo\"><\/span> Faroe Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"fj\"><span class=\"flag flag-fj\"><\/span> Fiji<\/li>\n\t\t\t\t\t\t<li data-value=\"fi\"><span class=\"flag flag-fi\"><\/span> Finland<\/li>\n\t\t\t\t\t\t<li data-value=\"fr\"><span class=\"flag flag-fr\"><\/span> France<\/li>\n\t\t\t\t\t\t<li data-value=\"gf\"><span class=\"flag flag-gf\"><\/span> French Guiana<\/li>\n\t\t\t\t\t\t<li data-value=\"pf\"><span class=\"flag flag-pf\"><\/span> French Polynesia<\/li>\n\t\t\t\t\t\t<li data-value=\"tf\"><span class=\"flag flag-tf\"><\/span> Southern France<\/li>\n\t\t\t\t\t\t<li data-value=\"ga\"><span class=\"flag flag-ga\"><\/span> Gabon<\/li>\n\t\t\t\t\t\t<li data-value=\"gm\"><span class=\"flag flag-gm\"><\/span> The Gambia<\/li>\n\t\t\t\t\t\t<li data-value=\"ge\"><span class=\"flag flag-ge\"><\/span> Georgia<\/li>\n\t\t\t\t\t\t<li data-value=\"de\"><span class=\"flag flag-de\"><\/span> Germany<\/li>\n\t\t\t\t\t\t<li data-value=\"gh\"><span class=\"flag flag-gh\"><\/span> Ghana<\/li>\n\t\t\t\t\t\t<li data-value=\"gi\"><span class=\"flag flag-gi\"><\/span> Gibraltar<\/li>\n\t\t\t\t\t\t<li data-value=\"gr\"><span class=\"flag flag-gr\"><\/span> Greece<\/li>\n\t\t\t\t\t\t<li data-value=\"gl\"><span class=\"flag flag-gl\"><\/span> Greenland<\/li>\n\t\t\t\t\t\t<li data-value=\"gd\"><span class=\"flag flag-gd\"><\/span> Grenada<\/li>\n\t\t\t\t\t\t<li data-value=\"gp\"><span class=\"flag flag-gp\"><\/span> Guadeloupe<\/li>\n\t\t\t\t\t\t<li data-value=\"gu\"><span class=\"flag flag-gu\"><\/span> Guam<\/li>\n\t\t\t\t\t\t<li data-value=\"gt\"><span class=\"flag flag-gt\"><\/span> Guatemala<\/li>\n\t\t\t\t\t\t<li data-value=\"gg\"><span class=\"flag flag-gg\"><\/span> Guernsey<\/li>\n\t\t\t\t\t\t<li data-value=\"gn\"><span class=\"flag flag-gn\"><\/span> Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"gw\"><span class=\"flag flag-gw\"><\/span> Guinea-Bissau<\/li>\n\t\t\t\t\t\t<li data-value=\"gy\"><span class=\"flag flag-gy\"><\/span> Guyana<\/li>\n\t\t\t\t\t\t<li data-value=\"ht\"><span class=\"flag flag-ht\"><\/span> Haiti<\/li>\n\t\t\t\t\t\t<li data-value=\"hm\"><span class=\"flag flag-hm\"><\/span> Heard Island and McDonald Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"va\"><span class=\"flag flag-va\"><\/span> Holy See (Vatican City State)<\/li>\n\t\t\t\t\t\t<li data-value=\"hn\"><span class=\"flag flag-hn\"><\/span> Honduras<\/li>\n\t\t\t\t\t\t<li data-value=\"hk\"><span class=\"flag flag-hk\"><\/span> Hong Kong<\/li>\n\t\t\t\t\t\t<li data-value=\"hu\"><span class=\"flag flag-hu\"><\/span> Hungary<\/li>\n\t\t\t\t\t\t<li data-value=\"is\"><span class=\"flag flag-is\"><\/span> Iceland<\/li>\n\t\t\t\t\t\t<li data-value=\"in\"><span class=\"flag flag-in\"><\/span> India<\/li>\n\t\t\t\t\t\t<li data-value=\"id\"><span class=\"flag flag-id\"><\/span> Indonesia<\/li>\n\t\t\t\t\t\t<li data-value=\"ir\"><span class=\"flag flag-ir\"><\/span> Islamic Republic of Iran<\/li>\n\t\t\t\t\t\t<li data-value=\"iq\"><span class=\"flag flag-iq\"><\/span> Iraq<\/li>\n\t\t\t\t\t\t<li data-value=\"ie\"><span class=\"flag flag-ie\"><\/span> Ireland<\/li>\n\t\t\t\t\t\t<li data-value=\"im\"><span class=\"flag flag-im\"><\/span> Isle of Man<\/li>\n\t\t\t\t\t\t<li data-value=\"il\"><span class=\"flag flag-il\"><\/span> Israel<\/li>\n\t\t\t\t\t\t<li data-value=\"it\"><span class=\"flag flag-it\"><\/span> Italy<\/li>\n\t\t\t\t\t\t<li data-value=\"jm\"><span class=\"flag flag-jm\"><\/span> Jamaica<\/li>\n\t\t\t\t\t\t<li data-value=\"jp\"><span class=\"flag flag-jp\"><\/span> Japan<\/li>\n\t\t\t\t\t\t<li data-value=\"je\"><span class=\"flag flag-je\"><\/span> Jersey<\/li>\n\t\t\t\t\t\t<li data-value=\"jo\"><span class=\"flag flag-jo\"><\/span> Jordan<\/li>\n\t\t\t\t\t\t<li data-value=\"kz\"><span class=\"flag flag-kz\"><\/span> Kazakhstan<\/li>\n\t\t\t\t\t\t<li data-value=\"ke\"><span class=\"flag flag-ke\"><\/span> Kenya<\/li>\n\t\t\t\t\t\t<li data-value=\"ki\"><span class=\"flag flag-ki\"><\/span> Kiribati<\/li>\n\t\t\t\t\t\t<li data-value=\"kr\"><span class=\"flag flag-kr\"><\/span> Korea<\/li>\n\t\t\t\t\t\t<li data-value=\"kw\"><span class=\"flag flag-kw\"><\/span> Kuwait<\/li>\n\t\t\t\t\t\t<li data-value=\"kg\"><span class=\"flag flag-kg\"><\/span> Kyrgyzstan<\/li>\n\t\t\t\t\t\t<li data-value=\"la\"><span class=\"flag flag-la\"><\/span> Lao People's Democratic Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"lv\"><span class=\"flag flag-lv\"><\/span> Latvia<\/li>\n\t\t\t\t\t\t<li data-value=\"lb\"><span class=\"flag flag-lb\"><\/span> Lebanon<\/li>\n\t\t\t\t\t\t<li data-value=\"ls\"><span class=\"flag flag-ls\"><\/span> Lesotho<\/li>\n\t\t\t\t\t\t<li data-value=\"lr\"><span class=\"flag flag-lr\"><\/span> Liberia<\/li>\n\t\t\t\t\t\t<li data-value=\"ly\"><span class=\"flag flag-ly\"><\/span> Libyan Arab Jamahiriya<\/li>\n\t\t\t\t\t\t<li data-value=\"li\"><span class=\"flag flag-li\"><\/span> Liechtenstein<\/li>\n\t\t\t\t\t\t<li data-value=\"lt\"><span class=\"flag flag-lt\"><\/span> Lithuania<\/li>\n\t\t\t\t\t\t<li data-value=\"lu\"><span class=\"flag flag-lu\"><\/span> Luxembourg<\/li>\n\t\t\t\t\t\t<li data-value=\"mo\"><span class=\"flag flag-mo\"><\/span> Macau<\/li>\n\t\t\t\t\t\t<li data-value=\"mk\"><span class=\"flag flag-mk\"><\/span> Macedonia<\/li>\n\t\t\t\t\t\t<li data-value=\"mg\"><span class=\"flag flag-mg\"><\/span> Madagascar<\/li>\n\t\t\t\t\t\t<li data-value=\"mw\"><span class=\"flag flag-mw\"><\/span> Malawi<\/li>\n\t\t\t\t\t\t<li data-value=\"my\"><span class=\"flag flag-my\"><\/span> Malaysia<\/li>\n\t\t\t\t\t\t<li data-value=\"mv\"><span class=\"flag flag-mv\"><\/span> Maldives<\/li>\n\t\t\t\t\t\t<li data-value=\"ml\"><span class=\"flag flag-ml\"><\/span> Mali<\/li>\n\t\t\t\t\t\t<li data-value=\"mt\"><span class=\"flag flag-mt\"><\/span> Malta<\/li>\n\t\t\t\t\t\t<li data-value=\"mh\"><span class=\"flag flag-mh\"><\/span> Marshall Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"mq\"><span class=\"flag flag-mq\"><\/span> Martinique<\/li>\n\t\t\t\t\t\t<li data-value=\"mr\"><span class=\"flag flag-mr\"><\/span> Mauritania<\/li>\n\t\t\t\t\t\t<li data-value=\"mu\"><span class=\"flag flag-mu\"><\/span> Mauritius<\/li>\n\t\t\t\t\t\t<li data-value=\"yt\"><span class=\"flag flag-yt\"><\/span> Mayotte<\/li>\n\t\t\t\t\t\t<li data-value=\"mx\"><span class=\"flag flag-mx\"><\/span> Mexico<\/li>\n\t\t\t\t\t\t<li data-value=\"fm\"><span class=\"flag flag-fm\"><\/span> Federated States of Micronesia<\/li>\n\t\t\t\t\t\t<li data-value=\"md\"><span class=\"flag flag-md\"><\/span> Moldova<\/li>\n\t\t\t\t\t\t<li data-value=\"mc\"><span class=\"flag flag-mc\"><\/span> Monaco<\/li>\n\t\t\t\t\t\t<li data-value=\"mn\"><span class=\"flag flag-mn\"><\/span> Mongolia<\/li>\n\t\t\t\t\t\t<li data-value=\"me\"><span class=\"flag flag-me\"><\/span> Montenegro<\/li>\n\t\t\t\t\t\t<li data-value=\"ms\"><span class=\"flag flag-ms\"><\/span> Montserrat<\/li>\n\t\t\t\t\t\t<li data-value=\"ma\"><span class=\"flag flag-ma\"><\/span> Morocco<\/li>\n\t\t\t\t\t\t<li data-value=\"mz\"><span class=\"flag flag-mz\"><\/span> Mozambique<\/li>\n\t\t\t\t\t\t<li data-value=\"mm\"><span class=\"flag flag-mm\"><\/span> Myanmar<\/li>\n\t\t\t\t\t\t<li data-value=\"na\"><span class=\"flag flag-na\"><\/span> Namibia<\/li>\n\t\t\t\t\t\t<li data-value=\"nr\"><span class=\"flag flag-nr\"><\/span> Nauru<\/li>\n\t\t\t\t\t\t<li data-value=\"np\"><span class=\"flag flag-np\"><\/span> Nepal<\/li>\n\t\t\t\t\t\t<li data-value=\"nl\"><span class=\"flag flag-nl\"><\/span> Netherlands<\/li>\n\t\t\t\t\t\t<li data-value=\"an\"><span class=\"flag flag-an\"><\/span> Netherlands Antilles<\/li>\n\t\t\t\t\t\t<li data-value=\"nc\"><span class=\"flag flag-nc\"><\/span> New Caledonia<\/li>\n\t\t\t\t\t\t<li data-value=\"nz\"><span class=\"flag flag-nz\"><\/span> New Zealand<\/li>\n\t\t\t\t\t\t<li data-value=\"ni\"><span class=\"flag flag-ni\"><\/span> Nicaragua<\/li>\n\t\t\t\t\t\t<li data-value=\"ne\"><span class=\"flag flag-ne\"><\/span> Niger<\/li>\n\t\t\t\t\t\t<li data-value=\"ng\"><span class=\"flag flag-ng\"><\/span> Nigeria<\/li>\n\t\t\t\t\t\t<li data-value=\"nu\"><span class=\"flag flag-nu\"><\/span> Niue<\/li>\n\t\t\t\t\t\t<li data-value=\"nf\"><span class=\"flag flag-nf\"><\/span> Norfolk Island<\/li>\n\t\t\t\t\t\t<li data-value=\"mp\"><span class=\"flag flag-mp\"><\/span> Northern Mariana Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"no\"><span class=\"flag flag-no\"><\/span> Norway<\/li>\n\t\t\t\t\t\t<li data-value=\"om\"><span class=\"flag flag-om\"><\/span> Oman<\/li>\n\t\t\t\t\t\t<li data-value=\"pk\"><span class=\"flag flag-pk\"><\/span> Pakistan<\/li>\n\t\t\t\t\t\t<li data-value=\"pw\"><span class=\"flag flag-pw\"><\/span> Palau<\/li>\n\t\t\t\t\t\t<li data-value=\"ps\"><span class=\"flag flag-ps\"><\/span> Palestinian Territory}, Occupied<\/li>\n\t\t\t\t\t\t<li data-value=\"pa\"><span class=\"flag flag-pa\"><\/span> Panama<\/li>\n\t\t\t\t\t\t<li data-value=\"pg\"><span class=\"flag flag-pg\"><\/span> Papua New Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"py\"><span class=\"flag flag-py\"><\/span> Paraguay<\/li>\n\t\t\t\t\t\t<li data-value=\"pe\"><span class=\"flag flag-pe\"><\/span> Peru<\/li>\n\t\t\t\t\t\t<li data-value=\"ph\"><span class=\"flag flag-ph\"><\/span> Philippines<\/li>\n\t\t\t\t\t\t<li data-value=\"pn\"><span class=\"flag flag-pn\"><\/span> Pitcairn<\/li>\n\t\t\t\t\t\t<li data-value=\"pl\"><span class=\"flag flag-pl\"><\/span> Poland<\/li>\n\t\t\t\t\t\t<li data-value=\"pt\"><span class=\"flag flag-pt\"><\/span> Portugal<\/li>\n\t\t\t\t\t\t<li data-value=\"pr\"><span class=\"flag flag-pr\"><\/span> Puerto Rico<\/li>\n\t\t\t\t\t\t<li data-value=\"qa\"><span class=\"flag flag-qa\"><\/span> Qatar<\/li>\n\t\t\t\t\t\t<li data-value=\"re\"><span class=\"flag flag-re\"><\/span> Reunion<\/li>\n\t\t\t\t\t\t<li data-value=\"ro\"><span class=\"flag flag-ro\"><\/span> Romania<\/li>\n\t\t\t\t\t\t<li data-value=\"ru\"><span class=\"flag flag-ru\"><\/span> Russian Federation<\/li>\n\t\t\t\t\t\t<li data-value=\"rw\"><span class=\"flag flag-rw\"><\/span> Rwanda<\/li>\n\t\t\t\t\t\t<li data-value=\"bl\"><span class=\"flag flag-bl\"><\/span> St. Barthelmey<\/li>\n\t\t\t\t\t\t<li data-value=\"sh\"><span class=\"flag flag-sh\"><\/span> St. Helena<\/li>\n\t\t\t\t\t\t<li data-value=\"kn\"><span class=\"flag flag-kn\"><\/span> St. Kitts and Nevis<\/li>\n\t\t\t\t\t\t<li data-value=\"lc\"><span class=\"flag flag-lc\"><\/span> St. Lucia<\/li>\n\t\t\t\t\t\t<li data-value=\"mf\"><span class=\"flag flag-mf\"><\/span> St. Maarten<\/li>\n\t\t\t\t\t\t<li data-value=\"pm\"><span class=\"flag flag-pm\"><\/span> Saint-Pierre-et-Miquelon<\/li>\n\t\t\t\t\t\t<li data-value=\"vc\"><span class=\"flag flag-vc\"><\/span> Saint Vincent and the Grenadines<\/li>\n\t\t\t\t\t\t<li data-value=\"ws\"><span class=\"flag flag-ws\"><\/span> Samoa<\/li>\n\t\t\t\t\t\t<li data-value=\"sm\"><span class=\"flag flag-sm\"><\/span> San Marino<\/li>\n\t\t\t\t\t\t<li data-value=\"st\"><span class=\"flag flag-st\"><\/span> Sao Tome and Principe<\/li>\n\t\t\t\t\t\t<li data-value=\"sa\"><span class=\"flag flag-sa\"><\/span> Saudi Arabia<\/li>\n\t\t\t\t\t\t<li data-value=\"sn\"><span class=\"flag flag-sn\"><\/span> Senegal<\/li>\n\t\t\t\t\t\t<li data-value=\"rs\"><span class=\"flag flag-rs\"><\/span> Serbia<\/li>\n\t\t\t\t\t\t<li data-value=\"sc\"><span class=\"flag flag-sc\"><\/span> Seychelles<\/li>\n\t\t\t\t\t\t<li data-value=\"sl\"><span class=\"flag flag-sl\"><\/span> Sierra Leone<\/li>\n\t\t\t\t\t\t<li data-value=\"sg\"><span class=\"flag flag-sg\"><\/span> Singapore<\/li>\n\t\t\t\t\t\t<li data-value=\"sk\"><span class=\"flag flag-sk\"><\/span> Slovakia<\/li>\n\t\t\t\t\t\t<li data-value=\"si\"><span class=\"flag flag-si\"><\/span> Slovenia<\/li>\n\t\t\t\t\t\t<li data-value=\"sb\"><span class=\"flag flag-sb\"><\/span> Solomon Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"so\"><span class=\"flag flag-so\"><\/span> Somalia<\/li>\n\t\t\t\t\t\t<li data-value=\"za\"><span class=\"flag flag-za\"><\/span> South Africa<\/li>\n\t\t\t\t\t\t<li data-value=\"gs\"><span class=\"flag flag-gs\"><\/span> South Georgia and Sandwich Island<\/li>\n\t\t\t\t\t\t<li data-value=\"es\"><span class=\"flag flag-es\"><\/span> Spain<\/li>\n\t\t\t\t\t\t<li data-value=\"lk\"><span class=\"flag flag-lk\"><\/span> Sri Lanka<\/li>\n\t\t\t\t\t\t<li data-value=\"sd\"><span class=\"flag flag-sd\"><\/span> Sudan<\/li>\n\t\t\t\t\t\t<li data-value=\"sr\"><span class=\"flag flag-sr\"><\/span> Suriname<\/li>\n\t\t\t\t\t\t<li data-value=\"sj\"><span class=\"flag flag-sj\"><\/span> Svalbard and Jan Mayen<\/li>\n\t\t\t\t\t\t<li data-value=\"sz\"><span class=\"flag flag-sz\"><\/span> Swaziland<\/li>\n\t\t\t\t\t\t<li data-value=\"se\"><span class=\"flag flag-se\"><\/span> Sweden<\/li>\n\t\t\t\t\t\t<li data-value=\"ch\"><span class=\"flag flag-ch\"><\/span> Switzerland<\/li>\n\t\t\t\t\t\t<li data-value=\"sy\"><span class=\"flag flag-sy\"><\/span> Syrian Arab Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"tw\"><span class=\"flag flag-tw\"><\/span> Taiwan<\/li>\n\t\t\t\t\t\t<li data-value=\"tj\"><span class=\"flag flag-tj\"><\/span> Tajikistan<\/li>\n\t\t\t\t\t\t<li data-value=\"tz\"><span class=\"flag flag-tz\"><\/span> Tanzania<\/li>\n\t\t\t\t\t\t<li data-value=\"th\"><span class=\"flag flag-th\"><\/span> Thailand<\/li>\n\t\t\t\t\t\t<li data-value=\"tl\"><span class=\"flag flag-tl\"><\/span> East Timor<\/li>\n\t\t\t\t\t\t<li data-value=\"tg\"><span class=\"flag flag-tg\"><\/span> Togo<\/li>\n\t\t\t\t\t\t<li data-value=\"tk\"><span class=\"flag flag-tk\"><\/span> Tokelau<\/li>\n\t\t\t\t\t\t<li data-value=\"to\"><span class=\"flag flag-to\"><\/span> Tonga<\/li>\n\t\t\t\t\t\t<li data-value=\"tt\"><span class=\"flag flag-tt\"><\/span> Trinidad and Tobago<\/li>\n\t\t\t\t\t\t<li data-value=\"tn\"><span class=\"flag flag-tn\"><\/span> Tunisia<\/li>\n\t\t\t\t\t\t<li data-value=\"tr\"><span class=\"flag flag-tr\"><\/span> Turkey<\/li>\n\t\t\t\t\t\t<li data-value=\"tm\"><span class=\"flag flag-tm\"><\/span> Turkmenistan<\/li>\n\t\t\t\t\t\t<li data-value=\"tc\"><span class=\"flag flag-tc\"><\/span> Turks and Caicos Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"tv\"><span class=\"flag flag-tv\"><\/span> Tuvalu<\/li>\n\t\t\t\t\t\t<li data-value=\"ug\"><span class=\"flag flag-ug\"><\/span> Uganda<\/li>\n\t\t\t\t\t\t<li data-value=\"ua\"><span class=\"flag flag-ua\"><\/span> Ukraine<\/li>\n\t\t\t\t\t\t<li data-value=\"ae\"><span class=\"flag flag-ae\"><\/span> United Arab Emirates<\/li>\n\t\t\t\t\t\t<li data-value=\"gb\"><span class=\"flag flag-gb\"><\/span> UK<\/li>\n\t\t\t\t\t\t<li data-value=\"us\"><span class=\"flag flag-us\"><\/span> USA<\/li>\n\t\t\t\t\t\t<li data-value=\"um\"><span class=\"flag flag-um\"><\/span> Outlying U.S. islands<\/li>\n\t\t\t\t\t\t<li data-value=\"uy\"><span class=\"flag flag-uy\"><\/span> Uruguay<\/li>\n\t\t\t\t\t\t<li data-value=\"uz\"><span class=\"flag flag-uz\"><\/span> Uzbekistan<\/li>\n\t\t\t\t\t\t<li data-value=\"vu\"><span class=\"flag flag-vu\"><\/span> Vanuatu<\/li>\n\t\t\t\t\t\t<li data-value=\"ve\"><span class=\"flag flag-ve\"><\/span> Venezuela<\/li>\n\t\t\t\t\t\t<li data-value=\"vn\"><span class=\"flag flag-vn\"><\/span> Vietnam<\/li>\n\t\t\t\t\t\t<li data-value=\"vg\"><span class=\"flag flag-vg\"><\/span> Virgin Islands - British<\/li>\n\t\t\t\t\t\t<li data-value=\"vi\"><span class=\"flag flag-vi\"><\/span> Virgin Islands - USA<\/li>\n\t\t\t\t\t\t<li data-value=\"wf\"><span class=\"flag flag-wf\"><\/span> Wallis and Futuna<\/li>\n\t\t\t\t\t\t<li data-value=\"eh\"><span class=\"flag flag-eh\"><\/span> Western Sahara<\/li>\n\t\t\t\t\t\t<li data-value=\"ye\"><span class=\"flag flag-ye\"><\/span> Yemen<\/li>\n\t\t\t\t\t\t<li data-value=\"zm\"><span class=\"flag flag-zm\"><\/span> Zambia<\/li>\n\t\t\t\t\t\t<li data-value=\"zw\"><span class=\"flag flag-zw\"><\/span> Zimbabwe<\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"field w50 country-select right\">\n\t\t\t\t<input id=\"custom_field_14\" name=\"custom_field_14\" required=\"required\" type=\"text\" placeholder=\" \">\n\t\t\t\t<div class=\"country-select-container\">\n\t\t\t\t\t<div class=\"input-field\">Citizenship *<\/div>\n\t\t\t\t\t<div class=\"close\"><\/div>\n\t\t\t\t\t<ul class=\"pick-list\">\n\t\t\t\t\t\t<li data-value=\"af\"><span class=\"flag flag-af\"><\/span> Afghanistan<\/li>\n\t\t\t\t\t\t<li data-value=\"ax\"><span class=\"flag flag-ax\"><\/span> \u00c5land Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"al\"><span class=\"flag flag-al\"><\/span> Albania<\/li>\n\t\t\t\t\t\t<li data-value=\"dz\"><span class=\"flag flag-dz\"><\/span> Algeria<\/li>\n\t\t\t\t\t\t<li data-value=\"as\"><span class=\"flag flag-as\"><\/span> American Samoa<\/li>\n\t\t\t\t\t\t<li data-value=\"ad\"><span class=\"flag flag-ad\"><\/span> Andorra<\/li>\n\t\t\t\t\t\t<li data-value=\"ao\"><span class=\"flag flag-ao\"><\/span> Angola<\/li>\n\t\t\t\t\t\t<li data-value=\"ai\"><span class=\"flag flag-ai\"><\/span> Anguilla<\/li>\n\t\t\t\t\t\t<li data-value=\"aq\"><span class=\"flag flag-aq\"><\/span> Antarctica<\/li>\n\t\t\t\t\t\t<li data-value=\"ag\"><span class=\"flag flag-ag\"><\/span> Antigua and Barbuda<\/li>\n\t\t\t\t\t\t<li data-value=\"ar\"><span class=\"flag flag-ar\"><\/span> Argentina<\/li>\n\t\t\t\t\t\t<li data-value=\"am\"><span class=\"flag flag-am\"><\/span> Armenia<\/li>\n\t\t\t\t\t\t<li data-value=\"aw\"><span class=\"flag flag-aw\"><\/span> Aruba<\/li>\n\t\t\t\t\t\t<li data-value=\"au\"><span class=\"flag flag-au\"><\/span> Australia<\/li>\n\t\t\t\t\t\t<li data-value=\"at\"><span class=\"flag flag-at\"><\/span> Austria<\/li>\n\t\t\t\t\t\t<li data-value=\"az\"><span class=\"flag flag-az\"><\/span> Azerbaijan<\/li>\n\t\t\t\t\t\t<li data-value=\"bs\"><span class=\"flag flag-bs\"><\/span> The Bahamas<\/li>\n\t\t\t\t\t\t<li data-value=\"bh\"><span class=\"flag flag-bh\"><\/span> Bahrain<\/li>\n\t\t\t\t\t\t<li data-value=\"bd\"><span class=\"flag flag-bd\"><\/span> Bangladesh<\/li>\n\t\t\t\t\t\t<li data-value=\"bb\"><span class=\"flag flag-bb\"><\/span> Barbados<\/li>\n\t\t\t\t\t\t<li data-value=\"by\"><span class=\"flag flag-by\"><\/span> Belarus<\/li>\n\t\t\t\t\t\t<li data-value=\"be\"><span class=\"flag flag-be\"><\/span> Belgium<\/li>\n\t\t\t\t\t\t<li data-value=\"bz\"><span class=\"flag flag-bz\"><\/span> Belize<\/li>\n\t\t\t\t\t\t<li data-value=\"bj\"><span class=\"flag flag-bj\"><\/span> Benin<\/li>\n\t\t\t\t\t\t<li data-value=\"bm\"><span class=\"flag flag-bm\"><\/span> Bermuda<\/li>\n\t\t\t\t\t\t<li data-value=\"bt\"><span class=\"flag flag-bt\"><\/span> Bhutan<\/li>\n\t\t\t\t\t\t<li data-value=\"bo\"><span class=\"flag flag-bo\"><\/span> Bolivia<\/li>\n\t\t\t\t\t\t<li data-value=\"ba\"><span class=\"flag flag-ba\"><\/span> Bosnia and Herzegovina<\/li>\n\t\t\t\t\t\t<li data-value=\"bw\"><span class=\"flag flag-bw\"><\/span> Botswana<\/li>\n\t\t\t\t\t\t<li data-value=\"bv\"><span class=\"flag flag-bv\"><\/span> Bouvet Island<\/li>\n\t\t\t\t\t\t<li data-value=\"br\"><span class=\"flag flag-br\"><\/span> Brazil<\/li>\n\t\t\t\t\t\t<li data-value=\"io\"><span class=\"flag flag-io\"><\/span> British Indian Ocean Territory<\/li>\n\t\t\t\t\t\t<li data-value=\"bn\"><span class=\"flag flag-bn\"><\/span> Brunei Darussalam<\/li>\n\t\t\t\t\t\t<li data-value=\"bg\"><span class=\"flag flag-bg\"><\/span> Bulgaria<\/li>\n\t\t\t\t\t\t<li data-value=\"bf\"><span class=\"flag flag-bf\"><\/span> Burkina Faso<\/li>\n\t\t\t\t\t\t<li data-value=\"bi\"><span class=\"flag flag-bi\"><\/span> Burundi<\/li>\n\t\t\t\t\t\t<li data-value=\"kh\"><span class=\"flag flag-kh\"><\/span> Cambodia<\/li>\n\t\t\t\t\t\t<li data-value=\"cm\"><span class=\"flag flag-cm\"><\/span> Cameroon<\/li>\n\t\t\t\t\t\t<li data-value=\"ca\"><span class=\"flag flag-ca\"><\/span> Canada<\/li>\n\t\t\t\t\t\t<li data-value=\"cv\"><span class=\"flag flag-cv\"><\/span> Cape Verde<\/li>\n\t\t\t\t\t\t<li data-value=\"ky\"><span class=\"flag flag-ky\"><\/span> Cayman Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"cf\"><span class=\"flag flag-cf\"><\/span> Central African Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"td\"><span class=\"flag flag-td\"><\/span> Chad<\/li>\n\t\t\t\t\t\t<li data-value=\"cl\"><span class=\"flag flag-cl\"><\/span> Chile<\/li>\n\t\t\t\t\t\t<li data-value=\"cn\"><span class=\"flag flag-cn\"><\/span> China<\/li>\n\t\t\t\t\t\t<li data-value=\"cx\"><span class=\"flag flag-cx\"><\/span> Christmas Island<\/li>\n\t\t\t\t\t\t<li data-value=\"cc\"><span class=\"flag flag-cc\"><\/span> Coconut Islands (Keeling)<\/li>\n\t\t\t\t\t\t<li data-value=\"co\"><span class=\"flag flag-co\"><\/span> Colombia<\/li>\n\t\t\t\t\t\t<li data-value=\"km\"><span class=\"flag flag-km\"><\/span> Comoros<\/li>\n\t\t\t\t\t\t<li data-value=\"cg\"><span class=\"flag flag-cg\"><\/span> Congo<\/li>\n\t\t\t\t\t\t<li data-value=\"cd\"><span class=\"flag flag-cd\"><\/span> Democratic Republic of Congo<\/li>\n\t\t\t\t\t\t<li data-value=\"ck\"><span class=\"flag flag-ck\"><\/span> Cook Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"cr\"><span class=\"flag flag-cr\"><\/span> Costa Rica<\/li>\n\t\t\t\t\t\t<li data-value=\"ci\"><span class=\"flag flag-ci\"><\/span> C\u00f4te d'Ivoire<\/li>\n\t\t\t\t\t\t<li data-value=\"hr\"><span class=\"flag flag-hr\"><\/span> Croatia<\/li>\n\t\t\t\t\t\t<li data-value=\"cu\"><span class=\"flag flag-cu\"><\/span> Cuba<\/li>\n\t\t\t\t\t\t<li data-value=\"cy\"><span class=\"flag flag-cy\"><\/span> Cyprus<\/li>\n\t\t\t\t\t\t<li data-value=\"cz\"><span class=\"flag flag-cz\"><\/span> Czech Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"dk\"><span class=\"flag flag-dk\"><\/span> Denmark<\/li>\n\t\t\t\t\t\t<li data-value=\"dj\"><span class=\"flag flag-dj\"><\/span> Djibouti<\/li>\n\t\t\t\t\t\t<li data-value=\"dm\"><span class=\"flag flag-dm\"><\/span> Dominica<\/li>\n\t\t\t\t\t\t<li data-value=\"do\"><span class=\"flag flag-do\"><\/span> Dominican Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"ec\"><span class=\"flag flag-ec\"><\/span> Ecuador<\/li>\n\t\t\t\t\t\t<li data-value=\"eg\"><span class=\"flag flag-eg\"><\/span> Egypt<\/li>\n\t\t\t\t\t\t<li data-value=\"sv\"><span class=\"flag flag-sv\"><\/span> Salvador<\/li>\n\t\t\t\t\t\t<li data-value=\"gq\"><span class=\"flag flag-gq\"><\/span> Equatorial Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"er\"><span class=\"flag flag-er\"><\/span> Eritrea<\/li>\n\t\t\t\t\t\t<li data-value=\"ee\"><span class=\"flag flag-ee\"><\/span> Estonia<\/li>\n\t\t\t\t\t\t<li data-value=\"et\"><span class=\"flag flag-et\"><\/span> Ethiopia<\/li>\n\t\t\t\t\t\t<li data-value=\"fk\"><span class=\"flag flag-fk\"><\/span> Falkland Islands (Malvinas)<\/li>\n\t\t\t\t\t\t<li data-value=\"fo\"><span class=\"flag flag-fo\"><\/span> Faroe Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"fj\"><span class=\"flag flag-fj\"><\/span> Fiji<\/li>\n\t\t\t\t\t\t<li data-value=\"fi\"><span class=\"flag flag-fi\"><\/span> Finland<\/li>\n\t\t\t\t\t\t<li data-value=\"fr\"><span class=\"flag flag-fr\"><\/span> France<\/li>\n\t\t\t\t\t\t<li data-value=\"gf\"><span class=\"flag flag-gf\"><\/span> French Guiana<\/li>\n\t\t\t\t\t\t<li data-value=\"pf\"><span class=\"flag flag-pf\"><\/span> French Polynesia<\/li>\n\t\t\t\t\t\t<li data-value=\"tf\"><span class=\"flag flag-tf\"><\/span> Southern France<\/li>\n\t\t\t\t\t\t<li data-value=\"ga\"><span class=\"flag flag-ga\"><\/span> Gabon<\/li>\n\t\t\t\t\t\t<li data-value=\"gm\"><span class=\"flag flag-gm\"><\/span> The Gambia<\/li>\n\t\t\t\t\t\t<li data-value=\"ge\"><span class=\"flag flag-ge\"><\/span> Georgia<\/li>\n\t\t\t\t\t\t<li data-value=\"de\"><span class=\"flag flag-de\"><\/span> Germany<\/li>\n\t\t\t\t\t\t<li data-value=\"gh\"><span class=\"flag flag-gh\"><\/span> Ghana<\/li>\n\t\t\t\t\t\t<li data-value=\"gi\"><span class=\"flag flag-gi\"><\/span> Gibraltar<\/li>\n\t\t\t\t\t\t<li data-value=\"gr\"><span class=\"flag flag-gr\"><\/span> Greece<\/li>\n\t\t\t\t\t\t<li data-value=\"gl\"><span class=\"flag flag-gl\"><\/span> Greenland<\/li>\n\t\t\t\t\t\t<li data-value=\"gd\"><span class=\"flag flag-gd\"><\/span> Grenada<\/li>\n\t\t\t\t\t\t<li data-value=\"gp\"><span class=\"flag flag-gp\"><\/span> Guadeloupe<\/li>\n\t\t\t\t\t\t<li data-value=\"gu\"><span class=\"flag flag-gu\"><\/span> Guam<\/li>\n\t\t\t\t\t\t<li data-value=\"gt\"><span class=\"flag flag-gt\"><\/span> Guatemala<\/li>\n\t\t\t\t\t\t<li data-value=\"gg\"><span class=\"flag flag-gg\"><\/span> Guernsey<\/li>\n\t\t\t\t\t\t<li data-value=\"gn\"><span class=\"flag flag-gn\"><\/span> Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"gw\"><span class=\"flag flag-gw\"><\/span> Guinea-Bissau<\/li>\n\t\t\t\t\t\t<li data-value=\"gy\"><span class=\"flag flag-gy\"><\/span> Guyana<\/li>\n\t\t\t\t\t\t<li data-value=\"ht\"><span class=\"flag flag-ht\"><\/span> Haiti<\/li>\n\t\t\t\t\t\t<li data-value=\"hm\"><span class=\"flag flag-hm\"><\/span> Heard Island and McDonald Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"va\"><span class=\"flag flag-va\"><\/span> Holy See (Vatican City State)<\/li>\n\t\t\t\t\t\t<li data-value=\"hn\"><span class=\"flag flag-hn\"><\/span> Honduras<\/li>\n\t\t\t\t\t\t<li data-value=\"hk\"><span class=\"flag flag-hk\"><\/span> Hong Kong<\/li>\n\t\t\t\t\t\t<li data-value=\"hu\"><span class=\"flag flag-hu\"><\/span> Hungary<\/li>\n\t\t\t\t\t\t<li data-value=\"is\"><span class=\"flag flag-is\"><\/span> Iceland<\/li>\n\t\t\t\t\t\t<li data-value=\"in\"><span class=\"flag flag-in\"><\/span> India<\/li>\n\t\t\t\t\t\t<li data-value=\"id\"><span class=\"flag flag-id\"><\/span> Indonesia<\/li>\n\t\t\t\t\t\t<li data-value=\"ir\"><span class=\"flag flag-ir\"><\/span> Islamic Republic of Iran<\/li>\n\t\t\t\t\t\t<li data-value=\"iq\"><span class=\"flag flag-iq\"><\/span> Iraq<\/li>\n\t\t\t\t\t\t<li data-value=\"ie\"><span class=\"flag flag-ie\"><\/span> Ireland<\/li>\n\t\t\t\t\t\t<li data-value=\"im\"><span class=\"flag flag-im\"><\/span> Isle of Man<\/li>\n\t\t\t\t\t\t<li data-value=\"il\"><span class=\"flag flag-il\"><\/span> Israel<\/li>\n\t\t\t\t\t\t<li data-value=\"it\"><span class=\"flag flag-it\"><\/span> Italy<\/li>\n\t\t\t\t\t\t<li data-value=\"jm\"><span class=\"flag flag-jm\"><\/span> Jamaica<\/li>\n\t\t\t\t\t\t<li data-value=\"jp\"><span class=\"flag flag-jp\"><\/span> Japan<\/li>\n\t\t\t\t\t\t<li data-value=\"je\"><span class=\"flag flag-je\"><\/span> Jersey<\/li>\n\t\t\t\t\t\t<li data-value=\"jo\"><span class=\"flag flag-jo\"><\/span> Jordan<\/li>\n\t\t\t\t\t\t<li data-value=\"kz\"><span class=\"flag flag-kz\"><\/span> Kazakhstan<\/li>\n\t\t\t\t\t\t<li data-value=\"ke\"><span class=\"flag flag-ke\"><\/span> Kenya<\/li>\n\t\t\t\t\t\t<li data-value=\"ki\"><span class=\"flag flag-ki\"><\/span> Kiribati<\/li>\n\t\t\t\t\t\t<li data-value=\"kr\"><span class=\"flag flag-kr\"><\/span> Korea<\/li>\n\t\t\t\t\t\t<li data-value=\"kw\"><span class=\"flag flag-kw\"><\/span> Kuwait<\/li>\n\t\t\t\t\t\t<li data-value=\"kg\"><span class=\"flag flag-kg\"><\/span> Kyrgyzstan<\/li>\n\t\t\t\t\t\t<li data-value=\"la\"><span class=\"flag flag-la\"><\/span> Lao People's Democratic Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"lv\"><span class=\"flag flag-lv\"><\/span> Latvia<\/li>\n\t\t\t\t\t\t<li data-value=\"lb\"><span class=\"flag flag-lb\"><\/span> Lebanon<\/li>\n\t\t\t\t\t\t<li data-value=\"ls\"><span class=\"flag flag-ls\"><\/span> Lesotho<\/li>\n\t\t\t\t\t\t<li data-value=\"lr\"><span class=\"flag flag-lr\"><\/span> Liberia<\/li>\n\t\t\t\t\t\t<li data-value=\"ly\"><span class=\"flag flag-ly\"><\/span> Libyan Arab Jamahiriya<\/li>\n\t\t\t\t\t\t<li data-value=\"li\"><span class=\"flag flag-li\"><\/span> Liechtenstein<\/li>\n\t\t\t\t\t\t<li data-value=\"lt\"><span class=\"flag flag-lt\"><\/span> Lithuania<\/li>\n\t\t\t\t\t\t<li data-value=\"lu\"><span class=\"flag flag-lu\"><\/span> Luxembourg<\/li>\n\t\t\t\t\t\t<li data-value=\"mo\"><span class=\"flag flag-mo\"><\/span> Macau<\/li>\n\t\t\t\t\t\t<li data-value=\"mk\"><span class=\"flag flag-mk\"><\/span> Macedonia<\/li>\n\t\t\t\t\t\t<li data-value=\"mg\"><span class=\"flag flag-mg\"><\/span> Madagascar<\/li>\n\t\t\t\t\t\t<li data-value=\"mw\"><span class=\"flag flag-mw\"><\/span> Malawi<\/li>\n\t\t\t\t\t\t<li data-value=\"my\"><span class=\"flag flag-my\"><\/span> Malaysia<\/li>\n\t\t\t\t\t\t<li data-value=\"mv\"><span class=\"flag flag-mv\"><\/span> Maldives<\/li>\n\t\t\t\t\t\t<li data-value=\"ml\"><span class=\"flag flag-ml\"><\/span> Mali<\/li>\n\t\t\t\t\t\t<li data-value=\"mt\"><span class=\"flag flag-mt\"><\/span> Malta<\/li>\n\t\t\t\t\t\t<li data-value=\"mh\"><span class=\"flag flag-mh\"><\/span> Marshall Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"mq\"><span class=\"flag flag-mq\"><\/span> Martinique<\/li>\n\t\t\t\t\t\t<li data-value=\"mr\"><span class=\"flag flag-mr\"><\/span> Mauritania<\/li>\n\t\t\t\t\t\t<li data-value=\"mu\"><span class=\"flag flag-mu\"><\/span> Mauritius<\/li>\n\t\t\t\t\t\t<li data-value=\"yt\"><span class=\"flag flag-yt\"><\/span> Mayotte<\/li>\n\t\t\t\t\t\t<li data-value=\"mx\"><span class=\"flag flag-mx\"><\/span> Mexico<\/li>\n\t\t\t\t\t\t<li data-value=\"fm\"><span class=\"flag flag-fm\"><\/span> Federated States of Micronesia<\/li>\n\t\t\t\t\t\t<li data-value=\"md\"><span class=\"flag flag-md\"><\/span> Moldova<\/li>\n\t\t\t\t\t\t<li data-value=\"mc\"><span class=\"flag flag-mc\"><\/span> Monaco<\/li>\n\t\t\t\t\t\t<li data-value=\"mn\"><span class=\"flag flag-mn\"><\/span> Mongolia<\/li>\n\t\t\t\t\t\t<li data-value=\"me\"><span class=\"flag flag-me\"><\/span> Montenegro<\/li>\n\t\t\t\t\t\t<li data-value=\"ms\"><span class=\"flag flag-ms\"><\/span> Montserrat<\/li>\n\t\t\t\t\t\t<li data-value=\"ma\"><span class=\"flag flag-ma\"><\/span> Morocco<\/li>\n\t\t\t\t\t\t<li data-value=\"mz\"><span class=\"flag flag-mz\"><\/span> Mozambique<\/li>\n\t\t\t\t\t\t<li data-value=\"mm\"><span class=\"flag flag-mm\"><\/span> Myanmar<\/li>\n\t\t\t\t\t\t<li data-value=\"na\"><span class=\"flag flag-na\"><\/span> Namibia<\/li>\n\t\t\t\t\t\t<li data-value=\"nr\"><span class=\"flag flag-nr\"><\/span> Nauru<\/li>\n\t\t\t\t\t\t<li data-value=\"np\"><span class=\"flag flag-np\"><\/span> Nepal<\/li>\n\t\t\t\t\t\t<li data-value=\"nl\"><span class=\"flag flag-nl\"><\/span> Netherlands<\/li>\n\t\t\t\t\t\t<li data-value=\"an\"><span class=\"flag flag-an\"><\/span> Netherlands Antilles<\/li>\n\t\t\t\t\t\t<li data-value=\"nc\"><span class=\"flag flag-nc\"><\/span> New Caledonia<\/li>\n\t\t\t\t\t\t<li data-value=\"nz\"><span class=\"flag flag-nz\"><\/span> New Zealand<\/li>\n\t\t\t\t\t\t<li data-value=\"ni\"><span class=\"flag flag-ni\"><\/span> Nicaragua<\/li>\n\t\t\t\t\t\t<li data-value=\"ne\"><span class=\"flag flag-ne\"><\/span> Niger<\/li>\n\t\t\t\t\t\t<li data-value=\"ng\"><span class=\"flag flag-ng\"><\/span> Nigeria<\/li>\n\t\t\t\t\t\t<li data-value=\"nu\"><span class=\"flag flag-nu\"><\/span> Niue<\/li>\n\t\t\t\t\t\t<li data-value=\"nf\"><span class=\"flag flag-nf\"><\/span> Norfolk Island<\/li>\n\t\t\t\t\t\t<li data-value=\"mp\"><span class=\"flag flag-mp\"><\/span> Northern Mariana Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"no\"><span class=\"flag flag-no\"><\/span> Norway<\/li>\n\t\t\t\t\t\t<li data-value=\"om\"><span class=\"flag flag-om\"><\/span> Oman<\/li>\n\t\t\t\t\t\t<li data-value=\"pk\"><span class=\"flag flag-pk\"><\/span> Pakistan<\/li>\n\t\t\t\t\t\t<li data-value=\"pw\"><span class=\"flag flag-pw\"><\/span> Palau<\/li>\n\t\t\t\t\t\t<li data-value=\"ps\"><span class=\"flag flag-ps\"><\/span> Palestinian Territory}, Occupied<\/li>\n\t\t\t\t\t\t<li data-value=\"pa\"><span class=\"flag flag-pa\"><\/span> Panama<\/li>\n\t\t\t\t\t\t<li data-value=\"pg\"><span class=\"flag flag-pg\"><\/span> Papua New Guinea<\/li>\n\t\t\t\t\t\t<li data-value=\"py\"><span class=\"flag flag-py\"><\/span> Paraguay<\/li>\n\t\t\t\t\t\t<li data-value=\"pe\"><span class=\"flag flag-pe\"><\/span> Peru<\/li>\n\t\t\t\t\t\t<li data-value=\"ph\"><span class=\"flag flag-ph\"><\/span> Philippines<\/li>\n\t\t\t\t\t\t<li data-value=\"pn\"><span class=\"flag flag-pn\"><\/span> Pitcairn<\/li>\n\t\t\t\t\t\t<li data-value=\"pl\"><span class=\"flag flag-pl\"><\/span> Poland<\/li>\n\t\t\t\t\t\t<li data-value=\"pt\"><span class=\"flag flag-pt\"><\/span> Portugal<\/li>\n\t\t\t\t\t\t<li data-value=\"pr\"><span class=\"flag flag-pr\"><\/span> Puerto Rico<\/li>\n\t\t\t\t\t\t<li data-value=\"qa\"><span class=\"flag flag-qa\"><\/span> Qatar<\/li>\n\t\t\t\t\t\t<li data-value=\"re\"><span class=\"flag flag-re\"><\/span> Reunion<\/li>\n\t\t\t\t\t\t<li data-value=\"ro\"><span class=\"flag flag-ro\"><\/span> Romania<\/li>\n\t\t\t\t\t\t<li data-value=\"ru\"><span class=\"flag flag-ru\"><\/span> Russian Federation<\/li>\n\t\t\t\t\t\t<li data-value=\"rw\"><span class=\"flag flag-rw\"><\/span> Rwanda<\/li>\n\t\t\t\t\t\t<li data-value=\"bl\"><span class=\"flag flag-bl\"><\/span> St. Barthelmey<\/li>\n\t\t\t\t\t\t<li data-value=\"sh\"><span class=\"flag flag-sh\"><\/span> St. Helena<\/li>\n\t\t\t\t\t\t<li data-value=\"kn\"><span class=\"flag flag-kn\"><\/span> St. Kitts and Nevis<\/li>\n\t\t\t\t\t\t<li data-value=\"lc\"><span class=\"flag flag-lc\"><\/span> St. Lucia<\/li>\n\t\t\t\t\t\t<li data-value=\"mf\"><span class=\"flag flag-mf\"><\/span> St. Maarten<\/li>\n\t\t\t\t\t\t<li data-value=\"pm\"><span class=\"flag flag-pm\"><\/span> Saint-Pierre-et-Miquelon<\/li>\n\t\t\t\t\t\t<li data-value=\"vc\"><span class=\"flag flag-vc\"><\/span> Saint Vincent and the Grenadines<\/li>\n\t\t\t\t\t\t<li data-value=\"ws\"><span class=\"flag flag-ws\"><\/span> Samoa<\/li>\n\t\t\t\t\t\t<li data-value=\"sm\"><span class=\"flag flag-sm\"><\/span> San Marino<\/li>\n\t\t\t\t\t\t<li data-value=\"st\"><span class=\"flag flag-st\"><\/span> Sao Tome and Principe<\/li>\n\t\t\t\t\t\t<li data-value=\"sa\"><span class=\"flag flag-sa\"><\/span> Saudi Arabia<\/li>\n\t\t\t\t\t\t<li data-value=\"sn\"><span class=\"flag flag-sn\"><\/span> Senegal<\/li>\n\t\t\t\t\t\t<li data-value=\"rs\"><span class=\"flag flag-rs\"><\/span> Serbia<\/li>\n\t\t\t\t\t\t<li data-value=\"sc\"><span class=\"flag flag-sc\"><\/span> Seychelles<\/li>\n\t\t\t\t\t\t<li data-value=\"sl\"><span class=\"flag flag-sl\"><\/span> Sierra Leone<\/li>\n\t\t\t\t\t\t<li data-value=\"sg\"><span class=\"flag flag-sg\"><\/span> Singapore<\/li>\n\t\t\t\t\t\t<li data-value=\"sk\"><span class=\"flag flag-sk\"><\/span> Slovakia<\/li>\n\t\t\t\t\t\t<li data-value=\"si\"><span class=\"flag flag-si\"><\/span> Slovenia<\/li>\n\t\t\t\t\t\t<li data-value=\"sb\"><span class=\"flag flag-sb\"><\/span> Solomon Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"so\"><span class=\"flag flag-so\"><\/span> Somalia<\/li>\n\t\t\t\t\t\t<li data-value=\"za\"><span class=\"flag flag-za\"><\/span> South Africa<\/li>\n\t\t\t\t\t\t<li data-value=\"gs\"><span class=\"flag flag-gs\"><\/span> South Georgia and Sandwich Island<\/li>\n\t\t\t\t\t\t<li data-value=\"es\"><span class=\"flag flag-es\"><\/span> Spain<\/li>\n\t\t\t\t\t\t<li data-value=\"lk\"><span class=\"flag flag-lk\"><\/span> Sri Lanka<\/li>\n\t\t\t\t\t\t<li data-value=\"sd\"><span class=\"flag flag-sd\"><\/span> Sudan<\/li>\n\t\t\t\t\t\t<li data-value=\"sr\"><span class=\"flag flag-sr\"><\/span> Suriname<\/li>\n\t\t\t\t\t\t<li data-value=\"sj\"><span class=\"flag flag-sj\"><\/span> Svalbard and Jan Mayen<\/li>\n\t\t\t\t\t\t<li data-value=\"sz\"><span class=\"flag flag-sz\"><\/span> Swaziland<\/li>\n\t\t\t\t\t\t<li data-value=\"se\"><span class=\"flag flag-se\"><\/span> Sweden<\/li>\n\t\t\t\t\t\t<li data-value=\"ch\"><span class=\"flag flag-ch\"><\/span> Switzerland<\/li>\n\t\t\t\t\t\t<li data-value=\"sy\"><span class=\"flag flag-sy\"><\/span> Syrian Arab Republic<\/li>\n\t\t\t\t\t\t<li data-value=\"tw\"><span class=\"flag flag-tw\"><\/span> Taiwan<\/li>\n\t\t\t\t\t\t<li data-value=\"tj\"><span class=\"flag flag-tj\"><\/span> Tajikistan<\/li>\n\t\t\t\t\t\t<li data-value=\"tz\"><span class=\"flag flag-tz\"><\/span> Tanzania<\/li>\n\t\t\t\t\t\t<li data-value=\"th\"><span class=\"flag flag-th\"><\/span> Thailand<\/li>\n\t\t\t\t\t\t<li data-value=\"tl\"><span class=\"flag flag-tl\"><\/span> East Timor<\/li>\n\t\t\t\t\t\t<li data-value=\"tg\"><span class=\"flag flag-tg\"><\/span> Togo<\/li>\n\t\t\t\t\t\t<li data-value=\"tk\"><span class=\"flag flag-tk\"><\/span> Tokelau<\/li>\n\t\t\t\t\t\t<li data-value=\"to\"><span class=\"flag flag-to\"><\/span> Tonga<\/li>\n\t\t\t\t\t\t<li data-value=\"tt\"><span class=\"flag flag-tt\"><\/span> Trinidad and Tobago<\/li>\n\t\t\t\t\t\t<li data-value=\"tn\"><span class=\"flag flag-tn\"><\/span> Tunisia<\/li>\n\t\t\t\t\t\t<li data-value=\"tr\"><span class=\"flag flag-tr\"><\/span> Turkey<\/li>\n\t\t\t\t\t\t<li data-value=\"tm\"><span class=\"flag flag-tm\"><\/span> Turkmenistan<\/li>\n\t\t\t\t\t\t<li data-value=\"tc\"><span class=\"flag flag-tc\"><\/span> Turks and Caicos Islands<\/li>\n\t\t\t\t\t\t<li data-value=\"tv\"><span class=\"flag flag-tv\"><\/span> Tuvalu<\/li>\n\t\t\t\t\t\t<li data-value=\"ug\"><span class=\"flag flag-ug\"><\/span> Uganda<\/li>\n\t\t\t\t\t\t<li data-value=\"ua\"><span class=\"flag flag-ua\"><\/span> Ukraine<\/li>\n\t\t\t\t\t\t<li data-value=\"ae\"><span class=\"flag flag-ae\"><\/span> United Arab Emirates<\/li>\n\t\t\t\t\t\t<li data-value=\"gb\"><span class=\"flag flag-gb\"><\/span> UK<\/li>\n\t\t\t\t\t\t<li data-value=\"us\"><span class=\"flag flag-us\"><\/span> USA<\/li>\n\t\t\t\t\t\t<li data-value=\"um\"><span class=\"flag flag-um\"><\/span> Outlying U.S. islands<\/li>\n\t\t\t\t\t\t<li data-value=\"uy\"><span class=\"flag flag-uy\"><\/span> Uruguay<\/li>\n\t\t\t\t\t\t<li data-value=\"uz\"><span class=\"flag flag-uz\"><\/span> Uzbekistan<\/li>\n\t\t\t\t\t\t<li data-value=\"vu\"><span class=\"flag flag-vu\"><\/span> Vanuatu<\/li>\n\t\t\t\t\t\t<li data-value=\"ve\"><span class=\"flag flag-ve\"><\/span> Venezuela<\/li>\n\t\t\t\t\t\t<li data-value=\"vn\"><span class=\"flag flag-vn\"><\/span> Vietnam<\/li>\n\t\t\t\t\t\t<li data-value=\"vg\"><span class=\"flag flag-vg\"><\/span> Virgin Islands - British<\/li>\n\t\t\t\t\t\t<li data-value=\"vi\"><span class=\"flag flag-vi\"><\/span> Virgin Islands - USA<\/li>\n\t\t\t\t\t\t<li data-value=\"wf\"><span class=\"flag flag-wf\"><\/span> Wallis and Futuna<\/li>\n\t\t\t\t\t\t<li data-value=\"eh\"><span class=\"flag flag-eh\"><\/span> Western Sahara<\/li>\n\t\t\t\t\t\t<li data-value=\"ye\"><span class=\"flag flag-ye\"><\/span> Yemen<\/li>\n\t\t\t\t\t\t<li data-value=\"zm\"><span class=\"flag flag-zm\"><\/span> Zambia<\/li>\n\t\t\t\t\t\t<li data-value=\"zw\"><span class=\"flag flag-zw\"><\/span> Zimbabwe<\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"field w50 left\"><select id=\"custom_field_6\" name=\"custom_field_6\" placeholder=\"\u041d\u0430\u043b\u0438\u0447\u0438\u0435 \u0432\u0438\u0437\u044b \u0432 \u041a\u0430\u043d\u0430\u0434\u0443\" data-rule-required=\"false\">\n\t\t\t    <option value=\"\">Visa to Canada *<\/option>\n\t\t\t    <option value=\"Yes\">Yes<\/option>\n\t\t\t    <option value=\"No\">No<\/option>\n\t\t    <\/select><\/div>\n\t\t\t<div class=\"field w50 right\">\n\t\t\t\t<input id=\"custom_field_2\" name=\"custom_field_2\" required=\"required\" type=\"text\" placeholder=\" \">\n\t\t\t\t<div id=\"request\" class=\"request-container\">\n\t\t\t\t\t<div id=\"if\" class=\"input-field\">The purpose of your appeal *<\/div>\n\t\t\t\t\t<div class=\"close\"><\/div>\n\t\t\t\t\t<ul id=\"sw\" class=\"pick-list\">\n\t\t\t\t\t\t<li data-value=\"Childbirth\">Childbirth<\/li>\n\t\t\t\t\t\t<li data-value=\"Studying\">Study<\/li>\n\t\t\t\t\t\t<li data-value=\"Immigration\">Immigration<\/li>\n\t\t\t\t\t\t<li data-value=\"Other\">Other<\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t<div class=\"pick-hint\">Select one or more values<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"secondary-info\">\n\t\t\t<div class=\"description\"><em>This information will be needed to determine your chances of obtaining a visa<\/em><\/div>\n\t\t\t<div class=\"field w50 left\"><select id=\"custom_field_7\" name=\"custom_field_7\" placeholder=\"\u041e\u0442\u043a\u0430\u0437\u044b\u0432\u0430\u043b\u0438 \u043b\u0438 \u0432\u0430\u043c \u0432 \u0432\u044b\u0434\u0430\u0447\u0435 \u0432\u0438\u0437\u044b \u0438\u043b\u0438 \u0432\u044a\u0435\u0437\u0434\u0435 \u041a\u0430\u043d\u0430\u0434\u0443 \u0438\u043b\u0438 \u043b\u044e\u0431\u0443\u044e \u0434\u0440\u0443\u0433\u0443\u044e \u0441\u0442\u0440\u0430\u043d\u0443?\" data-rule-required=\"false\">\n\t\t\t    <option value=\"\">Have you ever been refused a visa?<\/option>\n\t\t\t    <option value=\"Yes\">Yes<\/option>\n\t\t\t    <option value=\"No\">No<\/option>\n\t\t    <\/select><\/div>\n\t\t    <div class=\"field w50 right\"><select id=\"custom_field_11\" name=\"custom_field_11\" placeholder=\"\u0423\u0440\u043e\u0432\u0435\u043d\u044c \u0432\u043b\u0430\u0434\u0435\u043d\u0438\u044f \u0410\u043d\u0433\u043b\u0438\u0439\u0441\u043a\u0438\u043c \u044f\u0437\u044b\u043a\u043e\u043c\" data-rule-required=\"false\">\n\t\t\t    <option value=\"\">English Proficiency Level<\/option>\n\t\t\t    <option value=\"Do not speak\">I don't.<\/option>\n\t\t\t    <option value=\"Beginner\">Elementary (with dictionary)<\/option>\n\t\t\t    <option value=\"Conversational\">Talking<\/option>\n\t\t\t    <option value=\"Advanced\">Advanced<\/option>\n\t\t\t    <option value=\"Narrator\">Carrier<\/option>\n\t\t    <\/select><\/div>\n\t\t    <div class=\"field w50 left\"><input type=\"text\" name=\"custom_field_9\" value=\"\" id=\"custom_field_9\" placeholder=\"Average salary or income per month\"><\/div>\n\t\t    <div class=\"field w50 right\"><input type=\"text\" name=\"custom_field_10\" value=\"\" id=\"custom_field_10\" placeholder=\"Scope of work\"><\/div>\n\t\t    <div class=\"field w50 left\"><input type=\"text\" name=\"custom_field_65\" value=\"\" id=\"custom_field_65\" placeholder=\"Company or business name\"><\/div>\n\t\t    <div class=\"field w50 right\">\n\t\t\t    <input type=\"date\" name=\"custom_field_66\" value=\"\" id=\"custom_field_66\" placeholder=\" \"><label for=\"custom_field_66\">Date of birth<\/label>\n\t\t\t    <input type=\"hidden\" name=\"custom_field_12\" value=\"\" id=\"custom_field_12\" placeholder=\"Your age (number)\">\n\t\t    <\/div>\n\t\t    <div class=\"field w50 left\"><input type=\"text\" name=\"custom_field_67\" value=\"\" id=\"custom_field_67\" placeholder=\"Country of birth\"><\/div>\n\t\t    <div class=\"field w50 right\"><input type=\"text\" name=\"custom_field_68\" value=\"\" id=\"custom_field_68\" placeholder=\"City of birth\"><\/div>\n\t\t    <div class=\"field w100\"><textarea name=\"custom_field_69\" cols=\"20\" rows=\"10\" id=\"custom_field_69\" placeholder=\"Validity of the passport and the issuing authority\"><\/textarea><\/div>\n\t\t    <div class=\"field w100\"><textarea name=\"custom_field_8\" cols=\"20\" rows=\"10\" id=\"custom_field_8\" placeholder=\"Countries you have visited in the last 10 years\"><\/textarea><\/div>\n\t\t    <div class=\"field w50 left\"><select id=\"custom_field_70\" name=\"custom_field_70\" placeholder=\"\u0421\u0435\u043c\u0435\u0439\u043d\u043e\u0435 \u043f\u043e\u043b\u043e\u0436\u0435\u043d\u0438\u0435\" data-rule-required=\"false\">\n\t\t\t    <option value=\"\">Marital status<\/option>\n\t\t\t    <option value=\"Married\">In marriage.<\/option>\n\t\t\t    <option value=\"Single\">Single<\/option>\n\t\t    <\/select><\/div>\n\t\t    <div class=\"field w50 right\"><input type=\"text\" name=\"custom_field_71\" value=\"\" id=\"custom_field_71\" placeholder=\"Previously used surnames\/names\"><\/div>\n\t\t    <div class=\"field w50 left\"><input type=\"text\" name=\"custom_field_63\" value=\"\" id=\"custom_field_63\" placeholder=\"Relatives in Canada\"><\/div>\n\t\t    <div class=\"field w50 right\"><select id=\"custom_field_72\" name=\"custom_field_72\" placeholder=\"\u0415\u0441\u0442\u044c \u043b\u0438 \u0443 \u0432\u0430\u0441 \u0434\u0435\u0442\u0438?\" data-rule-required=\"false\">\n\t\t\t    <option value=\"\">Do you have children?<\/option>\n\t\t\t    <option value=\"Yes\">Yes<\/option>\n\t\t\t    <option value=\"No\">No<\/option>\n\t\t    <\/select><\/div>\n\t\t    <div class=\"field w100\"><textarea name=\"custom_field_73\" cols=\"20\" rows=\"10\" id=\"custom_field_73\" placeholder=\"Information about children: Name - Date and country of birth - Address of residence\"><\/textarea><\/div>\n\t\t<\/div>\n\t\t<div class=\"validate\">Please fill in the required fields<\/div>\n\t\t<button type=\"submit\" id=\"submit\">Send<\/button>\n\t<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Dear customers, for more detailed consideration of your question - please fill out this form. Personal data provided by Users are confidential information and are not subject to disclosure. First Name * Last Name * Email * Phone Number * Enter contact phone number in international format. For example: +1234567890 Country of stay * Afghanistan Aland Islands Albania Albania Algeria American Samoa Andorra Angola Anguilla [...]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"_links":{"self":[{"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/pages\/660"}],"collection":[{"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/comments?post=660"}],"version-history":[{"count":62,"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/pages\/660\/revisions"}],"predecessor-version":[{"id":954,"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/pages\/660\/revisions\/954"}],"wp:attachment":[{"href":"https:\/\/canadamama.ca\/en\/wp-json\/wp\/v2\/media?parent=660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}