      <div class="main-right">
        <?php include('include/top-place.php'); ?>
        <div class="main-right-content c-d">
          <div class="titile-welcome">TAILOR - MADE FORM <span class="b-down"></span></div>
          <div class="main-right-body">
            <style>
              #form label{
                width: 254px;
              }
            </style>
            <?php
                if(isset($_GET['thanks']))
                  { 
                   echo '<strong><font color="green" style="font-size:20px;">Your booking requrest has been sent. Thank you!</font></strong>';
                  } 
              ?>
            <form id="form" method="post" class="clearfix" style="width:679px" action="custom-submit.php">
              <span class="t-title">DESIGN YOUR OWN TOUR / TAILOR - MADE</span>
              <p>
                <label>Title:</label>
                <select class="input-text" name="Itm_1" required>
                  <option value="" selected="">Select</option>
                  <option value="Mr">Mr.</option>
                  <option value="Mrs">Mrs.</option>
                  <option value="Ms">Ms</option>
                  <option value="Dr">Dr.</option>
                  <option value="Prof">Prof.</option>
                </select>
                <span class="cls"></span>
              </p>                            
                            <p>
                              <label>Name:</label>  
                                <input type="text" value="" name="Itm_2" required>
                                <div class="cls"></div>
                            </p>
                            <p>
                              <label>Email:</label> 
                                <input type="email" value="" name="Itm_3" required>
                                <div class="cls"></div>
                            </p>
                            <p>
                              <label>Phone:</label>
                                <input type="text" value="" name="Itm_4" required>
                                <div class="cls"></div> 
                            </p>
                            <p>
                                <label>Country:</label>
                                <select name="Itm_5" id="Itm_4" required class="input-text">
                                  <option selected="selected">--Select country--</option>
                                  <option value="Afghanistan">Afghanistan</option>
                                  <option value="Albania">Albania</option>
                                  <option value="Algeria">Algeria</option>
                                  <option value="American Samoa">American Samoa</option>
                                  <option value="Andorra">Andorra</option>
                                  <option value="Angola">Angola</option>
                                  <option value="Anguilla">Anguilla</option>
                                  <option value="Antarctica">Antarctica</option>
                                  <option value="Antigua And Barbuda">Antigua And Barbuda</option>
                                  <option value="Argentina">Argentina</option>
                                  <option value="Armenia">Armenia</option>
                                  <option value="Aruba">Aruba</option>
                                  <option value="Australia">Australia</option>
                                  <option value="Austria">Austria</option>
                                  <option value="Azerbaijan">Azerbaijan</option>
                                  <option value="Bahamas">Bahamas</option>
                                  <option value="Bahrain">Bahrain</option>
                                  <option value="Bangladesh">Bangladesh</option>
                                  <option value="Barbados">Barbados</option>
                                  <option value="Belarus">Belarus</option>
                                  <option value="Belgium">Belgium</option>
                                  <option value="Belize">Belize</option>
                                  <option value="Benin">Benin</option>
                                  <option value="Bermuda">Bermuda</option>
                                  <option value="Bhutan">Bhutan</option>
                                  <option value="Bolivia">Bolivia</option>
                                  <option value="Bosnia And Herzegowina">Bosnia And Herzegowina</option>
                                  <option value="Botswana">Botswana</option>
                                  <option value="Bouvet Island">Bouvet Island</option>
                                  <option value="Brazil">Brazil</option>
                                  <option value="British Indian">British Indian</option>
                                  <option value="Brunei Darussalam">Brunei Darussalam</option>
                                  <option value="Bulgaria">Bulgaria</option>
                                  <option value="Burkina Faso">Burkina Faso</option>
                                  <option value="Burundi">Burundi</option>
                                  <option value="Cambodia">Cambodia</option>
                                  <option value="Cameroon">Cameroon</option>
                                  <option value="Canada">Canada</option>
                                  <option value="Cape Verde">Cape Verde</option>
                                  <option value="Cayman Islands">Cayman Islands</option>
                                  <option value="Central African Republic">Central African Republic</option>
                                  <option value="Chad">Chad</option>
                                  <option value="Chile">Chile</option>
                                  <option value="China">China</option>
                                  <option value="Christmas Island">Christmas Island</option>
                                  <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
                                  <option value="Colombia">Colombia</option>
                                  <option value="Comoros">Comoros</option>
                                  <option value="Congo">Congo</option>
                                  <option value="Cook Islands">Cook Islands</option>
                                  <option value="Costa Rica">Costa Rica</option>
                                  <option value="Cote D Ivoire">Cote D Ivoire</option>
                                  <option value="Croatia">Croatia</option>
                                  <option value="Cuba">Cuba</option>
                                  <option value="Cyprus">Cyprus</option>
                                  <option value="Czech Republic">Czech Republic</option>
                                  <option value="Denmark">Denmark</option>
                                  <option value="Djibouti">Djibouti</option>
                                  <option value="Dominica">Dominica</option>
                                  <option value="Dominican Republic">Dominican Republic</option>
                                  <option value="East Timor">East Timor</option>
                                  <option value="Ecuador">Ecuador</option>
                                  <option value="Egypt">Egypt</option>
                                  <option value="El Salvador">El Salvador</option>
                                  <option value="Equatorial Guinea">Equatorial Guinea</option>
                                  <option value="Eritrea">Eritrea</option>
                                  <option value="Estonia">Estonia</option>
                                  <option value="Ethiopia">Ethiopia</option>
                                  <option value="Falkland Islands">Falkland Islands</option>
                                  <option value="Faroe Islands">Faroe Islands</option>
                                  <option value="Fiji">Fiji</option>
                                  <option value="Finland">Finland</option>
                                  <option value="France">France</option>
                                  <option value="France, Metropolitan">France, Metropolitan</option>
                                  <option value="French Guiana">French Guiana</option>
                                  <option value="French Polynesia">French Polynesia</option>
                                  <option value="Gabon">Gabon</option>
                                  <option value="Gambia">Gambia</option>
                                  <option value="Georgia">Georgia</option>
                                  <option value="Germany">Germany</option>
                                  <option value="Ghana">Ghana</option>
                                  <option value="Gibraltar">Gibraltar</option>
                                  <option value="Greece">Greece</option>
                                  <option value="Greenland">Greenland</option>
                                  <option value="Grenada">Grenada</option>
                                  <option value="Guadeloupe">Guadeloupe</option>
                                  <option value="Guam">Guam</option>
                                  <option value="Guatemala">Guatemala</option>
                                  <option value="Guinea">Guinea</option>
                                  <option value="Guinea-Bissau">Guinea-Bissau</option>
                                  <option value="Guyana">Guyana</option>
                                  <option value="Haiti">Haiti</option>
                                  <option value="Honduras">Honduras</option>
                                  <option value="Hungary">Hungary</option>
                                  <option value="Hong Kong">Hong Kong</option>
                                  <option value="Iceland">Iceland</option>
                                  <option value="India">India</option>
                                  <option value="Indonesia">Indonesia</option>
                                  <option value="Iran">Iran</option>
                                  <option value="Iraq">Iraq</option>
                                  <option value="Ireland">Ireland</option>
                                  <option value="Israel">Israel</option>
                                  <option value="Italy">Italy</option>
                                  <option value="Jamaica">Jamaica</option>
                                  <option value="Japan">Japan</option>
                                  <option value="Jordan">Jordan</option>
                                  <option value="Kazakhstan">Kazakhstan</option>
                                  <option value="Kenya">Kenya</option>
                                  <option value="Kiribati">Kiribati</option>
                                  <option value="North Korea">North Korea</option>
                                  <option value="South Korea">South Korea</option>
                                  <option value="Kuwait">Kuwait</option>
                                  <option value="Kyrgyzstan">Kyrgyzstan</option>
                                  <option value="Laos">Laos</option>
                                  <option value="Latvia">Latvia</option>
                                  <option value="Lebanon">Lebanon</option>
                                  <option value="Lesotho">Lesotho</option>
                                  <option value="Liberia">Liberia</option>
                                  <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
                                  <option value="Liechtenstein">Liechtenstein</option>
                                  <option value="Lithuania">Lithuania</option>
                                  <option value="Luxembourg">Luxembourg</option>
                                  <option value="Macau">Macau</option>
                                  <option value="Macedonia">Macedonia</option>
                                  <option value="Madagascar">Madagascar</option>
                                  <option value="Malawi">Malawi</option>
                                  <option value="Malaysia">Malaysia</option>
                                  <option value="Maldives">Maldives</option>
                                  <option value="Mali">Mali</option>
                                  <option value="Malta">Malta</option>
                                  <option value="Marshall Islands">Marshall Islands</option>
                                  <option value="Martinique">Martinique</option>
                                  <option value="Mauritania">Mauritania</option>
                                  <option value="Mauritius">Mauritius</option>
                                  <option value="Mayotte">Mayotte</option>
                                  <option value="Mexico">Mexico</option>
                                  <option value="Micronesia">Micronesia</option>
                                  <option value="Moldova">Moldova</option>
                                  <option value="Monaco">Monaco</option>
                                  <option value="Mongolia">Mongolia</option>
                                  <option value="Montserrat">Montserrat</option>
                                  <option value="Morocco">Morocco</option>
                                  <option value="Mozambique">Mozambique</option>
                                  <option value="Myanmar">Myanmar</option>
                                  <option value="Namibia">Namibia</option>
                                  <option value="Nauru">Nauru</option>
                                  <option value="Nepal">Nepal</option>
                                  <option value="Netherlands">Netherlands</option>
                                  <option value="Netherlands Antilles">Netherlands Antilles</option>
                                  <option value="New Caledonia">New Caledonia</option>
                                  <option value="New Zealand">New Zealand</option>
                                  <option value="Nicaragua">Nicaragua</option>
                                  <option value="Niger">Niger</option>
                                  <option value="Nigeria">Nigeria</option>
                                  <option value="Niue">Niue</option>
                                  <option value="Norfolk Island">Norfolk Island</option>
                                  <option value="Northern Mariana Islands">Northern Mariana Islands</option>
                                  <option value="Norway">Norway</option>
                                  <option value="Oman">Oman</option>
                                  <option value="Pakistan">Pakistan</option>
                                  <option value="Palau">Palau</option>
                                  <option value="Palestinian Territory">Palestinian Territory</option>
                                  <option value="Panama">Panama</option>
                                  <option value="Papua New Guinea">Papua New Guinea</option>
                                  <option value="Paraguay">Paraguay</option>
                                  <option value="Peru">Peru</option>
                                  <option value="Philippines">Philippines</option>
                                  <option value="Pitcairn">Pitcairn</option>
                                  <option value="Poland">Poland</option>
                                  <option value="Portugal">Portugal</option>
                                  <option value="Puerto Rico">Puerto Rico</option>
                                  <option value="Qatar">Qatar</option>
                                  <option value="Reunion">Reunion</option>
                                  <option value="Romania">Romania</option>
                                  <option value="Russian Federation">Russian Federation</option>
                                  <option value="Rwanda">Rwanda</option>
                                  <option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
                                  <option value="Saint Lucia">Saint Lucia</option>
                                  <option value="Samoa">Samoa</option>
                                  <option value="San Marino">San Marino</option>
                                  <option value="Sao Tome And Principe">Sao Tome And Principe</option>
                
                                  <option value="Saudi Arabia">Saudi Arabia</option>
                                  <option value="Senegal">Senegal</option>
                                  <option value="Seychelles">Seychelles</option>
                                  <option value="Sierra Leone">Sierra Leone</option>
                                  <option value="Singapore">Singapore</option>
                                  <option value="Slovakia">Slovakia</option>
                                  <option value="Slovenia">Slovenia</option>
                                  <option value="Solomon Islands">Solomon Islands</option>
                                  <option value="Somalia">Somalia</option>
                                  <option value="South Africa">South Africa</option>
                                  <option value="South Georgia">South Georgia</option>
                                  <option value="Spain">Spain</option>
                                  <option value="Sri Lanka">Sri Lanka</option>
                                  <option value="St Helena">St Helena</option>
                                  <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>
                                  <option value="Sudan">Sudan</option>
                                  <option value="Suriname">Suriname</option>
                                  <option value="Swaziland">Swaziland</option>
                                  <option value="Sweden">Sweden</option>
                                  <option value="Switzerland">Switzerland</option>

                                  <option value="Syrian Arab Republic">Syrian Arab Republic</option>
                                  <option value="Taiwan">Taiwan</option>
                                  <option value="Tajikistan">Tajikistan</option>
                                  <option value="Tanzania">Tanzania</option>
                                  <option value="Thailand">Thailand</option>
                                  <option value="Togo">Togo</option>
                                  <option value="Tokelau">Tokelau</option>
                                  <option value="Tonga">Tonga</option>
                                  <option value="Trinidad And Tobago">Trinidad And Tobago</option>
                                  <option value="Tunisia">Tunisia</option>
                                  <option value="Turkey">Turkey</option>
                                  <option value="Turkmenistan">Turkmenistan</option>
                                  <option value="Turks And Caicos Islands">Turks And Caicos Islands</option>
                                  <option value="Tuvalu">Tuvalu</option>
                                  <option value="Uganda">Uganda</option>
                                  <option value="Ukraine">Ukraine</option>
                                  <option value="United Arab Emirates">United Arab Emirates</option>
                                  <option value="United Kingdom">United Kingdom</option>
                                  <option value="United States">United States</option>
                                  <option value="US Minor Outlying Islands">US Minor Outlying Islands</option>
                                  <option value="Uruguay">Uruguay</option>
                                  <option value="Uzbekistan">Uzbekistan</option>
                                  <option value="Vanuatu">Vanuatu</option>
                                  <option value="Vatican City State">Vatican City State</option>
                                  <option value="Venezuela">Venezuela</option>
                                  <option value="Vietnam">Vietnam</option>
                                  <option value="Virgin Islands (British)">Virgin Islands (British)</option>
                                  <option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
                                  <option value="Wallis And Futuna Islands">Wallis And Futuna Islands</option>
                                  <option value="Western Sahara">Western Sahara</option>
                                  <option value="Yemen">Yemen</option>
                                  <option value="Yugoslavia">Yugoslavia</option>
                                  <option value="Zaire">Zaire</option>
                                  <option value="Zambia">Zambia</option>
                                  <option value="Zimbabwe">Zimbabwe</option>
                                </select>
                                <div class="cls"></div>
                            </p>
                            <p>
                             <b> TRAVEL ITINERARY INFORMATION</b>
                              <br>For which destination would you like to request further information? 
                              <br>(if you are considering several destination for your travel plans, please inquire in the destination you believe is the lead destination)
                            </p>
                            <p>
                              <label>Select Your Destination:</label>
                              <select name="Itm_6" required class="input-text">
                                <option value="" selected="">Please choose the next destination</option>
                                <option value="Cambodia">Cambodia</option>
                                <option value="Laos">Laos</option>
                                <option value="Vietnam">Vietnam</option>
                                <option value="Thailand">Thailand</option>
                                <option value="Myanmar">Myanmar</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              
                                If you are interested in visiting more than one destination, 
please tick the appropriate places: 
                              
                            </p>
                            <p>
                              <input type="checkbox" name="Itm_7" value="Cambodia"> Cambodia
                              <input type="checkbox" name="Itm_8" value="Laos"> Laos
                              <input type="checkbox" name="Itm_9" value="Vietnam"> Vietnam
                              <input type="checkbox" name="Itm_10" value="Thailand"> Thailand
                              <input type="checkbox" name="Itm_11" value="Myanmar"> Myanmar
                              <div class="cls"></div>
                            </p>
                            <p>
                              <b>TRAVEL PERIOD</b>
                            </p>
                            <p>
                              <label>I would like to travel for:</label>
                              <select class="input-text" required name="Itm_12">
                                <option value="" selected="">Please select duration</option>
                                <option value="Less than 3 days">Less than 3 days</option>
                                <option value="3 to 7 days">3 to 7 days</option>
                                <option value="8 to 10 days">8 to 10 days</option>
                                <option value="11 to 15 days">11 to 15 days</option>
                                <option value="More than 15 days">More than 15 days</option>
                                <option value="Not sure">Not sure</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              I know the exact dates of my holidays and I want to travel:
                            </p>
                            <p>
                              <label>From:</label>
                                <input name="Itm_13" id="datepicker-example7-start" type="text">
                                <div class="cls"></div> 
                            </p>
                            <p>
                              <label>To:</label>
                                <input id="datepicker-example7-end" name="Itm_14" type="text">
                                <div class="cls"></div> 
                            </p>
                            <p>
                              <label>I am unsure but probably in:</label>
                              <input id="datepicker-example11" name="Itm_15" type="text">
                              <div class="cls"></div>
                            </p>
                            <p>
                              <b>TOUR STYLE & DETAILS</b>
                            </p>
                            <p>
                              
                              <label>What kind of tour are you looking for?</label>
                              <select name="Itm_16">
                              <option value="" selected=""  required>Select a tour type</option>
                              <?php
                                $result=$Con->query("SELECT * FROM tbl_travel WHERE language_id={$lang}");
                                while($row=mysqli_fetch_object($result)){
                              ?>                                
                                <option value="<?php echo $row->category; ?>"><?php echo $row->category; ?></option>
                                <?php } ?>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              My interests are (please let us know on a scale of 1-5 the level of interest you have in each category. 
                               1 = no interest / 5 = high interest)
                            </p>
                            <p>
                              <label>Real Adventure:</label>
                              <select  name="Itm_17" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Soft Adventure:</label>
                              <select  name="Itm_18" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Culture (Temples, Archaeological, Heritage sites):</label>
                              <select  name="Itm_19" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Culture (meeting and learning about local people and customs):</label>
                              <select  name="Itm_20" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Golf:</label>
                              <select  name="Itm_21" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Spa / Wellness:</label>
                              <select  name="Itm_22" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Shopping:</label>
                              <select  name="Itm_23" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Cooking Classes:</label>
                              <select  name="Itm_24" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>Cruises:</label>
                              <select name="Itm_25" class="sub-title">
                                <option value="" selected="">Select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              
Please, use the box below to give us as much detail as possible about your tour. 
If you have a route in mind, please let us know. Please, add any information you
would like to include, such as special requirements, must-see places, pace or 
timing of your journey, etc.
                            </p>
                            <p>
                              <label>Message:</label>
                                <textarea required name="Itm_26" cols="20" rows="2"></textarea> 
                                <div class="cls"></div>
                            </p>
                            <p>
                              <b>HOTEL INFORMATION</b>
                            </p>
                            <p>
                              I prefer you to organize my trip with a majority of: 
                            </p>
                             <p>
                              <input type="radio" value="Standard" name="Itm_27">Standard hotels <i class="fa fa-star"></i><i class="fa fa-star"></i>
                              <br><input type="radio" value="First-class hotels " name="Itm_27">First-class hotels <i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i>
                              <br><input type="radio" value="Superior hotels" name="Itm_27">Superior hotels <i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i>
                              <br><input type="radio" value="Deluxe hotels" name="Itm_27">Deluxe hotels <i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i><i class="fa fa-star"></i>
                              <br><input type="radio" value="Boutique" name="Itm_27">Boutique
                              <div class="cls"></div>
                            </p>
                            <p>
                              I would like you to organize my trip on a: 
                            </p>
                            <p>
                              <input type="checkbox" name="Itm_28" value="Room and Breakfast basis" >Room and breakfast basis 
                              <br><input type="checkbox" name="Itm_29" value="Half board basis" >Half board basis  
                              <br><input type="checkbox" name="Itm_30" value="Full board basis" >Full board basis
                              <div class="cls"></div>
                            </p>
                            <p>
                              Almost done...
                            </p>
                            <p>
                              Do you already have your international flight tickets? 
                              <input type="radio" value="Yes" name="Itm_31"> Yes
                              <input type="radio" value="No" name="Itm_31"> No
                              <div class="cls"></div>
                            </p>
                            <p>
                              Do you require any airline assistance for your international flights? 
                              <input type="radio" value="Yes" name="Itm_32"> Yes
                              <input type="radio" value="No" name="Itm_32"> No
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label for="">How many adults will be travelling?</label>
                              <select name="Itm_33" id="tx_pilmailform_pi1">
                                <option value="" selected="">Please select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                                <option value="more_than_5">More than 
                                5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label for="">How many infant(s) below two years will be travelling?</label>
                              <select name="Itm_34" class="sub-title">
                                <option value="" selected="">Please select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                                <option value="more_than_5">More than 
                                5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>How many child/children will be travelling?</label>
                              <select name="Itm_35" class="sub-title">
                                <option value="" selected="">Please select</option>
                                <option value="1">1</option>
                                <option value="2">2</option>
                                <option value="3">3</option>
                                <option value="4">4</option>
                                <option value="5">5</option>
                                <option value="more_than_5">More than 
                                5</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>The group is:</label>
                              <select name="Itm_36" class="sub-title">
                                <option value="" selected="">Please 
                                select</option>
                                <option value="Individual">An individual 
                                traveller</option>
                                <option value="Couple">A couple</option>
                                <option value="Family">A family</option>
                                <option value="Friends">A group of 
                                friends</option>
                                <option value="Other">Other</option>
                              </select>
                              <div class="cls"></div>
                            </p>
                            <p>
                              <label>If other, please specify:</label>  
                                <input type="text" value="" name="Itm_37" required>
                                <div class="cls"></div>
                            </p>
                            <p>
                              <label>How did you hear about us?</label>
                              <select name="Itm_38" class="sub-title">
                                  <option value="" selected="">Please select</option>
                                  <option value="I am already a client of Exotissimo">I am already a client of IDEAINDOCHINA</option>
                                  <option value="My local newspaper">My local newspaper</option>
                                  <option value="My community magazine">My community magazine</option>
                                  <option value="My preferred magazine">My preferred magazine</option>
                                  <option value="Travel trade show">Travel trade show</option>
                                  <option value="The Exotissimo Travel Newsletter">The Exotissimo Travel Newsletter</option>
                                  <option value="I have been recommended by a friend">I have been recommended by a friend</option>
                                  <option value="Google">Google</option>
                                  <option value="Altavista">Altavista</option>
                                  <option value="Yahoo!">Yahoo!</option>
                                  <option value="MSN Search">MSN Search</option>
                                  <option value="Lycos">Lycos</option>
                                  <option value="Other search engine">Other search engine</option>
                                  <option value="Link from a website">Link from a website</option>
                                  <option value="Other">Other</option>
                                </select>
                                <div class="cls"></div>
                            </p>

                            <p>
                              <label style="margin-top:10px;">Enter Code:<script language="JavaScript"><!--
ts = 1367312933;
--></script>  </label>
                <input type="text" name="code" size="7" maxlength="5" required class="input-code" style="width:100px !important; margin-top:5px;">
                &nbsp;<img id="__code__" src="captcha/code.php?id=1367312933" style="border:1px solid #000000; margin-top:5px;">
                &nbsp;<a href="refresh_code" onclick="document.getElementById('__code__').src = 'captcha/code.php?id=' + ++ts; return false" style="margin-top:5px !important;">Refresh Image</a>
                        <div class="cls"></div>
                            </p>

                            <div class="btns clearfix" style="margin-left: 19.5555em;">
                              
                                <input type="submit" name="submit" value="Submit" class="but button_example">
                                <input type="reset" name="reset" value="Clear" class="but button_example">
                            </div>
                            <p>
                              <center>
                                Please, press submit only one time. 
It may take a few seconds for your inquiry to be processed.
                              </center>
                            </p>
                        </form>
          </div>          
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