<div class="col-md-8">
<form id="application-form" action="/recruitment/apply" method="post">
<legend>Application</legend>
<div class="form-group" ><label class="control-label" for="id_cid">Character</label> <select class="form-control" placeholder="Select a Character" name="cid" id="id_cid">
<option value="56940f26002aa8085caa1cdd">Shuyin Baham - Gilgamesh</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed5cec002aa80334092d3c">Lodestone Link</label> <input class="form-control" type="text" name="54ed5cec002aa80334092d3c" id="id_54ed5cec002aa80334092d3c" /> <p class="help-block">Link your Lodestone profile.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5d51002aa803352dec3b">What position are you applying for?</label> <select class="form-control" name="54ed5d51002aa803352dec3b" id="id_54ed5d51002aa803352dec3b">
<option value="1">Raider</option>
<option value="2">Crafter</option>
<option value="3">Social</option>
<option value="4">PvP</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_55d89a08002aa82cfa58e530">Raiders: Are you applying for a specific raid group? If so, please select the raid leader.</label> <select class="form-control" name="55d89a08002aa82cfa58e530" id="id_55d89a08002aa82cfa58e530">
<option value="1">I am not applying as a Raider.</option>
<option value="2">My raid leader is not on this list.</option>
<option value="3">Cleric Stance</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed5d9f002aa803352dec74">Raiders: Please select your main job.</label> <select class="form-control" name="54ed5d9f002aa803352dec74" id="id_54ed5d9f002aa803352dec74">
<option value="1">Bard</option>
<option value="2">Black Mage</option>
<option value="3">Summoner</option>
<option value="4">Dragoon</option>
<option value="5">Monk</option>
<option value="6">Ninja</option>
<option value="7">Paladin</option>
<option value="8">Warrior</option>
<option value="9">Scholar</option>
<option value="10">White mage</option>
<option value="11">Dark Knight</option>
<option value="12">Astrologian</option>
<option value="13">Machinist</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed6236002aa80334093240">Raiders: Please select your secondary job.</label> <select class="form-control" name="54ed6236002aa80334093240" id="id_54ed6236002aa80334093240">
<option value="1">Bard</option>
<option value="2">Black Mage</option>
<option value="3">Summoner</option>
<option value="4">Dragoon</option>
<option value="5">Monk</option>
<option value="6">Ninja</option>
<option value="7">Paladin</option>
<option value="8">Warrior</option>
<option value="9">Scholar</option>
<option value="10">White mage</option>
<option value="11">Dark Knight</option>
<option value="12">Astrologian</option>
<option value="13">Machinist</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_5508166c002aa84082d72b4f">Raiders: How many days a week do you plan on raiding during progression?</label> <select class="form-control" name="5508166c002aa84082d72b4f" id="id_5508166c002aa84082d72b4f">
<option value="1">1-2 days</option>
<option value="2">3-5 days</option>
<option value="3">5-7 days</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_55081873002aa84081ed9ab2">Raiders: On raid days, how many hours can you dedicate to raiding?</label> <select class="form-control" name="55081873002aa84081ed9ab2" id="id_55081873002aa84081ed9ab2">
<option value="1">1-2 hours</option>
<option value="2">3-5 hours</option>
<option value="3">6-8 hours</option>
<option value="4">9-11 hours</option>
<option value="5">12+ hours</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54f39bb4002aa803340ec695">Raiders: What floors have you cleared in Creator Savage?</label> <input class="form-control" type="text" name="54f39bb4002aa803340ec695" id="id_54f39bb4002aa803340ec695" /> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_55a8535e002aa84ca841d0d5">Raiders: *Optional* What have you cleared in Midas Savage and previous raids?</label> <input class="form-control" type="text" name="55a8535e002aa84ca841d0d5" id="id_55a8535e002aa84ca841d0d5" /> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5f29002aa80334092f7a">Raiders: What time zone do you raid? Also list your availability for raiding.</label> <textarea id="id_54ed5f29002aa80334092f7a" rows="10" cols="40" name="54ed5f29002aa80334092f7a" class="form-control"></textarea> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5f70002aa80334092fbf">Raider: Please post a link to your fflogs. If you do not have an fflogs account, please post an image of an ACT parse.</label> <textarea id="id_54ed5f70002aa80334092fbf" rows="10" cols="40" name="54ed5f70002aa80334092fbf" class="form-control"></textarea> <p class="help-block">Other applicants reply N/A</p></div>
<div class="form-group" ><label class="control-label" for="id_55120a1b002aa84082dacead">Raiders: *Optional* Post video(s) of your raid gameplay.</label> <textarea id="id_55120a1b002aa84082dacead" rows="10" cols="40" name="55120a1b002aa84082dacead" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed5c9a002aa80334092cfd">Raiders and Crafters: Using ffxiv.ariyala.com, please link your BiS. Describe your reasoning.</label> <textarea id="id_54ed5c9a002aa80334092cfd" rows="10" cols="40" name="54ed5c9a002aa80334092cfd" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed619d002aa803352def5a_0">Crafters: List all your three star crafting classes.</label> <label for="id_54ed619d002aa803352def5a_0" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="1" id="id_54ed619d002aa803352def5a_0" /> Alchemist</label>
<label for="id_54ed619d002aa803352def5a_1" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="2" id="id_54ed619d002aa803352def5a_1" /> Armorer</label>
<label for="id_54ed619d002aa803352def5a_2" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="3" id="id_54ed619d002aa803352def5a_2" /> Blacksmith</label>
<label for="id_54ed619d002aa803352def5a_3" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="4" id="id_54ed619d002aa803352def5a_3" /> Botanist</label>
<label for="id_54ed619d002aa803352def5a_4" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="5" id="id_54ed619d002aa803352def5a_4" /> Carpenter</label>
<label for="id_54ed619d002aa803352def5a_5" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="6" id="id_54ed619d002aa803352def5a_5" /> Culinarian</label>
<label for="id_54ed619d002aa803352def5a_6" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="7" id="id_54ed619d002aa803352def5a_6" /> Fisher</label>
<label for="id_54ed619d002aa803352def5a_7" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="8" id="id_54ed619d002aa803352def5a_7" /> Goldsmith</label>
<label for="id_54ed619d002aa803352def5a_8" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="9" id="id_54ed619d002aa803352def5a_8" /> Leatherworker</label>
<label for="id_54ed619d002aa803352def5a_9" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="10" id="id_54ed619d002aa803352def5a_9" /> Miner</label>
<label for="id_54ed619d002aa803352def5a_10" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="11" id="id_54ed619d002aa803352def5a_10" /> Weaver</label></div>
<div class="form-group" ><label class="control-label" for="id_5508cdcc002aa840807a4bca">Social and Crafters: How many hours a week do you spend in game?</label> <select class="form-control" name="5508cdcc002aa840807a4bca" id="id_5508cdcc002aa840807a4bca">
<option value="1">1-3 hours</option>
<option value="2">4-6 hours</option>
<option value="3">6-9 hours</option>
<option value="4">10-14 hours</option>
<option value="5">13-19 hours</option>
<option value="6">20+ hours</option>
</select> <p class="help-block">Other applicants leave this as default.</p></div>
<div class="form-group" ><label class="control-label" for="id_55059fee002aa84082d5b43d">Please provide a screenshot of your UI and Hotkey setup.</label> <div class="" data-name="55059fee002aa84082d5b43d[]" data-url="recruitment.upload_image" id="id_55059fee002aa84082d5b43d"><div class="" id="id_55059fee002aa84082d5b43d_attachment" style="display: none;"><input name="55059fee002aa84082d5b43d" type="hidden"/></div><div class="" id="id_55059fee002aa84082d5b43d_progress" style="display: none;"></div><button class="btn btn-default fa fa-upload" id="id_55059fee002aa84082d5b43d_b" name="55059fee002aa84082d5b43d"> Upload Image</button><input data-desc="PNG/JPEG/GIF Files" data-extension="*.png;*.jpg;*.jpeg;*.gif" data-id="id_55059fee002aa84082d5b43d" data-image-field="true" data-limit="1" data-size="5 MB" type="hidden"/></div></div>
<div class="form-group" ><label class="control-label" for="id_5508cefe002aa840807a4c58">What is your FFXIV history?</label> <input class="form-control" type="text" name="5508cefe002aa840807a4c58" id="id_5508cefe002aa840807a4c58" /> <p class="help-block">Ex: Did you server transfer? What FC were you originally from?</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5fed002aa803352dee56">List your previous gaming history and accolades.</label> <textarea id="id_54ed5fed002aa803352dee56" rows="10" cols="40" name="54ed5fed002aa803352dee56" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed60d0002aa8033409312f">How did you hear about us? Why do you think you'd be a good fit in our Free Company?</label> <textarea id="id_54ed60d0002aa8033409312f" rows="10" cols="40" name="54ed60d0002aa8033409312f" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54faf31a002aa80ab2d8fb87">Tell us a bit about yourself.</label> <textarea id="id_54faf31a002aa80ab2d8fb87" rows="10" cols="40" name="54faf31a002aa80ab2d8fb87" class="form-control"></textarea> <p class="help-block">We'd like to get to know you!</p></div>
<div class="form-group" ><label class="control-label" for="id_578c0f99002aa87f4e298ddd">Why are you leaving your current/previous Free Company?</label> <textarea id="id_578c0f99002aa87f4e298ddd" rows="10" cols="40" name="578c0f99002aa87f4e298ddd" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54f66d0d002aa80a9aa20504">If applicable, list an FC member as a reference.</label> <input class="form-control" type="text" name="54f66d0d002aa80a9aa20504" id="id_54f66d0d002aa80a9aa20504" /> <p class="help-block">Having a reference will help push your application along.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed60e9002aa803352deedc">List any questions you may have for us.</label> <textarea id="id_54ed60e9002aa803352deedc" rows="10" cols="40" name="54ed60e9002aa803352deedc" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54faf2d6002aa80a7a774535">Did you read the rules and regulations provided?</label> <input class="form-control" type="text" name="54faf2d6002aa80a7a774535" id="id_54faf2d6002aa80a7a774535" /> <p class="help-block">It is mandatory that you read the rules and regulations.</p></div>
<button class="btn btn-lg btn-primary" type="submit">Apply</button>
</form>
</div>
</div>
</div>
<form id="application-form" action="/recruitment/apply" method="post">
<legend>Application</legend>
<div class="form-group" ><label class="control-label" for="id_cid">Character</label> <select class="form-control" placeholder="Select a Character" name="cid" id="id_cid">
<option value="56940f26002aa8085caa1cdd">Shuyin Baham - Gilgamesh</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed5cec002aa80334092d3c">Lodestone Link</label> <input class="form-control" type="text" name="54ed5cec002aa80334092d3c" id="id_54ed5cec002aa80334092d3c" /> <p class="help-block">Link your Lodestone profile.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5d51002aa803352dec3b">What position are you applying for?</label> <select class="form-control" name="54ed5d51002aa803352dec3b" id="id_54ed5d51002aa803352dec3b">
<option value="1">Raider</option>
<option value="2">Crafter</option>
<option value="3">Social</option>
<option value="4">PvP</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_55d89a08002aa82cfa58e530">Raiders: Are you applying for a specific raid group? If so, please select the raid leader.</label> <select class="form-control" name="55d89a08002aa82cfa58e530" id="id_55d89a08002aa82cfa58e530">
<option value="1">I am not applying as a Raider.</option>
<option value="2">My raid leader is not on this list.</option>
<option value="3">Cleric Stance</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed5d9f002aa803352dec74">Raiders: Please select your main job.</label> <select class="form-control" name="54ed5d9f002aa803352dec74" id="id_54ed5d9f002aa803352dec74">
<option value="1">Bard</option>
<option value="2">Black Mage</option>
<option value="3">Summoner</option>
<option value="4">Dragoon</option>
<option value="5">Monk</option>
<option value="6">Ninja</option>
<option value="7">Paladin</option>
<option value="8">Warrior</option>
<option value="9">Scholar</option>
<option value="10">White mage</option>
<option value="11">Dark Knight</option>
<option value="12">Astrologian</option>
<option value="13">Machinist</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54ed6236002aa80334093240">Raiders: Please select your secondary job.</label> <select class="form-control" name="54ed6236002aa80334093240" id="id_54ed6236002aa80334093240">
<option value="1">Bard</option>
<option value="2">Black Mage</option>
<option value="3">Summoner</option>
<option value="4">Dragoon</option>
<option value="5">Monk</option>
<option value="6">Ninja</option>
<option value="7">Paladin</option>
<option value="8">Warrior</option>
<option value="9">Scholar</option>
<option value="10">White mage</option>
<option value="11">Dark Knight</option>
<option value="12">Astrologian</option>
<option value="13">Machinist</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_5508166c002aa84082d72b4f">Raiders: How many days a week do you plan on raiding during progression?</label> <select class="form-control" name="5508166c002aa84082d72b4f" id="id_5508166c002aa84082d72b4f">
<option value="1">1-2 days</option>
<option value="2">3-5 days</option>
<option value="3">5-7 days</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_55081873002aa84081ed9ab2">Raiders: On raid days, how many hours can you dedicate to raiding?</label> <select class="form-control" name="55081873002aa84081ed9ab2" id="id_55081873002aa84081ed9ab2">
<option value="1">1-2 hours</option>
<option value="2">3-5 hours</option>
<option value="3">6-8 hours</option>
<option value="4">9-11 hours</option>
<option value="5">12+ hours</option>
</select></div>
<div class="form-group" ><label class="control-label" for="id_54f39bb4002aa803340ec695">Raiders: What floors have you cleared in Creator Savage?</label> <input class="form-control" type="text" name="54f39bb4002aa803340ec695" id="id_54f39bb4002aa803340ec695" /> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_55a8535e002aa84ca841d0d5">Raiders: *Optional* What have you cleared in Midas Savage and previous raids?</label> <input class="form-control" type="text" name="55a8535e002aa84ca841d0d5" id="id_55a8535e002aa84ca841d0d5" /> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5f29002aa80334092f7a">Raiders: What time zone do you raid? Also list your availability for raiding.</label> <textarea id="id_54ed5f29002aa80334092f7a" rows="10" cols="40" name="54ed5f29002aa80334092f7a" class="form-control"></textarea> <p class="help-block">Other applicants reply N/A.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5f70002aa80334092fbf">Raider: Please post a link to your fflogs. If you do not have an fflogs account, please post an image of an ACT parse.</label> <textarea id="id_54ed5f70002aa80334092fbf" rows="10" cols="40" name="54ed5f70002aa80334092fbf" class="form-control"></textarea> <p class="help-block">Other applicants reply N/A</p></div>
<div class="form-group" ><label class="control-label" for="id_55120a1b002aa84082dacead">Raiders: *Optional* Post video(s) of your raid gameplay.</label> <textarea id="id_55120a1b002aa84082dacead" rows="10" cols="40" name="55120a1b002aa84082dacead" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed5c9a002aa80334092cfd">Raiders and Crafters: Using ffxiv.ariyala.com, please link your BiS. Describe your reasoning.</label> <textarea id="id_54ed5c9a002aa80334092cfd" rows="10" cols="40" name="54ed5c9a002aa80334092cfd" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed619d002aa803352def5a_0">Crafters: List all your three star crafting classes.</label> <label for="id_54ed619d002aa803352def5a_0" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="1" id="id_54ed619d002aa803352def5a_0" /> Alchemist</label>
<label for="id_54ed619d002aa803352def5a_1" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="2" id="id_54ed619d002aa803352def5a_1" /> Armorer</label>
<label for="id_54ed619d002aa803352def5a_2" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="3" id="id_54ed619d002aa803352def5a_2" /> Blacksmith</label>
<label for="id_54ed619d002aa803352def5a_3" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="4" id="id_54ed619d002aa803352def5a_3" /> Botanist</label>
<label for="id_54ed619d002aa803352def5a_4" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="5" id="id_54ed619d002aa803352def5a_4" /> Carpenter</label>
<label for="id_54ed619d002aa803352def5a_5" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="6" id="id_54ed619d002aa803352def5a_5" /> Culinarian</label>
<label for="id_54ed619d002aa803352def5a_6" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="7" id="id_54ed619d002aa803352def5a_6" /> Fisher</label>
<label for="id_54ed619d002aa803352def5a_7" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="8" id="id_54ed619d002aa803352def5a_7" /> Goldsmith</label>
<label for="id_54ed619d002aa803352def5a_8" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="9" id="id_54ed619d002aa803352def5a_8" /> Leatherworker</label>
<label for="id_54ed619d002aa803352def5a_9" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="10" id="id_54ed619d002aa803352def5a_9" /> Miner</label>
<label for="id_54ed619d002aa803352def5a_10" class="checkbox"><input type="checkbox" name="54ed619d002aa803352def5a[]" value="11" id="id_54ed619d002aa803352def5a_10" /> Weaver</label></div>
<div class="form-group" ><label class="control-label" for="id_5508cdcc002aa840807a4bca">Social and Crafters: How many hours a week do you spend in game?</label> <select class="form-control" name="5508cdcc002aa840807a4bca" id="id_5508cdcc002aa840807a4bca">
<option value="1">1-3 hours</option>
<option value="2">4-6 hours</option>
<option value="3">6-9 hours</option>
<option value="4">10-14 hours</option>
<option value="5">13-19 hours</option>
<option value="6">20+ hours</option>
</select> <p class="help-block">Other applicants leave this as default.</p></div>
<div class="form-group" ><label class="control-label" for="id_55059fee002aa84082d5b43d">Please provide a screenshot of your UI and Hotkey setup.</label> <div class="" data-name="55059fee002aa84082d5b43d[]" data-url="recruitment.upload_image" id="id_55059fee002aa84082d5b43d"><div class="" id="id_55059fee002aa84082d5b43d_attachment" style="display: none;"><input name="55059fee002aa84082d5b43d" type="hidden"/></div><div class="" id="id_55059fee002aa84082d5b43d_progress" style="display: none;"></div><button class="btn btn-default fa fa-upload" id="id_55059fee002aa84082d5b43d_b" name="55059fee002aa84082d5b43d"> Upload Image</button><input data-desc="PNG/JPEG/GIF Files" data-extension="*.png;*.jpg;*.jpeg;*.gif" data-id="id_55059fee002aa84082d5b43d" data-image-field="true" data-limit="1" data-size="5 MB" type="hidden"/></div></div>
<div class="form-group" ><label class="control-label" for="id_5508cefe002aa840807a4c58">What is your FFXIV history?</label> <input class="form-control" type="text" name="5508cefe002aa840807a4c58" id="id_5508cefe002aa840807a4c58" /> <p class="help-block">Ex: Did you server transfer? What FC were you originally from?</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed5fed002aa803352dee56">List your previous gaming history and accolades.</label> <textarea id="id_54ed5fed002aa803352dee56" rows="10" cols="40" name="54ed5fed002aa803352dee56" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54ed60d0002aa8033409312f">How did you hear about us? Why do you think you'd be a good fit in our Free Company?</label> <textarea id="id_54ed60d0002aa8033409312f" rows="10" cols="40" name="54ed60d0002aa8033409312f" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54faf31a002aa80ab2d8fb87">Tell us a bit about yourself.</label> <textarea id="id_54faf31a002aa80ab2d8fb87" rows="10" cols="40" name="54faf31a002aa80ab2d8fb87" class="form-control"></textarea> <p class="help-block">We'd like to get to know you!</p></div>
<div class="form-group" ><label class="control-label" for="id_578c0f99002aa87f4e298ddd">Why are you leaving your current/previous Free Company?</label> <textarea id="id_578c0f99002aa87f4e298ddd" rows="10" cols="40" name="578c0f99002aa87f4e298ddd" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54f66d0d002aa80a9aa20504">If applicable, list an FC member as a reference.</label> <input class="form-control" type="text" name="54f66d0d002aa80a9aa20504" id="id_54f66d0d002aa80a9aa20504" /> <p class="help-block">Having a reference will help push your application along.</p></div>
<div class="form-group" ><label class="control-label" for="id_54ed60e9002aa803352deedc">List any questions you may have for us.</label> <textarea id="id_54ed60e9002aa803352deedc" rows="10" cols="40" name="54ed60e9002aa803352deedc" class="form-control"></textarea></div>
<div class="form-group" ><label class="control-label" for="id_54faf2d6002aa80a7a774535">Did you read the rules and regulations provided?</label> <input class="form-control" type="text" name="54faf2d6002aa80a7a774535" id="id_54faf2d6002aa80a7a774535" /> <p class="help-block">It is mandatory that you read the rules and regulations.</p></div>
<button class="btn btn-lg btn-primary" type="submit">Apply</button>
</form>
</div>
</div>
</div>
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