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</div> </div> <!--Start of question row--> <div class="row cdiv martop10"> <div class="col-md-12" style="padding-left:0px;padding-right:0px;"> <form action="coinmsub.php" method="post" class="addev" style="padding:30px;"> <h></h> <h4 style="padding-bottom:20px;">Please subscribe to know about our latest conferences </h4> <div class="row"> <div class="col-md-2"> <label>Personal Details</label> </div> <div class="col-md-5"> <input type="text" name="name" id="fname" placeholder="" required /> <p><span>Name</span></p> </div> <div class="col-md-5"> <input type="text" name="email" id="mail" placeholder="" required /> <p><span>Email Id</span></p> </div> </div> <div class="row martop20"> <div class="col-md-2"> <!--<label>Conference Details</label> --> </div> <div class="col-md-5"> <input type="text" name="phone" id="mobile" placeholder="" required /> <p><span>Mobile Number</span></p> </div> </div> <div class="row"> <div class="col-md-2"> <label></label> </div> <div class="col-md-5"> <!-- <input type="text" name="institute_name" id="insttitute_name" /> <p><span>Institute Name</span></p>--> </div> </div> <div class="row" style=" margin-top:30px;"> <div class="col-md-2"> <label>Topics</label> </div> <div class="col-md-5"> <select name="topic" id="stopic" required> <optgroup> <option style="background-color:#09F" value="-1" required>Topics</option> <option value="Medicine">Medicine</option> <option value="Mathematics">Mathematics</option> <option value="Engineering">Engineering</option> <option value="Business">Business</option> <option value="Life Sciences">Life Sciences</option> <option value="Social Sciences">Social Sciences</option> <option value="Education">Education</option> <option value="Interdisciplinary">Interdisciplinary</option> <option value="Regional">Regional</option> <option value="Law">Law</option> </optgroup> </select> <p><span></span></p> </div> </div> <div class="row" style=" margin-top:30px;"> <div class="col-md-2"> <label>Country</label> </div> <div class="col-md-5"> <input type="text" name="place" id="place" placeholder="" required /> <p><span></span></p> </div> </div> <div id="captcha-group" class="form-group row cotainer"> <script src="https://www.google.com/recaptcha/api.js"></script> <div class="g-recaptcha brochure__form__captcha" data-sitekey="6LfswyAbAAAAANBQdwqHeMZTRGi_E6QkJjHI4Emg" style="width:10%"></div> </div> </div> <div class="row" style=" margin-top:30px;"> <div class="col-md-2"> </div> <div class="col-md-10"> <input type="submit" value="subscribe" name="submit"> <input type="hidden" name="submitted" value="true" /> </div> </div> </form> </div> </div> <!--End of question row--> </div> </div> <!--End of left side content--> <!--Start of right side content--> <div class="col-md-2"> <!--Start of left ads--> <!--<div class="row"> <div class="col-md-12"> <a href="https://conferenceinmalaysia.com/journals.php"> <img src="images/Journal-Publications.jpg" alt="Journal Publications" width="100%" style="border: 1px solid teal;" /></a> </div> </div>--> <div class="row martop10"> <div class="col-md-12"> <a href="https://conferenceinmalaysia.com/subtopic.php?sub=Nursing"><img src="images/malaysia-conference-nursing-2018.jpg" alt="Malaysia Conference Nursing 2018" width="100%" style="border: 1px solid teal;" /></a> </div> </div> <div class="row martop10"> <div class="col-md-12"> <a href="https://conferenceinmalaysia.com/subtopic.php?sub=Pharmacy"> <img src="images/malaysia-conference-Pharmacy-2018.jpg" alt="Malaysia Conference Pharmacy 2018" width="100%" style="border: 1px solid teal;" /></a> </div> </div> <div class="row martop10"> <div class="col-md-12"> <a href="https://conferenceinmalaysia.com/subtopic.php?sub=Infectious-diseases"> <img src="images/malaysia-conference-infectious-diseases-2018.jpg" alt="malaysia conference infectious diseases 2018" width="100%" style="border: 1px solid teal;" /></a> </div> </div> <div class="row martop10"> <div class="col-md-12"> <a href="https://conferenceinmalaysia.com/Indexifembedded.php" target="_blank" style="font-size:5px;">IfEmbed</a> </div> </div> <!--End of left ads--> </div> <!--End of right side content--> </div> </div> </section> <!--End of content section--> <!--Start of footer--> <footer id="footer"> <div class="container-fluid"> <div class="row"> <div class="col-md-12" style="padding:10px;text-align:center;"> © Conference in Malaysia 2024 </div> </div> </div> </footer> <!--End of footer--><!--Start of jquey library--> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.1.1/jquery.min.js"></script> <!--End of jquery library--> <!--Start of bootstrap js--> <script src="bootstrap-3.3.7/dist/js/bootstrap.min.js"></script> <!--End of bootstrap js--> <script> CKEDITOR.replace( 'venue' ); </script> <script type="text/javascript"> $(document).ready(function(){ $("#reload").click(function() { $("#captchaimg").attr("src", "captcha/captcha.php?"+Math.random()); }); }); </script> </body> </html>
