{"id":3555,"date":"2021-10-19T01:39:03","date_gmt":"2021-10-18T18:39:03","guid":{"rendered":"https:\/\/phaphoiquanam.com\/?page_id=3555"},"modified":"2023-10-26T10:43:57","modified_gmt":"2023-10-26T03:43:57","slug":"registration-praying-for-wellness-deceased","status":"publish","type":"page","link":"https:\/\/phaphoiquanam.com\/en\/registration\/registration-praying-for-wellness-deceased\/","title":{"rendered":"Registration Praying For Wellness,  Deceased"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3555\" class=\"elementor elementor-3555 elementor-3550\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-19972fa register-top elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"19972fa\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cd9f1d1\" data-id=\"cd9f1d1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-0282887 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0282887\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-c6b7b97 get-witdh-menu\" data-id=\"c6b7b97\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4bc2151 title title-small elementor-widget elementor-widget-heading\" data-id=\"4bc2151\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Registration<b><br> World Peace Gathering<\/b><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-80fe2e1 has-line  elementor-hidden-phone elementor-widget elementor-widget-spacer\" data-id=\"80fe2e1\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3fe1eb4 menu-program elementor-hidden-phone elementor-widget elementor-widget-wp-widget-nav_menu\" data-id=\"3fe1eb4\" data-element_type=\"widget\" id=\"menuProgram\" data-widget_type=\"wp-widget-nav_menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<nav class=\"menu-menu-register-program-en-container\" aria-label=\"Menu\"><ul id=\"menu-menu-register-program-en\" class=\"menu\"><li id=\"menu-item-2950\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2950\"><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-world-peace-gathering\/\">Registration World Peace Gathering<\/a><\/li>\n<li id=\"menu-item-3562\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3562\"><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-praying-for-wellness-deceased\/\">Praying For Wellness, Deceased<\/a><\/li>\n<li id=\"menu-item-2948\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2948\"><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-temporary-leaving-home-monk-nun\/\">Registration  Temporary Leaving-Home Monk\/Nun<\/a><\/li>\n<li id=\"menu-item-2947\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2947\"><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-bodhisattva-supporter\/\">Registration Bodhisattva Supporter<\/a><\/li>\n<\/ul><\/nav>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b41dfa3 elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-shortcode\" data-id=\"b41dfa3\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"dropdown-menu-page\"><div class=\"dropdown\"><button onclick=\"myFunction()\" class=\"dropbtn\">Praying For Wellness, Deceased<\/button><div id=\"myDropdown\" class=\"dropdown-content\"><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-world-peace-gathering\/\" class=\"menu-item \" >Registration World Peace Gathering<\/a><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-praying-for-wellness-deceased\/\" class=\"menu-item active\" >Praying For Wellness, Deceased<\/a><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-temporary-leaving-home-monk-nun\/\" class=\"menu-item \" >Registration  Temporary Leaving-Home Monk\/Nun<\/a><a href=\"https:\/\/phaphoiquanam.com\/en\/registration\/registration-bodhisattva-supporter\/\" class=\"menu-item \" >Registration Bodhisattva Supporter<\/a><\/div><\/div><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-94578d7\" data-id=\"94578d7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0f7bede slider-program elementor-pagination-position-outside elementor-widget elementor-widget-image-carousel\" data-id=\"0f7bede\" data-element_type=\"widget\" data-settings=\"{&quot;slides_to_show&quot;:&quot;1&quot;,&quot;navigation&quot;:&quot;dots&quot;,&quot;autoplay_speed&quot;:3000,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;infinite&quot;:&quot;yes&quot;,&quot;effect&quot;:&quot;slide&quot;,&quot;speed&quot;:500}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-carousel-wrapper swiper-container\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper\">\n\t\t\t\t<div class=\"swiper-slide\"><figure class=\"swiper-slide-inner\"><img class=\"swiper-slide-image\" src=\"https:\/\/phaphoiquanam.com\/wp-content\/uploads\/2021\/10\/nd-1.jpeg\" alt=\"nd-1\" \/><\/figure><\/div>\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0d8dc03 mb-md-58 register-location elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0d8dc03\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-545701d\" data-id=\"545701d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8c9ddfd line-enter elementor-widget elementor-widget-spacer\" data-id=\"8c9ddfd\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3138cd4 register-information elementor-view-default elementor-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"3138cd4\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span class=\"elementor-icon elementor-animation-\" >\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M12 19C12.1978 19 12.3911 18.9414 12.5556 18.8315C12.72 18.7216 12.8482 18.5654 12.9239 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>26\/11-05\/12-2022<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-602449b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"602449b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-daca3d2 green-box-program green-box-program-310\" data-id=\"daca3d2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-76d0c96 register-information elementor-view-default elementor-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"76d0c96\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span class=\"elementor-icon elementor-animation-\" >\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M21 10C21 17 12 23 12 23C12 23 3 17 3 10C3 7.61305 3.94821 5.32387 5.63604 3.63604C7.32387 1.94821 9.61305 1 12 1C14.3869 1 16.6761 1.94821 18.364 3.63604C20.0518 5.32387 21 7.61305 21 10Z\" stroke=\"white\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><path d=\"M12 13C13.6569 13 15 11.6569 15 10C15 8.34315 13.6569 7 12 7C10.3431 7 9 8.34315 9 10C9 11.6569 10.3431 13 12 13Z\" stroke=\"white\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\t\t\t\t<p class=\"elementor-icon-box-title\">\n\t\t\t\t\t<span >Anaheim Convention Center<br\/>800 W Katella Ave.,<br\/>Anaheim, CA 9280277584<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6822b55\" data-id=\"6822b55\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5458299 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5458299\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-76f1311\" data-id=\"76f1311\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-687905f\" data-id=\"687905f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ddf355f elementor-widget elementor-widget-shortcode\" data-id=\"ddf355f\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\n\t<form class=\"wellness-deceased-register\" method=\"post\" enctype=\"multipart\/form-data\" action=\"POST\">\n\t\t<input type=\"hidden\" name=\"cf7wellness\" value=\"3711\">\n\t\t<input type=\"hidden\" name=\"cf7deceased\" value=\"3712\">\n\t\t<h5 class=\"title-register\">Register names for \u201dPrayer for Wellness\u201d<\/h5>\n\t\t<div class=\"container-register\" data-target=\"true\">\n\t\t\t<button type=\"button\" class=\"btn-collapser\" data-target=\"true\"><span class=\"text-desc\">Shrink<\/span> <span class=\"icon-collapser\"><\/span><\/button>\n\t\t\t<h4 class=\"title-register\">Prayer for Wellness<\/h4>\n\t\t\t<p class=\"sub-register\">(Accept photos in portrait format; .jpg, .png file only)<\/p>\n\t\t\t<div class=\"container-collapser\">\n\t\t\t\t<div class=\"group-register group-register-wellness divTable\">\n\t\t\t\t\t<div class=\"divTableRow is-pc\">\n\t\t\t\t\t\t<div class=\"divTableCell\"><\/div>\n\t\t\t\t\t\t<div class=\"divTableCell\">Full Name<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Age<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Dharma Name<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Living in<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Photo<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div class=\"register divTableRow\">\n\t\t\t\t\t\t<div class=\"divTableCell cellNumber\">\n\t\t\t\t\t\t\t1\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Full Name<\/label>\n\t\t\t\t\t\t\t<div class=\"row no-gutters\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col pr-1\"><input type=\"text\" class=\"form-control form-control-name\" placeholder=\"First Name\" name=\"first_name[0]\"><\/div>\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"col pl-1\"><input type=\"text\" class=\"form-control form-control-name\" placeholder=\"Last Name\" name=\"last_name[0]\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Age<\/label>\n\t\t\t\t\t\t\t<input type=\"number\"  class=\"form-control form-control-age\" placeholder=\"Age\" name=\"your_age[0]\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Dharma Name<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" placeholder=\"Dharma Name\" name=\"religious[0]\">\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<div class=\"form-group  form-group-select divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Living in<\/label>\n\t\t\t\t\t\t\t<select name=\"nation[0]\" class=\"form-control form-select2\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\"  >Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"land Islands\"  >land Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Albania\"  >Albania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Algeria\"  >Algeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"American Samoa\"  >American Samoa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"AndorrA\"  >AndorrA<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Angola\"  >Angola<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Anguilla\"  >Anguilla<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Antarctica\"  >Antarctica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda\"  >Antigua and Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Argentina\"  >Argentina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Armenia\"  >Armenia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Aruba\"  >Aruba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Australia\"  >Australia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Austria\"  >Austria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan\"  >Azerbaijan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bahamas\"  >Bahamas<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bahrain\"  >Bahrain<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh\"  >Bangladesh<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Barbados\"  >Barbados<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belarus\"  >Belarus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belgium\"  >Belgium<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belize\"  >Belize<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Benin\"  >Benin<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bermuda\"  >Bermuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bhutan\"  >Bhutan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bolivia\"  >Bolivia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina\"  >Bosnia and Herzegovina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Botswana\"  >Botswana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bouvet Island\"  >Bouvet Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Brazil\"  >Brazil<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"British Indian Ocean Territory\"  >British Indian Ocean Territory<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Brunei Darussalam\"  >Brunei Darussalam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria\"  >Bulgaria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Burkina Faso\"  >Burkina Faso<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Burundi\"  >Burundi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cambodia\"  >Cambodia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cameroon\"  >Cameroon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Canada\"  >Canada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cape Verde\"  >Cape Verde<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cayman Islands\"  >Cayman Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Central African Republic\"  >Central African Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Chad\"  >Chad<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Chile\"  >Chile<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"China\"  >China<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Christmas Island\"  >Christmas Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cocos (Keeling) Islands\"  >Cocos (Keeling) Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Colombia\"  >Colombia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Comoros\"  >Comoros<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Congo\"  >Congo<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Congo, The Democratic Republic of the\"  >Congo, The Democratic Republic of the<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cook Islands\"  >Cook Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Costa Rica\"  >Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cote D\"Ivoire\"  >Cote D\"Ivoire<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Croatia\"  >Croatia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cuba\"  >Cuba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cyprus\"  >Cyprus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Czech Republic\"  >Czech Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Denmark\"  >Denmark<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Djibouti\"  >Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Dominica\"  >Dominica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Dominican Republic\"  >Dominican Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ecuador\"  >Ecuador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Egypt\"  >Egypt<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"El Salvador\"  >El Salvador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Equatorial Guinea\"  >Equatorial Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Eritrea\"  >Eritrea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Estonia\"  >Estonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia\"  >Ethiopia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Falkland Islands (Malvinas)\"  >Falkland Islands (Malvinas)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Faroe Islands\"  >Faroe Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Fiji\"  >Fiji<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Finland\"  >Finland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"France\"  >France<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Guiana\"  >French Guiana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Polynesia\"  >French Polynesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Southern Territories\"  >French Southern Territories<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gabon\"  >Gabon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gambia\"  >Gambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Georgia\"  >Georgia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Germany\"  >Germany<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ghana\"  >Ghana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gibraltar\"  >Gibraltar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Greece\"  >Greece<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Greenland\"  >Greenland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Grenada\"  >Grenada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guadeloupe\"  >Guadeloupe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guam\"  >Guam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guatemala\"  >Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guernsey\"  >Guernsey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guinea\"  >Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau\"  >Guinea-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guyana\"  >Guyana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Haiti\"  >Haiti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Heard Island and Mcdonald Islands\"  >Heard Island and Mcdonald Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Holy See (Vatican City State)\"  >Holy See (Vatican City State)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Honduras\"  >Honduras<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hong Kong\"  >Hong Kong<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hungary\"  >Hungary<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iceland\"  >Iceland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"India\"  >India<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Indonesia\"  >Indonesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iran, Islamic Republic Of\"  >Iran, Islamic Republic Of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iraq\"  >Iraq<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ireland\"  >Ireland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Isle of Man\"  >Isle of Man<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Israel\"  >Israel<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Italy\"  >Italy<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jamaica\"  >Jamaica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Japan\"  >Japan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jersey\"  >Jersey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jordan\"  >Jordan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan\"  >Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kenya\"  >Kenya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kiribati\"  >Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Korea, Democratic People\"S Republic of\"  >Korea, Democratic People\"S Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Korea, Republic of\"  >Korea, Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kuwait\"  >Kuwait<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan\"  >Kyrgyzstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lao People\"S Democratic Republic\"  >Lao People\"S Democratic Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Latvia\"  >Latvia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lebanon\"  >Lebanon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lesotho\"  >Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Liberia\"  >Liberia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Libyan Arab Jamahiriya\"  >Libyan Arab Jamahiriya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein\"  >Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lithuania\"  >Lithuania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg\"  >Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macao\"  >Macao<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macedonia, The Former Yugoslav Republic of\"  >Macedonia, The Former Yugoslav Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Madagascar\"  >Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malawi\"  >Malawi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malaysia\"  >Malaysia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Maldives\"  >Maldives<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mali\"  >Mali<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malta\"  >Malta<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands\"  >Marshall Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Martinique\"  >Martinique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mauritania\"  >Mauritania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mauritius\"  >Mauritius<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mayotte\"  >Mayotte<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mexico\"  >Mexico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Micronesia, Federated States of\"  >Micronesia, Federated States of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Moldova, Republic of\"  >Moldova, Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Monaco\"  >Monaco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mongolia\"  >Mongolia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Montenegro\"  >Montenegro<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Montserrat\"  >Montserrat<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Morocco\"  >Morocco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mozambique\"  >Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Myanmar\"  >Myanmar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Namibia\"  >Namibia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nauru\"  >Nauru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nepal\"  >Nepal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Netherlands\"  >Netherlands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Netherlands Antilles\"  >Netherlands Antilles<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Caledonia\"  >New Caledonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Zealand\"  >New Zealand<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua\"  >Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Niger\"  >Niger<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nigeria\"  >Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Niue\"  >Niue<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Norfolk Island\"  >Norfolk Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Northern Mariana Islands\"  >Northern Mariana Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Norway\"  >Norway<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Oman\"  >Oman<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pakistan\"  >Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Palau\"  >Palau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Palestinian Territory, Occupied\"  >Palestinian Territory, Occupied<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Panama\"  >Panama<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea\"  >Papua New Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Paraguay\"  >Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Peru\"  >Peru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Philippines\"  >Philippines<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pitcairn\"  >Pitcairn<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Poland\"  >Poland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Portugal\"  >Portugal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Puerto Rico\"  >Puerto Rico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Qatar\"  >Qatar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Reunion\"  >Reunion<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Romania\"  >Romania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Russian Federation\"  >Russian Federation<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"RWANDA\"  >RWANDA<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Helena\"  >Saint Helena<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis\"  >Saint Kitts and Nevis<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia\"  >Saint Lucia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Pierre and Miquelon\"  >Saint Pierre and Miquelon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines\"  >Saint Vincent and the Grenadines<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Samoa\"  >Samoa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"San Marino\"  >San Marino<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sao Tome and Principe\"  >Sao Tome and Principe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia\"  >Saudi Arabia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Senegal\"  >Senegal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Serbia\"  >Serbia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Seychelles\"  >Seychelles<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sierra Leone\"  >Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Singapore\"  >Singapore<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Slovakia\"  >Slovakia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Slovenia\"  >Slovenia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Solomon Islands\"  >Solomon Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Somalia\"  >Somalia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Africa\"  >South Africa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Georgia and the South Sandwich Islands\"  >South Georgia and the South Sandwich Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Spain\"  >Spain<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka\"  >Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sudan\"  >Sudan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Suriname\"  >Suriname<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Svalbard and Jan Mayen\"  >Svalbard and Jan Mayen<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Swaziland\"  >Swaziland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sweden\"  >Sweden<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Switzerland\"  >Switzerland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Syrian Arab Republic\"  >Syrian Arab Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Taiwan\"  >Taiwan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan\"  >Tajikistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tanzania, United Republic of\"  >Tanzania, United Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Thailand\"  >Thailand<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Timor-Leste\"  >Timor-Leste<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Togo\"  >Togo<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tokelau\"  >Tokelau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tonga\"  >Tonga<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago\"  >Trinidad and Tobago<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tunisia\"  >Tunisia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turkey\"  >Turkey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan\"  >Turkmenistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turks and Caicos Islands\"  >Turks and Caicos Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu\"  >Tuvalu<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uganda\"  >Uganda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ukraine\"  >Ukraine<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates\"  >United Arab Emirates<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom\"  >United Kingdom<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United States\" selected=\"selected\" >United States<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United States Minor Outlying Islands\"  >United States Minor Outlying Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uruguay\"  >Uruguay<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan\"  >Uzbekistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu\"  >Vanuatu<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Venezuela\"  >Venezuela<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vi\u1ec7t Nam\"  >Vi\u1ec7t Nam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Virgin Islands, British\"  >Virgin Islands, British<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Virgin Islands, U.S.\"  >Virgin Islands, U.S.<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Wallis and Futuna\"  >Wallis and Futuna<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Western Sahara\"  >Western Sahara<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Yemen\"  >Yemen<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Zambia\"  >Zambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\"  >Zimbabwe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group form-group-upload-file divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Upload Image<\/label>\n\t\t\t\t\t\t\t<div class=\"input-file-container\">\n\t\t\t\t\t\t\t\t<input type=\"file\"  data-name=\"userpic_0\" class=\"input-file\" accept=\"image\/*\">\n\t\t\t\t\t\t\t\t<input type=\"hidden\"  name=\"userpic[0]\" class=\"userpic_0 input_userpic\">\n\t\t\t\t\t\t\t\t<label tabindex=\"0\" for=\"my-file\" class=\"input-file-trigger\">Upload<\/label>\n\t\t\t\t\t\t\t\t<div class=\"file-return\"><div class=\"filename\">file.jpg<\/div><span class=\"remove-file\"><\/span><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<!-- <div class=\"form-group form-group-action divTableCell\">\n\t\t\t\t\t\t\t<div class=\"group-action\">\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-edit edit-row\"><\/a>\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-row empty-row\">Remove<\/a>\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-row lock-row\">Keep<\/a>\n\t\t\t\t\t\t\t\t<input type=\"checkbox\" value=\"1\" class=\"check_keep\" id=\"keep_0\" name=\"keep[0]\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div> -->\n\t\t\t\t\t<\/div>  \n\t\t\t\t<\/div>   \n\t\t\t\t<button type=\"button\" class=\"btn btn-add btn-add-wellness\" data-num=\"1\">Add <span class=\"icon-plus\"><\/span><\/button>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"container-register\" data-target=\"true\">\n\t\t\t<button type=\"button\" class=\"btn-collapser\" data-target=\"true\"><span class=\"text-desc\">Shrink<\/span> <span class=\"icon-collapser\"><\/span><\/button>\n\t\t\t<h4 class=\"title-register\">Prayer for the Deceased<\/h4>\n\t\t\t<p class=\"sub-register\">(Accept photos in portrait format; .jpg, .png file only)<\/p>\n\t\t\t<div class=\"container-collapser\">\n\t\t\t\t<div class=\"group-register group-register-deceased divTable\">\n\t\t\t\t\t<div class=\"divTableRow is-pc\">\n\t\t\t\t\t\t<div class=\"divTableCell\"><\/div>\n\t\t\t\t\t\t<div class=\"divTableCell\">Full Name<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Age<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Dharma Name<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Location of death<\/div>\n\t\t\t\t\t\t<div  class=\"divTableCell\">Photo<\/div>\n\t\t\t\t\t\t<!-- <div  class=\"divTableCell\"><\/div> -->\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"register divTableRow\">\n\t\t\t\t\t\t<div class=\"divTableCell cellNumber\">\n\t\t\t\t\t\t\t1\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Full Name<\/label>\n\t\t\t\t\t\t\t<div class=\"row no-gutters\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col pr-1\"><input type=\"text\" class=\"form-control form-control-name\" placeholder=\"First Name\" name=\"first_name_deceased[0]\"><\/div>\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"col pl-1\"><input type=\"text\" class=\"form-control form-control-name\" placeholder=\"Last Name\" name=\"last_name_deceased[0]\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Age<\/label>\n\t\t\t\t\t\t\t<input type=\"number\"  class=\"form-control form-control-age\" placeholder=\"Age\" name=\"your_age_deceased[0]\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Dharma Name<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" placeholder=\"Dharma Name\" name=\"religious_deceased[0]\">\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<div class=\"form-group form-group-select divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Died at<\/label>\n\t\t\t\t\t\t\t<select name=\"nation_deceased[0]\" class=\"form-control form-select2\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\"  >Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"land Islands\"  >land Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Albania\"  >Albania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Algeria\"  >Algeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"American Samoa\"  >American Samoa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"AndorrA\"  >AndorrA<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Angola\"  >Angola<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Anguilla\"  >Anguilla<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Antarctica\"  >Antarctica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda\"  >Antigua and Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Argentina\"  >Argentina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Armenia\"  >Armenia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Aruba\"  >Aruba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Australia\"  >Australia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Austria\"  >Austria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan\"  >Azerbaijan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bahamas\"  >Bahamas<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bahrain\"  >Bahrain<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh\"  >Bangladesh<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Barbados\"  >Barbados<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belarus\"  >Belarus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belgium\"  >Belgium<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Belize\"  >Belize<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Benin\"  >Benin<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bermuda\"  >Bermuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bhutan\"  >Bhutan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bolivia\"  >Bolivia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina\"  >Bosnia and Herzegovina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Botswana\"  >Botswana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bouvet Island\"  >Bouvet Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Brazil\"  >Brazil<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"British Indian Ocean Territory\"  >British Indian Ocean Territory<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Brunei Darussalam\"  >Brunei Darussalam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria\"  >Bulgaria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Burkina Faso\"  >Burkina Faso<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Burundi\"  >Burundi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cambodia\"  >Cambodia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cameroon\"  >Cameroon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Canada\"  >Canada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cape Verde\"  >Cape Verde<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cayman Islands\"  >Cayman Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Central African Republic\"  >Central African Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Chad\"  >Chad<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Chile\"  >Chile<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"China\"  >China<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Christmas Island\"  >Christmas Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cocos (Keeling) Islands\"  >Cocos (Keeling) Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Colombia\"  >Colombia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Comoros\"  >Comoros<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Congo\"  >Congo<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Congo, The Democratic Republic of the\"  >Congo, The Democratic Republic of the<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cook Islands\"  >Cook Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Costa Rica\"  >Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cote D\"Ivoire\"  >Cote D\"Ivoire<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Croatia\"  >Croatia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cuba\"  >Cuba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Cyprus\"  >Cyprus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Czech Republic\"  >Czech Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Denmark\"  >Denmark<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Djibouti\"  >Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Dominica\"  >Dominica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Dominican Republic\"  >Dominican Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ecuador\"  >Ecuador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Egypt\"  >Egypt<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"El Salvador\"  >El Salvador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Equatorial Guinea\"  >Equatorial Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Eritrea\"  >Eritrea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Estonia\"  >Estonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia\"  >Ethiopia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Falkland Islands (Malvinas)\"  >Falkland Islands (Malvinas)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Faroe Islands\"  >Faroe Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Fiji\"  >Fiji<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Finland\"  >Finland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"France\"  >France<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Guiana\"  >French Guiana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Polynesia\"  >French Polynesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"French Southern Territories\"  >French Southern Territories<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gabon\"  >Gabon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gambia\"  >Gambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Georgia\"  >Georgia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Germany\"  >Germany<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ghana\"  >Ghana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Gibraltar\"  >Gibraltar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Greece\"  >Greece<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Greenland\"  >Greenland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Grenada\"  >Grenada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guadeloupe\"  >Guadeloupe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guam\"  >Guam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guatemala\"  >Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guernsey\"  >Guernsey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guinea\"  >Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau\"  >Guinea-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Guyana\"  >Guyana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Haiti\"  >Haiti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Heard Island and Mcdonald Islands\"  >Heard Island and Mcdonald Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Holy See (Vatican City State)\"  >Holy See (Vatican City State)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Honduras\"  >Honduras<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hong Kong\"  >Hong Kong<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hungary\"  >Hungary<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iceland\"  >Iceland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"India\"  >India<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Indonesia\"  >Indonesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iran, Islamic Republic Of\"  >Iran, Islamic Republic Of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Iraq\"  >Iraq<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ireland\"  >Ireland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Isle of Man\"  >Isle of Man<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Israel\"  >Israel<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Italy\"  >Italy<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jamaica\"  >Jamaica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Japan\"  >Japan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jersey\"  >Jersey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Jordan\"  >Jordan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan\"  >Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kenya\"  >Kenya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kiribati\"  >Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Korea, Democratic People\"S Republic of\"  >Korea, Democratic People\"S Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Korea, Republic of\"  >Korea, Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kuwait\"  >Kuwait<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan\"  >Kyrgyzstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lao People\"S Democratic Republic\"  >Lao People\"S Democratic Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Latvia\"  >Latvia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lebanon\"  >Lebanon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lesotho\"  >Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Liberia\"  >Liberia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Libyan Arab Jamahiriya\"  >Libyan Arab Jamahiriya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein\"  >Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lithuania\"  >Lithuania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg\"  >Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macao\"  >Macao<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macedonia, The Former Yugoslav Republic of\"  >Macedonia, The Former Yugoslav Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Madagascar\"  >Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malawi\"  >Malawi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malaysia\"  >Malaysia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Maldives\"  >Maldives<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mali\"  >Mali<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Malta\"  >Malta<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands\"  >Marshall Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Martinique\"  >Martinique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mauritania\"  >Mauritania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mauritius\"  >Mauritius<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mayotte\"  >Mayotte<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mexico\"  >Mexico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Micronesia, Federated States of\"  >Micronesia, Federated States of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Moldova, Republic of\"  >Moldova, Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Monaco\"  >Monaco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mongolia\"  >Mongolia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Montenegro\"  >Montenegro<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Montserrat\"  >Montserrat<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Morocco\"  >Morocco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Mozambique\"  >Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Myanmar\"  >Myanmar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Namibia\"  >Namibia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nauru\"  >Nauru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nepal\"  >Nepal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Netherlands\"  >Netherlands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Netherlands Antilles\"  >Netherlands Antilles<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Caledonia\"  >New Caledonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"New Zealand\"  >New Zealand<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua\"  >Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Niger\"  >Niger<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Nigeria\"  >Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Niue\"  >Niue<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Norfolk Island\"  >Norfolk Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Northern Mariana Islands\"  >Northern Mariana Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Norway\"  >Norway<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Oman\"  >Oman<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pakistan\"  >Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Palau\"  >Palau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Palestinian Territory, Occupied\"  >Palestinian Territory, Occupied<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Panama\"  >Panama<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea\"  >Papua New Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Paraguay\"  >Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Peru\"  >Peru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Philippines\"  >Philippines<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pitcairn\"  >Pitcairn<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Poland\"  >Poland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Portugal\"  >Portugal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Puerto Rico\"  >Puerto Rico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Qatar\"  >Qatar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Reunion\"  >Reunion<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Romania\"  >Romania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Russian Federation\"  >Russian Federation<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"RWANDA\"  >RWANDA<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Helena\"  >Saint Helena<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis\"  >Saint Kitts and Nevis<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia\"  >Saint Lucia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Pierre and Miquelon\"  >Saint Pierre and Miquelon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines\"  >Saint Vincent and the Grenadines<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Samoa\"  >Samoa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"San Marino\"  >San Marino<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sao Tome and Principe\"  >Sao Tome and Principe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia\"  >Saudi Arabia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Senegal\"  >Senegal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Serbia\"  >Serbia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Seychelles\"  >Seychelles<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sierra Leone\"  >Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Singapore\"  >Singapore<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Slovakia\"  >Slovakia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Slovenia\"  >Slovenia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Solomon Islands\"  >Solomon Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Somalia\"  >Somalia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Africa\"  >South Africa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"South Georgia and the South Sandwich Islands\"  >South Georgia and the South Sandwich Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Spain\"  >Spain<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka\"  >Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sudan\"  >Sudan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Suriname\"  >Suriname<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Svalbard and Jan Mayen\"  >Svalbard and Jan Mayen<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Swaziland\"  >Swaziland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Sweden\"  >Sweden<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Switzerland\"  >Switzerland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Syrian Arab Republic\"  >Syrian Arab Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Taiwan\"  >Taiwan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan\"  >Tajikistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tanzania, United Republic of\"  >Tanzania, United Republic of<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Thailand\"  >Thailand<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Timor-Leste\"  >Timor-Leste<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Togo\"  >Togo<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tokelau\"  >Tokelau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tonga\"  >Tonga<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago\"  >Trinidad and Tobago<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tunisia\"  >Tunisia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turkey\"  >Turkey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan\"  >Turkmenistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Turks and Caicos Islands\"  >Turks and Caicos Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu\"  >Tuvalu<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uganda\"  >Uganda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Ukraine\"  >Ukraine<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates\"  >United Arab Emirates<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom\"  >United Kingdom<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United States\" selected=\"selected\" >United States<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"United States Minor Outlying Islands\"  >United States Minor Outlying Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uruguay\"  >Uruguay<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan\"  >Uzbekistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu\"  >Vanuatu<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Venezuela\"  >Venezuela<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vi\u1ec7t Nam\"  >Vi\u1ec7t Nam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Virgin Islands, British\"  >Virgin Islands, British<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Virgin Islands, U.S.\"  >Virgin Islands, U.S.<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Wallis and Futuna\"  >Wallis and Futuna<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Western Sahara\"  >Western Sahara<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Yemen\"  >Yemen<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Zambia\"  >Zambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\"  >Zimbabwe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t<div class=\"checkbox-covid\">\n\t\t\t\t\t\t\t\t<div class=\"checkbox-list-item\">\n\t\t\t\t\t\t\t\t\t<label>\n\t\t\t\t\t\t\t\t\t<input type=\"checkbox\" name=\"die_by_deceased[0]\" value=\"1\">\n\t\t\t\t\t\t\t\t\t<span class=\"checkbox-list-item-label\">Died due to COVID-19<\/span><\/label>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<label class=\"is-sp\">Upload Image<\/label>\n\t\t\t\t\t\t\t<div class=\"input-file-container\">\n\t\t\t\t\t\t\t\t<input type=\"file\"  data-name=\"userpic_deceased_0\" class=\"input-file\" accept=\"image\/*\">\n\t\t\t\t\t\t\t\t<input type=\"hidden\"  name=\"userpic_deceased[0]\" class=\"userpic_deceased_0 input_userpic\">\n\t\t\t\t\t\t\t\t<label tabindex=\"0\" for=\"my-file\" class=\"input-file-trigger\">Upload<\/label>\n\t\t\t\t\t\t\t\t<div class=\"file-return\"><div class=\"filename\">file.jpg<\/div><span class=\"remove-file\"><\/span><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<!-- <div class=\"form-group divTableCell\">\n\t\t\t\t\t\t\t<div class=\"group-action\">\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-edit edit-row\"><\/a>\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-row empty-row\">Remove<\/a>\n\t\t\t\t\t\t\t\t<a href=\"javascript: void(0)\" class=\"atc-row lock-row\">Keep<\/a>\n\t\t\t\t\t\t\t\t<input type=\"checkbox\" value=\"1\" class=\"check_keep\" id=\"keep_deceased_0\" name=\"keep_deceased[0]\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div> -->\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\n\t\t\t\t<\/div>   \n\t\t\t\t<button type=\"button\" class=\"btn btn-add btn-add-deceased\" data-num=\"1\">Add <span class=\"icon-plus\"><\/span><\/button>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\n\t\t<div class=\"form-group mb-30\">\n\t\t\t<label for=\"note\" class=\"bold green\">Notes\/Comments<\/label>\n\t\t\t<textarea class=\"form-control\" cols=\"3\" name=\"note\"><\/textarea>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\n\t\t<div class=\"container-form-butotn-submit\">\n\t\t\t<button type=\"button\" class=\"btn btn-register-wellness-deceased\" id=\"btnShowList\">Registration<\/button>\n\t\t\t<input type=\"submit\" name=\"submitbtn\" id=\"submitBtn\" value=\"Registration\" class=\"btn btn-register-wellness-deceased d-none\">\n\t\t\t\n\t\t<\/div>\n\t\t\n\t<\/form>\n\n\n\t<div class=\"remodal modal-show-register\" id=\"\" data-remodal-id=\"modalregister\" role=\"dialog\" aria-labelledby=\"modalregisterTitle\" aria-describedby=\"modalregisterDesc\">\n\t\t<button data-remodal-action=\"close\" class=\"remodal-close\" aria-label=\"Close\"><\/button>\n\t\t<h2 class=\"title\">Register names for \u201dPrayer for Wellness\u201d<\/h2>\n\t\t<div class=\"modal-body\">\n\t\t\t<h3 class=\"title\">Prayer for Wellness<\/h3>\n\t\t\t<table class=\"table-register table-wellness\">\n\t\t\t\t<thead>\n\t\t\t\t\t<tr>\n\t\t\t\t\t\t<th>Full Name<\/th>\n\t\t\t\t\t\t<th>Age<\/th>\n\t\t\t\t\t\t<th>Dharma Name<\/th>\n\t\t\t\t\t\t<th>Living in<\/th>\n\t\t\t\t\t\t<th>Photo<\/th>\n\t\t\t\t\t<\/tr>\n\t\t\t\t<\/thead>\n\t\t\t\t<tbody>\n\t\t\t\t\n\t\t\t\t<\/tbody>\n\t\t\t<\/table>\n\t\t\t\n\n\t\t\t<h3 class=\"title\">Prayer for the Deceased<\/h3>\n\t\t\t<table class=\"table-register table-deceased\">\n\t\t\t\t<thead>\n\t\t\t\t\t<tr>\n\t\t\t\t\t\t<th>Full Name<\/th>\n\t\t\t\t\t\t<th>Age<\/th>\n\t\t\t\t\t\t<th>Dharma Name<\/th>\n\t\t\t\t\t\t<th>Location of death<\/th>\n\t\t\t\t\t\t<th>Photo<\/th>\n\t\t\t\t\t<\/tr>\n\t\t\t\t<\/thead>\n\t\t\t\t<tbody>\n\t\t\t\t\t\n\t\t\t\t<\/tbody>\n\t\t\t<\/table>\n\t\t<\/div>\n\t\t<div class=\"modal-footer modal-footer-register-wellness-deceased\">\n\t\t\t<button type=\"button\" class=\"btn btn-crop\" id=\"btnSaveData\">Registration<\/button>\n\t\t\t<button type=\"button\" class=\"btn btn-secondary\" data-remodal-action=\"cancel\" >Cancel<\/button>\n\t\t\t<span class=\"ajax-loader\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\t\n\t\n\t<div class=\"remodal modal-crop-image\" id=\"\" data-remodal-id=\"modal\" role=\"dialog\" aria-labelledby=\"modal1Title\" aria-describedby=\"modal1Desc\">\n\t\t<button data-remodal-action=\"close\" class=\"remodal-close\" aria-label=\"Close\"><\/button>\n\t\t<button type=\"button\" id=\"rotate\" class=\"btn btn-rotate\">\n\t\t\t<span class=\"fa fa-redo-alt\"><\/span>\n\t\t<\/button>\n\t\t<div class=\"modal-body\">\n\t\t\t<div class=\"img-container\">\n\t\t\t\t<img src=\"\" id=\"sample_image\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"modal-footer\">\n\t\t\t\n\t\t\t<button type=\"button\" id=\"crop\" class=\"btn btn-crop\" data-remodal-action=\"confirm\">Crop<\/button>\n\t\t\t<button type=\"button\" class=\"btn btn-secondary\" data-remodal-action=\"cancel\" >Cancel<\/button>\n\t\t<\/div>\n\t<\/div>\t\t\t\t\t\t\t\t\t\n\n\t\t<div class=\"elementor-shortcode\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Registration World Peace Gathering 26\/11-05\/12-2022 Anaheim Convention Center800 W Katella Ave.,Anaheim, CA 9280277584<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2849,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-registration.php","meta":[],"_links":{"self":[{"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/pages\/3555"}],"collection":[{"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/comments?post=3555"}],"version-history":[{"count":40,"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/pages\/3555\/revisions"}],"predecessor-version":[{"id":5149,"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/pages\/3555\/revisions\/5149"}],"up":[{"embeddable":true,"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/pages\/2849"}],"wp:attachment":[{"href":"https:\/\/phaphoiquanam.com\/en\/wp-json\/wp\/v2\/media?parent=3555"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}