<a?php
header('Cache-Control: no-cache');
header('Pragma: no-cache');
//added this session start to access session across pages. Had issue when moved to php7.2
session_start();
$uri_pathh = parse_url($_SERVER['REQUEST_URI'], PHP_URL_PATH);
$uri_segmentss = explode('/', $uri_pathh);
//print_r($uri_segmentss[1]);
if($uri_segmentss[1] =='' || $uri_segmentss[1] =='index.php'){
	$key='Postgraduate program, Social entrepreneurship India, Leadership training, Leadership training program, masters in the development sector of India, Transforming India Initiative, ALC India, TII fellowship program, Entrepreneurship training, Entrepreneurship training program';
	$des='Transforming India Initiative is a 2-year fellowship program, focus on providing entrepreneurship training to solve challenges faced by the country today';
}else if($uri_segmentss[1] =='FAQ.php'){
	$key='Frequently asked questions TII, FAQ’s TII, postgraduate social sector, masters in development sector';
	$des='Know more about Transforming India Initiative by going through our frequently asked questions (FAQ’s)';
}else if($uri_segmentss[1] =='eligibility.php'){
	$key='Postgraduate Program eligibility, Fellowship program India eligibility, Leadership training program eligibility, Transforming India Initiative program eligibility, TII Postgraduate program eligibility, Entrepreneurship training program eligibility';
	$des='Know about the eligibility for transforming India initiative program, Learn if you are eligible to make a difference. Apply for ALC India TII Program';
}else if($uri_segmentss[1] =='selection.php'){
	$key='Postgraduate Program Selection process, Post graduate program India Selection process, Leadership training program Selection process, Social entrepreneurship, Transforming India Initiative Program Selection process, TII Fellowship Program Selection process, Entrepreneurship training program Selection process';
	$des='Learn about the selection process for ALC Transforming India Initiative program and Process with important dates which need to be shared';
}else if($uri_segmentss[1] =='apply.php'){
	$key='Apply for Transforming India Initiative, apply for postgraduate program, Apply for leadership training program, apply for entrepreneurship training program';
	$des='Know about how to apply for Transforming India Initiative program, Learn about the instruction to apply for ALC TII program';
}else if($uri_segmentss[1] =='whytii.php'){
	$key='Why postgraduate programs, Postgraduate program, Why transforming India Initiative, Why TII';
	$des='Learn more about ALC Transforming India Initiative, why TII. TII acts as a platform that connects the passion & competencies of graduates in addressing the most pressing challenges faced by the country today';
}else if($uri_segmentss[1] =='sep-overview.php'){
	$key='sep-overview, About Transforming India Initiative, About Postgraduate program, About Postgraduate program India, About Leadership training, Career opportunities in social sector, career opportunities in development sector, masters in the development sector, postgraduate program, About Leadership training program, About Transforming India Initiative, About ALC India, About TII fellowship program, About Entrepreneurship training, About Entrepreneurship training program';
	$des='Know about Transforming India Initiative program details about Facilitated learning and Experiential learning components, Fees details and important details';
}else if($uri_segmentss[1] =='about-tii.php'){
	$key='About TII, About Transforming India Initiative, About Postgraduate program, About Postgraduate program India, About Leadership training, Career opportunities in social sector, career opportunities in development sector, masters in the development sector, postgraduate program, About Leadership training program, About Transforming India Initiative, About ALC India, About TII fellowship program, About Entrepreneurship training, About Entrepreneurship training program';
	$des='Know about Transforming India Initiative program details about Facilitated learning and Experiential learning components, Fees details and important details';
}else if($uri_segmentss[1] =='programme-design.php'){
	$key='Program design for Transforming India Initiative, Program design for TII program, Program Design for Leadership training program, Program design for ALC India TII Program, Program design for Entrepreneurship training';
	$des='Know about the program design for transforming India Initiative by ALC India, which is focused on providing Experiential learning';
}else if($uri_segmentss[1] =='experiential-learning.php'){
	$key='Experiential learning for Entrepreneurship training, Social entrepreneurship, practical learning, start a business, Experiential learning in TII Postgraduate program';
	$des='Experiential learning for Entrepreneurship training, Experiential learning in fellowship program, Experiential learning in TII Postgraduate program';
}else if($uri_segmentss[1] =='curriculum.php'){
	$key='Experiential learning for Entrepreneurship training, Experiential learning in fellowship program, Experiential learning in TII Postgraduate program';
	$des='Experiential learning for Entrepreneurship training, Experiential learning in fellowship program, Experiential learning in TII Postgraduate program';
}else if($uri_segmentss[1] =='aboutus.php'){
	$key='ALC India, Transforming India Initiative, ALC India Hyderabad, Transforming India Initiative program by ALC India';
	$des='Know more about ALC India and Transforming India Initiative program, how we started and what’s our values';
}else if($uri_segmentss[1] =='team.php'){
	$key='ALC India Team, Transforming India Initiative team, ALC India People, Transforming India Initiative People, ALC India Hyderabad team';
	$des='Know about the team of ALC India, Transforming India Initiative program. Learn about their experience and work they have done in past. Get to know about our Advisory board';
}else if($uri_segmentss[1] =='partner.php'){
	$key='Partners for ALC India, Partners for Transforming India Initiative program, Partners for Transforming India Initiative program by ALC India';
	$des='Know about the partners of Transforming India Initiative for ALC India. we have partnered with more than 300+ enterprises, including government institutes, academic institutions, NGOs, public & private organisations, and other social enterprises in India and abroad';
}else if($uri_segmentss[1] =='post-program.php'){
	$key='Post Postgraduate support, ALC India Post fellowship support, Transforming India Initiative Post Postgraduate support, Transforming India Initiative by ALC India post fellowship support';
	$des='Learn about what you will get post fellowship from Transforming India Initiative program by ALC India initiative program';
}else if($uri_segmentss[1] =='beinspired.php'){
	$key='Inspiration for Postgraduate program, success stories, Inspiring stories';
	$des='Learn about the inspiring stories of Hero’s who have made a difference in the society. Know about our heroes and their inspiring stories and how they made a difference in the country';
}else{
	$key='Postgraduate program, Postgraduate program India, Leadership training, Leadership training program, Career opportunities in social sector, career opportunities in development sector, masters in the development sector, Development of India, Transforming India Initiative, ALC India, TII fellowship program, Entrepreneurship training, Entrepreneurship training program';
	$des='Transforming India Initiative is a 2-year fellowship program, focus on providing entrepreneurship training to solve challenges faced by the country today';
}
?>

<!DOCTYPE html>
<html lang="en">
	<head>
		<meta charset="utf-8">
		<meta http-equiv="X-UA-Compatible" content="IE=edge">
		<meta name="viewport" content="width=device-width, initial-scale=1">
		<meta name="description" content="">
		<meta name="keywords" content="">
		<link rel="icon" href="images/favicon-a59cb816717560d0f992c1ec460711f8.jpg">
		<title>Transforming India Initiative - ALC India</title>
		<!-- Bootstrap core CSS -->
		<link href="css/bootstrap.min.css" rel="stylesheet">
		<link href="css/font-awesome.css" rel="stylesheet">
		<link href="css/bootstrap-datetimepicker.css" rel="stylesheet">

		<!-- Custom styles for this template -->
		<link href="css/style.css" rel="stylesheet">
		<link href="css/new_style.css" rel="stylesheet">

		<!-- Google Tag Manager -->
		<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
		new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
		j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
		'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
		})(window,document,'script','dataLayer','GTM-54R3WF8');</script>
		<!-- End Google Tag Manager -->

		<!-- Facebook Pixel Code -->
		<!-- Facebook Pixel Code -->
		<script>
		!function(f,b,e,v,n,t,s)
		{if(f.fbq)return;n=f.fbq=function(){n.callMethod?
		n.callMethod.apply(n,arguments):n.queue.push(arguments)};
		if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';
		n.queue=[];t=b.createElement(e);t.async=!0;
		t.src=v;s=b.getElementsByTagName(e)[0];
		s.parentNode.insertBefore(t,s)}(window,document,'script',
		'https://connect.facebook.net/en_US/fbevents.js');
		 fbq('init', '2901196496638471');
		fbq('track', 'PageView');
		</script>
		<noscript>
		 <img height="1" width="1"
		src="https://www.facebook.com/tr?id=2901196496638471&ev=PageView
		&noscript=1"/>
		</noscript>
		<!-- End Facebook Pixel Code -->
		<!-- Facebook Pixel Code -->
		<script>
		!function(f,b,e,v,n,t,s)
		{if(f.fbq)return;n=f.fbq=function(){n.callMethod?
		n.callMethod.apply(n,arguments):n.queue.push(arguments)};
		if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';
		n.queue=[];t=b.createElement(e);t.async=!0;
		t.src=v;s=b.getElementsByTagName(e)[0];
		s.parentNode.insertBefore(t,s)}(window,document,'script',
		'https://connect.facebook.net/en_US/fbevents.js');
		 fbq('init', '746946915487127');
		fbq('track', 'PageView');
		</script>
		<noscript>
		 <img height="1" width="1"
		src="https://www.facebook.com/tr?id=746946915487127&ev=PageView
		&noscript=1"/>
		</noscript>
		<script>
		  (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
		  (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
		  m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
		  })(window,document,'script','https://www.google-analytics.com/analytics.js','ga');

		  ga('create', 'UA-40399202-2', 'auto');
		  ga('send', 'pageview');

		</script>
		<!-- End Facebook Pixel Code -->
				<!-- Google Code for Remarketing Tag -->
		<!--
		Remarketing tags may not be associated with personally identifiable information or placed on pages related to sensitive categories. See more information and instructions on how to setup the tag on: http://google.com/ads/remarketingsetup
		-->

		
<!-- Hotjar Tracking Code for  -->
<script>
(function(h,o,t,j,a,r){
		h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)};
		h._hjSettings={hjid:2276747,hjsv:6};
		a=o.getElementsByTagName('head')[0];
		r=o.createElement('script');r.async=1;
		r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv;
		a.appendChild(r);
})(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv=');
</script>
<!-- Meta Pixel Code added on May 20, 2024 -->
<script>
!function(f,b,e,v,n,t,s)
{if(f.fbq)return;n=f.fbq=function(){n.callMethod?
n.callMethod.apply(n,arguments):n.queue.push(arguments)};
if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';
n.queue=[];t=b.createElement(e);t.async=!0;
t.src=v;s=b.getElementsByTagName(e)[0];
s.parentNode.insertBefore(t,s)}(window, document,'script',
'https://connect.facebook.net/en_US/fbevents.js');
fbq('init', '2170916869944265');
fbq('track', 'PageView');
</script>
<noscript><img height="1" width="1" style="display:none"
src="https://www.facebook.com/tr?id=2170916869944265&ev=PageView&noscript=1"
/></noscript>
<!-- End Meta Pixel Code -->
<style>
@media (max-width: 364px){
	.logo-container.new a.logo img{
		width: 100px;
	}
	.carousel {
		top: 15px;
	}
}
</style>
<style>
	@media(min-width: 300px) and (max-width: 767px){
	.sep-blink-icon{
		padding-top: 25px; padding-bottom: 25px;
	}
}
</style>
	</head>

	<body>
	<!-- Google Tag Manager (noscript) -->
<noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-54R3WF8"
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
<!-- End Google Tag Manager (noscript) -->
		<nav>
			<div class="main-container">
				
				<div class="logo-container new">
					<a href="index.php" class="logo"><img src="images/access-livelihoods.png" /></a>
					
					<a href="sep-overview.php" class="logo1">Transforming India Initiative <span>Social Entrepreneurship Program</span></a>
					<!-- <div id="flash-message" style="color:#fec972; padding:0.5rem"><center>Applications are now open <a href="/register.php" id="apply-today"> Apply Now! </a></center></div> -->
					<!-- <center><a href="/register.php" id="apply-today"> Apply Now! </a> </center> -->
																<!-- <div class="header-logo"> -->

					<!-- <img src="images/NITI-AIM-logo-supported-by.png"> -->
					<!-- <img src="images/tiss-whitelogo.png" style="max-height:105px;">
					<img src="images/IRMA-Anand.png" style="max-height:72px;"> -->
						<!-- <span>Supported by</span>
						 <img src="images/niti-logo.jpg">
						 <img src="images/aim.jpg"> -->
					<!-- </div> -->
									</div>
				<div class="menu-container">
					<img src="images/menu-icon-orange.png" id="menulink" />
					<img src="images/menu-close-icon-orange.png" id="menuclose" style="display:none;" />
				</div>
				<div class="menulink-container">
					<ul class="nav nav-pills mainmenu">
						<li ><a href="sep-overview.php">Home</a></li>
						<!-- 3-9-2018 end-->
						<li >
						<a class="dropdown-toggle"  data-toggle="dropdown">+ SEP Detail</a>
							<ul class="dropdown-menu">
								<li ><a href="whytii.php">Why SEP<span>?</span></a></li>
								<!-- <li ><a href="sep-overview.php">Overview SEP</a></li> -->
								<li ><a href="about-tii.php">About SEP</a></li>
								<li ><a href="programme-design.php">Programme Design</a></li>
								<li ><a href="facilitated-learning.php">Facilitated Learning</a></li>
								<li ><a href="experiential-learning.php">Experiential Learning</a></li>
								<li ><a href="curriculum.php">Curriculum</a></li>
							</ul>
						</li>
						<li >
							<a class="dropdown-toggle"  data-toggle="dropdown">+ Join SEP</a>
							<ul class="dropdown-menu">
								<!--<li  class="active" ><a href="FAQ.php">FAQs</a></li>-->
								<li ><a href="eligibility.php">Eligibility</a></li>
								<li ><a href="selection.php">Selection</a></li>
								<li ><a href="apply.php">Apply!</a></li>
							</ul>
						</li>
						<!-- 3-9-2018 start-->
						<li ><a href="meettheseekers.php">Torch Bearers of SEP</a></li>
						<li >
							<a class="dropdown-toggle"  data-toggle="dropdown" >+ About Us</a>
							<ul class="dropdown-menu">
								<li ><a href="aboutus.php">About Access Livelihoods</a></li>
								<li ><a href="team.php">People</a></li>
								<li ><a href="partner.php">Partners</a></li>
							</ul>
						</li>
						<li >
							<a  href="post-program.php">Post Program</a>
						</li>
						<li  class="active" ><a href="FAQ.php">FAQs</a></li>
						<li ><a href="beinspired.php">Be Inspired<span>!</span></a></li>
					</ul>
					<ul class="nav nav-pills header-social-link">
						<li><a href="https://www.linkedin.com/company/access-livelihoods/" target="_blank"><i class="fa fa-linkedin-square" aria-hidden="true"></i></a></li>
						<li><a href="https://www.facebook.com/accesslivelihoods.org" target="_blank"><i class="fa fa-facebook-square" aria-hidden="true"></i></a></li>
						<li><a href="https://www.youtube.com/@AccessLivelihoods" target="_blank"><i class="fa fa-youtube-play" aria-hidden="true"></i></a></li>
						<li><a href="https://www.instagram.com/access.livelihoods/" target="_blank"><i class="fa fa-instagram" aria-hidden="true"></i></a></li>
					</ul>
				</div>
			</div>
		</nav>
		<div id="notice-bar" class="sep-blink-icon"><div class="main-container"><span class="noticebar-head"><span class="blink_me"><i class="fa fa-exclamation-circle" aria-hidden="true"></i></span> Update:</span> <span class="notice-text">Applications are open. Last date to apply 09 December 2024. <b><a href="https://tii.alcindia.org/register.php" target="_blank" style="top:0">Apply Now!</a></b></span></div></div>
		<script type="text/javascript">
		  window.location="login.php";
		</script>
		
<div class="container application-div">
	<div class="setting">
		<ul class="nav nav-pills pull-right">
			<li><a>Hi </a></li>
			<li><a href="dashboard.php">Dashboard</a></li>
			<li><a href="password.php">Change Password</a></li>
			<li><a href="logout.php">Logout</a></li>
		</ul>
		<div class="clear"></div>
	</div>
	<div class="appheading">TII Application Form</div>
	<div class="appheading1">
		<div class="row">
			<div class="col-xs-9">
				<div class="blackdiv"> </div> Personal details:
			</div>
		</div>
	</div>
	<form id="myForm" class="form-horizontal" autocomplete="off" action="/application.php" method="post" enctype="multipart/form-data">
		<div class="row">
			<div class="col-sm-9">
				<div class="form-group">
					<div class="col-sm-6 left">
						<input type="text" class="form-control"  name="fname" placeholder="First Name" value="Surbhi">
						<p class="error"> </p>
					</div>
					<div class="col-sm-6 right">
						 <input type="text" class="form-control" name="mname" placeholder="Middle Name" value="">
						 <p class="error"> </p>
					</div>
				</div>
				<div class="form-group">
					<div class="col-sm-6 left">
					  <input type="text" class="form-control" name="lname" placeholder="Last name" value="Anand">
					  <p class="error"> </p>
					</div>
					<div class="col-sm-6 right">
					   <input type="text" class="form-control" id="datetimepicker1" name="dob" placeholder="Date of Birth" value="13-02-2002">
					   <p class="error"> </p>
					</div>
				</div>
				<div class="form-group form-groupleft">
					<label class="col-sm-2 required">Gender:</label>
					<div class="col-sm-4">
						<select class="form-control" name="gender">
							<option value="" selected="">Select Gender</option>
							<option value="M" >Male</option>
							<option value="F" selected>Female</option>
							<option value="T" >Transgender</option>
						</select>
						<p class="error"> </p>
					</div>
					<label class="col-sm-2 right required">Marital Status:</label>
					<div class="col-sm-4">
						<label class="radio-inline">
						<input type="radio" name="optionsRadios2" value="S" checked>
						Single
						</label>
						<label class="radio-inline">
						<input type="radio" name="optionsRadios2" value="M" >
						Married
						</label>
						<p class="error"> </p>
					</div>
				</div>

				<div class="form-group form-groupleft">
					<label class="col-sm-2 sp_oc required">Spouse Occupation:</label>
					<div class="col-sm-4 left sp_oc required">
						<input type="text" class="form-control"  name="spouseOccupation" value="" >
						<p class="error"> </p>
					</div>
				</div>

				<br/>
				<div class="appheading1">
					<div class="row">
						<div class="col-xs-9">
							<div class="blackdiv"> </div> Parent Details:
						</div>
					</div>
				</div>
				<div class="form-group form-groupleft">
					<label class="col-sm-2">Mother Name:</label>
					<div class="col-sm-4">
						<input type="text" class="form-control" name="motherName" value="Shobha Anand" >
					</div>
					<label class="col-sm-2 right">Mother Occupation:</label>
					<div class="col-sm-4">
						<input type="text" class="form-control" name="motherOccupation" value="Homemaker"  >
					</div>
				</div>
				<div class="form-group form-groupleft">
					<label class="col-sm-2">Father Name:</label>
					<div class="col-sm-4">
						<input type="text" class="form-control" name="fatherName" value="Ramesh Anand"  >
					</div>
					<label class="col-sm-2 right">Father Occupation:</label>
					<div class="col-sm-4">
						<input type="text" class="form-control" name="fatherOccupation" value="Government Servant"  >
					</div>
				</div>
				<br/>
				<div class="form-group">
					<label class="col-xs-5 left required">Languages known:</label>
					<label class="col-xs-2">Read</label>
					<label class="col-xs-2">Speak</label>
					<label class="col-xs-2">Write</label>
					<label class="col-xs-5 "><p class="error"> </p></label>
					<label class="col-xs-5 "><p class="error"> </p></label>
				</div>
				<div class="form-group">
					<div class="col-xs-5 left">
						<input type="text" class="form-control" name="lang" value="">
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label >
							<input type="checkbox" value="R" name="lval[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="W" name="lval[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="S" name="lval[]" >
						  </label>
						</div>
					</div>
				</div>
				<div class="form-group">
					<div class="col-xs-5 left">
						<input type="text" class="form-control" name="lang1" value="">
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="R" name="lval1[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="W" name="lval1[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="S" name="lval1[]" >
						  </label>
						</div>
					</div>
				</div>
				<div class="form-group">
					<div class="col-xs-5 left">
						<input type="text" class="form-control" name="lang2" value="">
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="R" name="lval2[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="W" name="lval2[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="S" name="lval2[]" >
						  </label>
						</div>
					</div>
				</div>
				<div class="form-group">
					<div class="col-xs-5 left">
						<input type="text" class="form-control" name="lang3" value="">
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="R" name="lval3[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="W" name="lval3[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="S" name="lval3[]" >
						  </label>
						</div>
					</div>
				</div>
				<div class="form-group">
					<div class="col-xs-5 left">
						<input type="text" class="form-control" name="lang4" value="">
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="R" name="lval4[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="W" name="lval4[]" >
						  </label>
						</div>
					</div>
					<div class="col-xs-2">
						<div class="checkbox ">
						  <label>
							<input type="checkbox" value="S" name="lval4[]" >
						  </label>
						</div>
					</div>
				</div>

				<input type="hidden" class="form-control"  name="perstatus" value=1  >
			</div>
			<div class="col-sm-3 application-right">
				<div class="upload-div">
					<img src="uploads/Surbhi_1654247684.JPG" alt="ALC" id="blah" class="img-rounded img-responsive">
					<input type="file" name="fileToUpload" id="fileToUpload">
					<p class="error"></p>
					<input type="hidden" name="fileToUpload3"   value="Surbhi_1654247684.JPG"  />
					Passport size photo should be less than 5 MB
				</div>

			</div>
		</div>
		<br/><br/>
		<div class="appheading1">
			<div class="row">
				<div class="col-xs-9">
					<div class="blackdiv"> </div> Contact details:
				</div>
				<div class="col-xs-3">

				</div>
			</div>
		</div>

		<div class="form-group">
			<div class="col-sm-6 left">
				<label class="required">Current / Mailing Address:</label>
				<div class="minheightdiv"></div>
				<input type="text" class="form-control form-controlfirst" id="add1" name="add1" placeholder="Address one" value="199-Villa Prince and Princess Villa, Sevasi road, Gotri, Vadodara">
				<p class="error"> </p>
				<input type="text" class="form-control" id="add2" name="add2" placeholder="Address two" value="Beside Collbera building - Sevasi road, Gotri">
				<br/>
				<select name="country1" id="country1" class="form-control" onChange="getState(this.value);">
					<option value disabled selected>Select Country</option>

					<option value=1>Afghanistan</option><option value=2>Albania</option><option value=3>Algeria</option><option value=4>American Samoa</option><option value=5>Andorra</option><option value=6>Angola</option><option value=7>Anguilla</option><option value=8>Antarctica</option><option value=9>Antigua And Barbuda</option><option value=10>Argentina</option><option value=11>Armenia</option><option value=12>Aruba</option><option value=13>Australia</option><option value=14>Austria</option><option value=15>Azerbaijan</option><option value=16>Bahamas The</option><option value=17>Bahrain</option><option value=18>Bangladesh</option><option value=19>Barbados</option><option value=20>Belarus</option><option value=21>Belgium</option><option value=22>Belize</option><option value=23>Benin</option><option value=24>Bermuda</option><option value=25>Bhutan</option><option value=26>Bolivia</option><option value=27>Bosnia and Herzegovina</option><option value=28>Botswana</option><option value=29>Bouvet Island</option><option value=30>Brazil</option><option value=31>British Indian Ocean Territory</option><option value=32>Brunei</option><option value=33>Bulgaria</option><option value=34>Burkina Faso</option><option value=35>Burundi</option><option value=36>Cambodia</option><option value=37>Cameroon</option><option value=38>Canada</option><option value=39>Cape Verde</option><option value=40>Cayman Islands</option><option value=41>Central African Republic</option><option value=42>Chad</option><option value=43>Chile</option><option value=44>China</option><option value=45>Christmas Island</option><option value=46>Cocos (Keeling) Islands</option><option value=47>Colombia</option><option value=48>Comoros</option><option value=49>Republic Of The Congo</option><option value=50>Democratic Republic Of The Congo</option><option value=51>Cook Islands</option><option value=52>Costa Rica</option><option value=53>Cote D'Ivoire (Ivory Coast)</option><option value=54>Croatia (Hrvatska)</option><option value=55>Cuba</option><option value=56>Cyprus</option><option value=57>Czech Republic</option><option value=58>Denmark</option><option value=59>Djibouti</option><option value=60>Dominica</option><option value=61>Dominican Republic</option><option value=62>East Timor</option><option value=63>Ecuador</option><option value=64>Egypt</option><option value=65>El Salvador</option><option value=66>Equatorial Guinea</option><option value=67>Eritrea</option><option value=68>Estonia</option><option value=69>Ethiopia</option><option value=70>External Territories of Australia</option><option value=71>Falkland Islands</option><option value=72>Faroe Islands</option><option value=73>Fiji Islands</option><option value=74>Finland</option><option value=75>France</option><option value=76>French Guiana</option><option value=77>French Polynesia</option><option value=78>French Southern Territories</option><option value=79>Gabon</option><option value=80>Gambia The</option><option value=81>Georgia</option><option value=82>Germany</option><option value=83>Ghana</option><option value=84>Gibraltar</option><option value=85>Greece</option><option value=86>Greenland</option><option value=87>Grenada</option><option value=88>Guadeloupe</option><option value=89>Guam</option><option value=90>Guatemala</option><option value=91>Guernsey and Alderney</option><option value=92>Guinea</option><option value=93>Guinea-Bissau</option><option value=94>Guyana</option><option value=95>Haiti</option><option value=96>Heard and McDonald Islands</option><option value=97>Honduras</option><option value=98>Hong Kong S.A.R.</option><option value=99>Hungary</option><option value=100>Iceland</option><option value=101 selected>India</option><option value=102>Indonesia</option><option value=103>Iran</option><option value=104>Iraq</option><option value=105>Ireland</option><option value=106>Israel</option><option value=107>Italy</option><option value=108>Jamaica</option><option value=109>Japan</option><option value=110>Jersey</option><option value=111>Jordan</option><option value=112>Kazakhstan</option><option value=113>Kenya</option><option value=114>Kiribati</option><option value=115>Korea North</option><option value=116>Korea South</option><option value=117>Kuwait</option><option value=118>Kyrgyzstan</option><option value=119>Laos</option><option value=120>Latvia</option><option value=121>Lebanon</option><option value=122>Lesotho</option><option value=123>Liberia</option><option value=124>Libya</option><option value=125>Liechtenstein</option><option value=126>Lithuania</option><option value=127>Luxembourg</option><option value=128>Macau S.A.R.</option><option value=129>Macedonia</option><option value=130>Madagascar</option><option value=131>Malawi</option><option value=132>Malaysia</option><option value=133>Maldives</option><option value=134>Mali</option><option value=135>Malta</option><option value=136>Man (Isle of)</option><option value=137>Marshall Islands</option><option value=138>Martinique</option><option value=139>Mauritania</option><option value=140>Mauritius</option><option value=141>Mayotte</option><option value=142>Mexico</option><option value=143>Micronesia</option><option value=144>Moldova</option><option value=145>Monaco</option><option value=146>Mongolia</option><option value=147>Montserrat</option><option value=148>Morocco</option><option value=149>Mozambique</option><option value=150>Myanmar</option><option value=151>Namibia</option><option value=152>Nauru</option><option value=153>Nepal</option><option value=154>Netherlands Antilles</option><option value=155>Netherlands The</option><option value=156>New Caledonia</option><option value=157>New Zealand</option><option value=158>Nicaragua</option><option value=159>Niger</option><option value=160>Nigeria</option><option value=161>Niue</option><option value=162>Norfolk Island</option><option value=163>Northern Mariana Islands</option><option value=164>Norway</option><option value=165>Oman</option><option value=166>Pakistan</option><option value=167>Palau</option><option value=168>Palestinian Territory Occupied</option><option value=169>Panama</option><option value=170>Papua new Guinea</option><option value=171>Paraguay</option><option value=172>Peru</option><option value=173>Philippines</option><option value=174>Pitcairn Island</option><option value=175>Poland</option><option value=176>Portugal</option><option value=177>Puerto Rico</option><option value=178>Qatar</option><option value=179>Reunion</option><option value=180>Romania</option><option value=181>Russia</option><option value=182>Rwanda</option><option value=183>Saint Helena</option><option value=184>Saint Kitts And Nevis</option><option value=185>Saint Lucia</option><option value=186>Saint Pierre and Miquelon</option><option value=187>Saint Vincent And The Grenadines</option><option value=188>Samoa</option><option value=189>San Marino</option><option value=190>Sao Tome and Principe</option><option value=191>Saudi Arabia</option><option value=192>Senegal</option><option value=193>Serbia</option><option value=194>Seychelles</option><option value=195>Sierra Leone</option><option value=196>Singapore</option><option value=197>Slovakia</option><option value=198>Slovenia</option><option value=199>Smaller Territories of the UK</option><option value=200>Solomon Islands</option><option value=201>Somalia</option><option value=202>South Africa</option><option value=203>South Georgia</option><option value=204>South Sudan</option><option value=205>Spain</option><option value=206>Sri Lanka</option><option value=207>Sudan</option><option value=208>Suriname</option><option value=209>Svalbard And Jan Mayen Islands</option><option value=210>Swaziland</option><option value=211>Sweden</option><option value=212>Switzerland</option><option value=213>Syria</option><option value=214>Taiwan</option><option value=215>Tajikistan</option><option value=216>Tanzania</option><option value=217>Thailand</option><option value=218>Togo</option><option value=219>Tokelau</option><option value=220>Tonga</option><option value=221>Trinidad And Tobago</option><option value=222>Tunisia</option><option value=223>Turkey</option><option value=224>Turkmenistan</option><option value=225>Turks And Caicos Islands</option><option value=226>Tuvalu</option><option value=227>Uganda</option><option value=228>Ukraine</option><option value=229>United Arab Emirates</option><option value=230>United Kingdom</option><option value=231>United States</option><option value=232>United States Minor Outlying Islands</option><option value=233>Uruguay</option><option value=234>Uzbekistan</option><option value=235>Vanuatu</option><option value=236>Vatican City State (Holy See)</option><option value=237>Venezuela</option><option value=238>Vietnam</option><option value=239>Virgin Islands (British)</option><option value=240>Virgin Islands (US)</option><option value=241>Wallis And Futuna Islands</option><option value=242>Western Sahara</option><option value=243>Yemen</option><option value=244>Yugoslavia</option><option value=245>Zambia</option><option value=246>Zimbabwe</option>				</select>
				<p class="error"> </p>

				<select name="state1" id="state1" class="form-control" onChange="getCity(this.value);">
											<option value="12" selected>Gujarat</option>
									</select>
				<p class="error"> </p>

				<select name="city1" id="city1" class="form-control">
											<option value="1068" selected>Vadodara</option>
									</select>
				<p class="error"> </p>

				<input type="text" class="form-control" name="zip1" id="zip1" placeholder="Zip" style="margin-bottom:0px;" value="390021">
				<p class="error"> </p>
				<input type="hidden" class="form-control"  name="cstatus" value=1  >

				<label class="required">Permanent Address:</label>
				<div class="checkbox">
					<label>
						<input type="checkbox" id="check" name="check" value="C" checked>Permanent address is same as current address
					</label>
				</div>
				<div class="per_address">
					<input type="text" class="form-control form-controlfirst" id="add3" name="add3" placeholder="Address one" value="199-Villa Prince and Princess Villa, Sevasi road, Gotri, Vadodara">
					<p class="error"> </p>
					<input type="text" class="form-control" id="add4" name="add4" placeholder="Address two" value="Beside Collbera building - Sevasi road, Gotri">
					<br/>
					<div class="c_s_c">
						<select name="country2" id="country2" class="form-control" onChange="getState2(this.value);">
							<option value disabled selected>Select Country</option>
							<option value=1>Afghanistan</option><option value=2>Albania</option><option value=3>Algeria</option><option value=4>American Samoa</option><option value=5>Andorra</option><option value=6>Angola</option><option value=7>Anguilla</option><option value=8>Antarctica</option><option value=9>Antigua And Barbuda</option><option value=10>Argentina</option><option value=11>Armenia</option><option value=12>Aruba</option><option value=13>Australia</option><option value=14>Austria</option><option value=15>Azerbaijan</option><option value=16>Bahamas The</option><option value=17>Bahrain</option><option value=18>Bangladesh</option><option value=19>Barbados</option><option value=20>Belarus</option><option value=21>Belgium</option><option value=22>Belize</option><option value=23>Benin</option><option value=24>Bermuda</option><option value=25>Bhutan</option><option value=26>Bolivia</option><option value=27>Bosnia and Herzegovina</option><option value=28>Botswana</option><option value=29>Bouvet Island</option><option value=30>Brazil</option><option value=31>British Indian Ocean Territory</option><option value=32>Brunei</option><option value=33>Bulgaria</option><option value=34>Burkina Faso</option><option value=35>Burundi</option><option value=36>Cambodia</option><option value=37>Cameroon</option><option value=38>Canada</option><option value=39>Cape Verde</option><option value=40>Cayman Islands</option><option value=41>Central African Republic</option><option value=42>Chad</option><option value=43>Chile</option><option value=44>China</option><option value=45>Christmas Island</option><option value=46>Cocos (Keeling) Islands</option><option value=47>Colombia</option><option value=48>Comoros</option><option value=49>Republic Of The Congo</option><option value=50>Democratic Republic Of The Congo</option><option value=51>Cook Islands</option><option value=52>Costa Rica</option><option value=53>Cote D'Ivoire (Ivory Coast)</option><option value=54>Croatia (Hrvatska)</option><option value=55>Cuba</option><option value=56>Cyprus</option><option value=57>Czech Republic</option><option value=58>Denmark</option><option value=59>Djibouti</option><option value=60>Dominica</option><option value=61>Dominican Republic</option><option value=62>East Timor</option><option value=63>Ecuador</option><option value=64>Egypt</option><option value=65>El Salvador</option><option value=66>Equatorial Guinea</option><option value=67>Eritrea</option><option value=68>Estonia</option><option value=69>Ethiopia</option><option value=70>External Territories of Australia</option><option value=71>Falkland Islands</option><option value=72>Faroe Islands</option><option value=73>Fiji Islands</option><option value=74>Finland</option><option value=75>France</option><option value=76>French Guiana</option><option value=77>French Polynesia</option><option value=78>French Southern Territories</option><option value=79>Gabon</option><option value=80>Gambia The</option><option value=81>Georgia</option><option value=82>Germany</option><option value=83>Ghana</option><option value=84>Gibraltar</option><option value=85>Greece</option><option value=86>Greenland</option><option value=87>Grenada</option><option value=88>Guadeloupe</option><option value=89>Guam</option><option value=90>Guatemala</option><option value=91>Guernsey and Alderney</option><option value=92>Guinea</option><option value=93>Guinea-Bissau</option><option value=94>Guyana</option><option value=95>Haiti</option><option value=96>Heard and McDonald Islands</option><option value=97>Honduras</option><option value=98>Hong Kong S.A.R.</option><option value=99>Hungary</option><option value=100>Iceland</option><option value=101 selected>India</option><option value=102>Indonesia</option><option value=103>Iran</option><option value=104>Iraq</option><option value=105>Ireland</option><option value=106>Israel</option><option value=107>Italy</option><option value=108>Jamaica</option><option value=109>Japan</option><option value=110>Jersey</option><option value=111>Jordan</option><option value=112>Kazakhstan</option><option value=113>Kenya</option><option value=114>Kiribati</option><option value=115>Korea North</option><option value=116>Korea South</option><option value=117>Kuwait</option><option value=118>Kyrgyzstan</option><option value=119>Laos</option><option value=120>Latvia</option><option value=121>Lebanon</option><option value=122>Lesotho</option><option value=123>Liberia</option><option value=124>Libya</option><option value=125>Liechtenstein</option><option value=126>Lithuania</option><option value=127>Luxembourg</option><option value=128>Macau S.A.R.</option><option value=129>Macedonia</option><option value=130>Madagascar</option><option value=131>Malawi</option><option value=132>Malaysia</option><option value=133>Maldives</option><option value=134>Mali</option><option value=135>Malta</option><option value=136>Man (Isle of)</option><option value=137>Marshall Islands</option><option value=138>Martinique</option><option value=139>Mauritania</option><option value=140>Mauritius</option><option value=141>Mayotte</option><option value=142>Mexico</option><option value=143>Micronesia</option><option value=144>Moldova</option><option value=145>Monaco</option><option value=146>Mongolia</option><option value=147>Montserrat</option><option value=148>Morocco</option><option value=149>Mozambique</option><option value=150>Myanmar</option><option value=151>Namibia</option><option value=152>Nauru</option><option value=153>Nepal</option><option value=154>Netherlands Antilles</option><option value=155>Netherlands The</option><option value=156>New Caledonia</option><option value=157>New Zealand</option><option value=158>Nicaragua</option><option value=159>Niger</option><option value=160>Nigeria</option><option value=161>Niue</option><option value=162>Norfolk Island</option><option value=163>Northern Mariana Islands</option><option value=164>Norway</option><option value=165>Oman</option><option value=166>Pakistan</option><option value=167>Palau</option><option value=168>Palestinian Territory Occupied</option><option value=169>Panama</option><option value=170>Papua new Guinea</option><option value=171>Paraguay</option><option value=172>Peru</option><option value=173>Philippines</option><option value=174>Pitcairn Island</option><option value=175>Poland</option><option value=176>Portugal</option><option value=177>Puerto Rico</option><option value=178>Qatar</option><option value=179>Reunion</option><option value=180>Romania</option><option value=181>Russia</option><option value=182>Rwanda</option><option value=183>Saint Helena</option><option value=184>Saint Kitts And Nevis</option><option value=185>Saint Lucia</option><option value=186>Saint Pierre and Miquelon</option><option value=187>Saint Vincent And The Grenadines</option><option value=188>Samoa</option><option value=189>San Marino</option><option value=190>Sao Tome and Principe</option><option value=191>Saudi Arabia</option><option value=192>Senegal</option><option value=193>Serbia</option><option value=194>Seychelles</option><option value=195>Sierra Leone</option><option value=196>Singapore</option><option value=197>Slovakia</option><option value=198>Slovenia</option><option value=199>Smaller Territories of the UK</option><option value=200>Solomon Islands</option><option value=201>Somalia</option><option value=202>South Africa</option><option value=203>South Georgia</option><option value=204>South Sudan</option><option value=205>Spain</option><option value=206>Sri Lanka</option><option value=207>Sudan</option><option value=208>Suriname</option><option value=209>Svalbard And Jan Mayen Islands</option><option value=210>Swaziland</option><option value=211>Sweden</option><option value=212>Switzerland</option><option value=213>Syria</option><option value=214>Taiwan</option><option value=215>Tajikistan</option><option value=216>Tanzania</option><option value=217>Thailand</option><option value=218>Togo</option><option value=219>Tokelau</option><option value=220>Tonga</option><option value=221>Trinidad And Tobago</option><option value=222>Tunisia</option><option value=223>Turkey</option><option value=224>Turkmenistan</option><option value=225>Turks And Caicos Islands</option><option value=226>Tuvalu</option><option value=227>Uganda</option><option value=228>Ukraine</option><option value=229>United Arab Emirates</option><option value=230>United Kingdom</option><option value=231>United States</option><option value=232>United States Minor Outlying Islands</option><option value=233>Uruguay</option><option value=234>Uzbekistan</option><option value=235>Vanuatu</option><option value=236>Vatican City State (Holy See)</option><option value=237>Venezuela</option><option value=238>Vietnam</option><option value=239>Virgin Islands (British)</option><option value=240>Virgin Islands (US)</option><option value=241>Wallis And Futuna Islands</option><option value=242>Western Sahara</option><option value=243>Yemen</option><option value=244>Yugoslavia</option><option value=245>Zambia</option><option value=246>Zimbabwe</option>						</select>
					</div>
					<div class="c_s_c_original" style="display:none;">
						<select name="country2" id="country2" class="form-control" onChange="getState2(this.value);">
							<option value disabled selected>Select Country</option>
							<option value=1>Afghanistan</option><option value=2>Albania</option><option value=3>Algeria</option><option value=4>American Samoa</option><option value=5>Andorra</option><option value=6>Angola</option><option value=7>Anguilla</option><option value=8>Antarctica</option><option value=9>Antigua And Barbuda</option><option value=10>Argentina</option><option value=11>Armenia</option><option value=12>Aruba</option><option value=13>Australia</option><option value=14>Austria</option><option value=15>Azerbaijan</option><option value=16>Bahamas The</option><option value=17>Bahrain</option><option value=18>Bangladesh</option><option value=19>Barbados</option><option value=20>Belarus</option><option value=21>Belgium</option><option value=22>Belize</option><option value=23>Benin</option><option value=24>Bermuda</option><option value=25>Bhutan</option><option value=26>Bolivia</option><option value=27>Bosnia and Herzegovina</option><option value=28>Botswana</option><option value=29>Bouvet Island</option><option value=30>Brazil</option><option value=31>British Indian Ocean Territory</option><option value=32>Brunei</option><option value=33>Bulgaria</option><option value=34>Burkina Faso</option><option value=35>Burundi</option><option value=36>Cambodia</option><option value=37>Cameroon</option><option value=38>Canada</option><option value=39>Cape Verde</option><option value=40>Cayman Islands</option><option value=41>Central African Republic</option><option value=42>Chad</option><option value=43>Chile</option><option value=44>China</option><option value=45>Christmas Island</option><option value=46>Cocos (Keeling) Islands</option><option value=47>Colombia</option><option value=48>Comoros</option><option value=49>Republic Of The Congo</option><option value=50>Democratic Republic Of The Congo</option><option value=51>Cook Islands</option><option value=52>Costa Rica</option><option value=53>Cote D'Ivoire (Ivory Coast)</option><option value=54>Croatia (Hrvatska)</option><option value=55>Cuba</option><option value=56>Cyprus</option><option value=57>Czech Republic</option><option value=58>Denmark</option><option value=59>Djibouti</option><option value=60>Dominica</option><option value=61>Dominican Republic</option><option value=62>East Timor</option><option value=63>Ecuador</option><option value=64>Egypt</option><option value=65>El Salvador</option><option value=66>Equatorial Guinea</option><option value=67>Eritrea</option><option value=68>Estonia</option><option value=69>Ethiopia</option><option value=70>External Territories of Australia</option><option value=71>Falkland Islands</option><option value=72>Faroe Islands</option><option value=73>Fiji Islands</option><option value=74>Finland</option><option value=75>France</option><option value=76>French Guiana</option><option value=77>French Polynesia</option><option value=78>French Southern Territories</option><option value=79>Gabon</option><option value=80>Gambia The</option><option value=81>Georgia</option><option value=82>Germany</option><option value=83>Ghana</option><option value=84>Gibraltar</option><option value=85>Greece</option><option value=86>Greenland</option><option value=87>Grenada</option><option value=88>Guadeloupe</option><option value=89>Guam</option><option value=90>Guatemala</option><option value=91>Guernsey and Alderney</option><option value=92>Guinea</option><option value=93>Guinea-Bissau</option><option value=94>Guyana</option><option value=95>Haiti</option><option value=96>Heard and McDonald Islands</option><option value=97>Honduras</option><option value=98>Hong Kong S.A.R.</option><option value=99>Hungary</option><option value=100>Iceland</option><option value=101>India</option><option value=102>Indonesia</option><option value=103>Iran</option><option value=104>Iraq</option><option value=105>Ireland</option><option value=106>Israel</option><option value=107>Italy</option><option value=108>Jamaica</option><option value=109>Japan</option><option value=110>Jersey</option><option value=111>Jordan</option><option value=112>Kazakhstan</option><option value=113>Kenya</option><option value=114>Kiribati</option><option value=115>Korea North</option><option value=116>Korea South</option><option value=117>Kuwait</option><option value=118>Kyrgyzstan</option><option value=119>Laos</option><option value=120>Latvia</option><option value=121>Lebanon</option><option value=122>Lesotho</option><option value=123>Liberia</option><option value=124>Libya</option><option value=125>Liechtenstein</option><option value=126>Lithuania</option><option value=127>Luxembourg</option><option value=128>Macau S.A.R.</option><option value=129>Macedonia</option><option value=130>Madagascar</option><option value=131>Malawi</option><option value=132>Malaysia</option><option value=133>Maldives</option><option value=134>Mali</option><option value=135>Malta</option><option value=136>Man (Isle of)</option><option value=137>Marshall Islands</option><option value=138>Martinique</option><option value=139>Mauritania</option><option value=140>Mauritius</option><option value=141>Mayotte</option><option value=142>Mexico</option><option value=143>Micronesia</option><option value=144>Moldova</option><option value=145>Monaco</option><option value=146>Mongolia</option><option value=147>Montserrat</option><option value=148>Morocco</option><option value=149>Mozambique</option><option value=150>Myanmar</option><option value=151>Namibia</option><option value=152>Nauru</option><option value=153>Nepal</option><option value=154>Netherlands Antilles</option><option value=155>Netherlands The</option><option value=156>New Caledonia</option><option value=157>New Zealand</option><option value=158>Nicaragua</option><option value=159>Niger</option><option value=160>Nigeria</option><option value=161>Niue</option><option value=162>Norfolk Island</option><option value=163>Northern Mariana Islands</option><option value=164>Norway</option><option value=165>Oman</option><option value=166>Pakistan</option><option value=167>Palau</option><option value=168>Palestinian Territory Occupied</option><option value=169>Panama</option><option value=170>Papua new Guinea</option><option value=171>Paraguay</option><option value=172>Peru</option><option value=173>Philippines</option><option value=174>Pitcairn Island</option><option value=175>Poland</option><option value=176>Portugal</option><option value=177>Puerto Rico</option><option value=178>Qatar</option><option value=179>Reunion</option><option value=180>Romania</option><option value=181>Russia</option><option value=182>Rwanda</option><option value=183>Saint Helena</option><option value=184>Saint Kitts And Nevis</option><option value=185>Saint Lucia</option><option value=186>Saint Pierre and Miquelon</option><option value=187>Saint Vincent And The Grenadines</option><option value=188>Samoa</option><option value=189>San Marino</option><option value=190>Sao Tome and Principe</option><option value=191>Saudi Arabia</option><option value=192>Senegal</option><option value=193>Serbia</option><option value=194>Seychelles</option><option value=195>Sierra Leone</option><option value=196>Singapore</option><option value=197>Slovakia</option><option value=198>Slovenia</option><option value=199>Smaller Territories of the UK</option><option value=200>Solomon Islands</option><option value=201>Somalia</option><option value=202>South Africa</option><option value=203>South Georgia</option><option value=204>South Sudan</option><option value=205>Spain</option><option value=206>Sri Lanka</option><option value=207>Sudan</option><option value=208>Suriname</option><option value=209>Svalbard And Jan Mayen Islands</option><option value=210>Swaziland</option><option value=211>Sweden</option><option value=212>Switzerland</option><option value=213>Syria</option><option value=214>Taiwan</option><option value=215>Tajikistan</option><option value=216>Tanzania</option><option value=217>Thailand</option><option value=218>Togo</option><option value=219>Tokelau</option><option value=220>Tonga</option><option value=221>Trinidad And Tobago</option><option value=222>Tunisia</option><option value=223>Turkey</option><option value=224>Turkmenistan</option><option value=225>Turks And Caicos Islands</option><option value=226>Tuvalu</option><option value=227>Uganda</option><option value=228>Ukraine</option><option value=229>United Arab Emirates</option><option value=230>United Kingdom</option><option value=231>United States</option><option value=232>United States Minor Outlying Islands</option><option value=233>Uruguay</option><option value=234>Uzbekistan</option><option value=235>Vanuatu</option><option value=236>Vatican City State (Holy See)</option><option value=237>Venezuela</option><option value=238>Vietnam</option><option value=239>Virgin Islands (British)</option><option value=240>Virgin Islands (US)</option><option value=241>Wallis And Futuna Islands</option><option value=242>Western Sahara</option><option value=243>Yemen</option><option value=244>Yugoslavia</option><option value=245>Zambia</option><option value=246>Zimbabwe</option>						</select>
					</div>
					<p class="error"> </p>

					<select name="state2" id="state2" class="form-control" onChange="getCity2(this.value);">
													<option value="12" selected>Gujarat</option>
											</select>
					<p class="error"> </p>

					<select name="city2" id="city2" class="form-control">
													<option value="1068" selected>Vadodara</option>
											</select>

					<p class="error"> </p>
					<input type="text" class="form-control" name="zip2" id="zip2" placeholder="Zip" style="margin-bottom:0px;" value="390021">
					<p class="error"> </p>
				</div>
			</div>
			<div class="col-sm-6 right">
				<label class="required">	Email Address:</label>
				<input type="email" class="form-control" name="email1" placeholder="Primary Email ID" value="surbhianand158@gmail.com">
				<p class="error"> </p>
				<input type="email" class="form-control" name="email2" placeholder="Alternate Email ID" value="anandsurbh158@gmail.com" style="margin-bottom:0px;">
				<br/><br/>
				<label  class="required">	Mobile Number:</label>
				<input type="tel" class="form-control" name="tel1" placeholder="Primary No." maxlength="10" value="9624875849">
				<p class="error"> </p>
				<input type="tel" class="form-control" name="tel2" placeholder="Emergency No." value="9537169509" style="margin-bottom:0px;">

				<input type="hidden" class="form-control"  name="pstatus" value=1 >
			</div>
		</div>
		<div class="form-group">
			<div class="col-sm-6 left">
					</div>
			<div class="col-sm-6 right">
			</div>
		</div>
		<br/>
		<div class="sub_btn text-center">
			<a href="dashboard.php" class="btn btn-default back_dashboard">Back to dashboard</a>
			<a id="next"><input type="submit" value="Submit"> </a>
		</div>
	</form>
</div>


<footer>
	<div class="main-container">
		<div class="contact-heading">
			Contact us: <a href="tel:+916302868390">+91 63028 68390</a> / <a href="mailto:tii@accesslivelihoods.org">tii@accesslivelihoods.org</a>
		</div>
		<br />
		<div class="footer-upper">
			<ul class="nav nav-pills footeter-link">
				<li><a href="index.php">Home</a></li>
				<li><a href="eligibility.php">Be a SEP Seeker</a></li>
				<!-- 3-9-2018 start-->
+				<li><a href="meettheseekers.php">Meet The Seekers</a></li>
+				<!-- 3-9-2018 end-->
				<li><a href="whytii.php">About the Initiative</a></li>
				<li><a href="aboutus.php">About Us</a></li>
				<li><a href="post-program.php">Post Program</a></li>
				<li><a href="beinspired.php">Be Inspired<span>!</span></a></li>
			</ul>
			<ul class="nav nav-pills social-link">
						<li><a href="https://www.linkedin.com/company/access-livelihoods/" target="_blank"><i class="fa fa-linkedin-square" aria-hidden="true"></i></a></li>
						<li><a href="https://www.facebook.com/accesslivelihoods.org" target="_blank"><i class="fa fa-facebook-square" aria-hidden="true"></i></a></li>
						<li><a href="https://www.youtube.com/@AccessLivelihoods" target="_blank"><i class="fa fa-youtube-play" aria-hidden="true"></i></a></li>
						<li><a href="https://www.instagram.com/access.livelihoods/" target="_blank"><i class="fa fa-instagram" aria-hidden="true"></i></a></li>

			</ul>
		</div>
		<div class="footer-lower">
			<ul class="nav nav-pills">
				<li><a href="aboutus.php">About ALC</a></li>
				<li><a href="privacy-policy.php">Privacy Policy</a></li>
				<li><a href="disclaimer.php">Disclaimer</a></li>
				<li><a>&copy; Access Livelihoods 2017 - 2023</a></li>
				<li><a href="https://www.opendrops.com" target="_blank">Powered by Opendrops</a></li>
			</ul>
		</div>
	</div>
</footer>
		
		<!-- Javascript file -->
		<script src="js/jquery.min.js"></script>
		<script src="js/bootstrap.min.js"></script>
		<script src="js/moment.js"></script>
		<script src="js/bootstrap-datetimepicker.js"></script>
		<script>
			(function(){

				$('#partnerlider').carousel({ interval: false });
				}());

				(function(){
				$('.carousel-showmanymoveone .item').each(function(){
				var itemToClone = $(this);

				for (var i=1;i<6;i++) {
				itemToClone = itemToClone.next();


				if (!itemToClone.length) {
				itemToClone = $(this).siblings(':first');
				}


				itemToClone.children(':first-child').clone()
				.addClass("cloneditem-"+(i))
				.appendTo($(this));
				}
				});
			}());
		</script>
		<script>
			$(document).ready(function(){
				$("#menulink").click(function () {
					$(this).hide();
					$(".menulink-container").show("slow");
					$("#menuclose").show("slow");
				});
				$("#menuclose").click(function () {
					$(this).hide();
					$(".menulink-container").hide("slow");
					$("#menulink").show("slow");
				});
			});
		</script>
		<script>
			(function(){
				$('#pageslider').carousel({ interval: false });
				}());
				(function(){
				$('.carousel-pageslider .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<3;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
		</script>
<script>
			(function(){
				$('#seekerslider').carousel({ interval: false });
				}());
				(function(){
				$('.carousel-seekerslider .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<1;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
			(function(){
				$('#seekerslider2').carousel({ interval: false });
				}());
				(function(){
				$('.carousel-seekerslider2 .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<1;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
			// new experiential learning
			(function(){
				$('#seekerslider3').carousel({ interval: false });
				}());
				(function(){
				$('.carousel-seekerslider3 .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<3;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
		</script>
		<script>
			(function(){
				$('#teamslider').carousel({ interval: false });
				}());
				(function(){
				$('.testimonialslide .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<4;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
		</script>
		<script>
			(function(){
				$('#agri-faculty').carousel({ interval: false });
				}());
				(function(){
				$('.agri-faculty .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<4;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
		</script>
		<script>
			(function(){
				$('#tii_testimonail_slider').carousel({ interval: false });
				}());
				(function(){
				$('.tii_testimonial_slide .item').each(function(){
				var itemToClone = $(this);
				for (var i=1;i<1;i++) {
					itemToClone = itemToClone.next();
					if (!itemToClone.length) {
					itemToClone = $(this).siblings(':first');
					}
					itemToClone.children(':first-child').clone()
					.addClass("cloneditem-"+(i))
					.appendTo($(this));
					}
				});
			}());
		</script>
		<script>
			$(document).ready(function(){
				$(".faqques a").click(function () {
					$(this).parent().parent().parent().parent().children().children(".active").toggle();
					$(this).parent().parent().parent().parent().children().children(".inactive").toggle();
					$(this).removeClass("faqlinka");
					$(this).addClass("faqlinka1");
				});
			});
		</script>
		<script>
			$('#datetimepicker1').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate1').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate1').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate2').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate2').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate3').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate3').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate4').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate4').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate5').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate5').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate6').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate6').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#startDate7').datetimepicker({
				 format: 'DD-MM-YYYY'
			});

			$('#endDate7').datetimepicker({
				 format: 'DD-MM-YYYY'
			});
		</script>
		<script>
			$('.datepicker').datetimepicker({
				 format: 'DD-MM-YYYY'
			});
		</script>
<script type="text/javascript">
/* <![CDATA[ */
var google_conversion_id = 853939088;
var google_custom_params = window.google_tag_params;
var google_remarketing_only = true;
/* ]]> */
</script>
<script type="text/javascript" src="//www.googleadservices.com/pagead/conversion.js">
</script>
<noscript>
<div style="display:inline;">
<img height="1" width="1" style="border-style:none;" alt="" src="//googleads.g.doubleclick.net/pagead/viewthroughconversion/853939088/?guid=ON&amp;script=0"/>
</div>
</noscript>

	</body>
</html>
		<script type="text/javascript">
		    $(document).ready(function(){
					 $(".form-horizontal :input").prop("disabled", true);
		    });
		</script>
	<script>
$(document).ready(function(){
		$('#check').click(function(){
			if($(this). prop("checked") == true){
				var add1 = $('#add1').val();
				var add2 = $('#add2').val();
				var country1 = $('#country1').val();
				var country_name = $('#country1 option:selected').text();
				var city1 = $('#city1').val();
				var city_name = $('#city1 option:selected').text();
				var state1 = $('#state1').val();
				var state_name = $('#state1 option:selected').text();
				var zip1 = $('#zip1').val();
				$('#add3').val(add1);
				$('#add4').val(add2);
				// $('#country2').val(country1);
				document.getElementById('country2').innerHTML = "<option value='" + country1 + "'>" + country_name + "</option>";
				document.getElementById('state2').innerHTML = "<option value='" + state1 + "'>" + state_name + "</option>";
				document.getElementById('city2').innerHTML = "<option value='" + city1 + "'>" + city_name + "</option>";
				// $('#city2').val(city1);
				// $('#state2').val(state1);
				$('#zip2').val(zip1);
				$('.c_s_c').css('display', 'block');
				$('.c_s_c_original').css('display', 'none');
				$('.per_address').css('display', 'none');
			}else if($(this). prop("checked") == false){
				$('#add3').val('');
				$('#add4').val('');
				$('#country2').val('');
				// $('#country2').empty();
				$('#city2').val('');
				$('#state2').val('');
				$('#zip2').val('');
				$('.c_s_c').css('display', 'none');
				$('.c_s_c_original').css('display', 'block');
				$('.per_address').css('display', 'block');
			}
		});

		var is_checked = '';
		var c_check = 'C';
		var p_check = 'P';
		if(p_check == '' && c_check == '' && is_checked == ''){
			$('.per_address').css('display', 'none');
		}
		else if(is_checked == 'C'){
			$('.per_address').css('display', 'none');
		}
		else{
			$('.per_address').css('display', 'block');
		}
		var un_check = '';
		if(un_check == 'Uncheck'){
			$("#check").prop("checked", false);
			$('.per_address').css('display', 'block');
		}
});
</script>
<script>
	function readURL(input) {
    if (input.files && input.files[0]) {
        var reader = new FileReader();

        reader.onload = function (e) {
            $('#blah').attr('src', e.target.result);
        }

        reader.readAsDataURL(input.files[0]);
    }
}

$("#fileToUpload").change(function(){
    readURL(this);
});
</script>

<script type='text/javascript'>
window.__wtw_lucky_site_id = 104929;

(function() {
var wa = document.createElement('script'); wa.type = 'text/javascript'; wa.async = true;
wa.src = 'https://d10lpsik1i8c69.cloudfront.net/w.js';
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(wa, s);
})();

$("input[name$='optionsRadios2']").click(function() {
    var m_s = $(this).val();
		if (m_s == "S") {
			$('.sp_oc').hide();
		}
		if (m_s == "M") {
			$('.sp_oc').show();
		}

});

$(document).ready(function() {
		var m_st = "S";

		if (m_st == "S") {
			$('.sp_oc').hide();
		}
		if (m_st == "M") {
			$('.sp_oc').show();
		}
		if (m_st == "") {
			$('.sp_oc').hide();
		}
});


function getState(val) {
	$.ajax({
	type: "POST",
	url: "getState.php",
	data:'country_id='+val,
	success: function(data){
		$("#state1").html(data);
		getCity();
	}
	});
}


function getCity(val) {
	$.ajax({
	type: "POST",
	url: "getCity.php",
	data:'state_id='+val,
	success: function(data){
		$("#city1").html(data);
	}
	});
}

function getState2(val) {
	$.ajax({
	type: "POST",
	url: "getState.php",
	data:'country_id='+val,
	success: function(data){
		$("#state2").html(data);
		getCity2();
	}
	});
}


function getCity2(val) {
	$.ajax({
	type: "POST",
	url: "getCity.php",
	data:'state_id='+val,
	success: function(data){
		$("#city2").html(data);
	}
	});
}
</script>