{"id":6480,"date":"2026-09-03T16:07:10","date_gmt":"2026-09-03T16:07:10","guid":{"rendered":"https:\/\/dev.eptamed.com\/dentist-registration\/"},"modified":"2026-10-06T11:34:33","modified_gmt":"2026-10-06T11:34:33","slug":"dentist-registration","status":"publish","type":"page","link":"https:\/\/eptamed.com\/en\/dentist-registration\/","title":{"rendered":"Dentist Registration"},"content":{"rendered":"\t\t<div class=\"ept-ua-reg\">\n\t\t\t\n\t\t\t\t<h2 class=\"ept-ua-reg-title\">To place orders online you must be registered<\/h2>\n\t<p class=\"ept-ua-reg-intro\">If you are not already registered, fill in the required fields, including your professional register number. Your request will be checked as soon as possible. This form is intended exclusively for dentists.<\/p>\n\n\t<form class=\"ept-ua-reg-form\" method=\"post\" action=\"https:\/\/eptamed.com\/wp-admin\/admin-post.php\">\n\t\t<input type=\"hidden\" name=\"action\" value=\"eptamed_ua_register\">\n\t\t<input type=\"hidden\" name=\"reg_type\" value=\"odontoiatra\">\n\t\t<input type=\"hidden\" name=\"reg_lang\" value=\"en\">\n\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/eptamed.com\/en\/dentist-registration\/\">\n\t\t<input type=\"hidden\" id=\"ept_ua_nonce\" name=\"ept_ua_nonce\" value=\"1a901af641\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/6480\" \/>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-last_name\">Last name *<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-last_name\" name=\"last_name\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-first_name\">First name *<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-first_name\" name=\"first_name\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-company\">Company name<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-company\" name=\"company\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-vat_number\">VAT number<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-vat_number\" name=\"vat_number\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-tax_code\">Tax code<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-tax_code\" name=\"tax_code\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-specialization\">Specialisation *<\/label>\n\t\t\t\t\t\t\t<select id=\"ept-ua-specialization\" name=\"specialization\" required>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"odontoiatra\">Dentist<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ortodontista\">Orthodontist<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"altro\">Other<\/option>\n\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-address_1\">Address *<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-address_1\" name=\"address_1\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-city\">City or town *<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-city\" name=\"city\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-state\">Province (code)<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-state\" name=\"state\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-postcode\">Postcode *<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" id=\"ept-ua-postcode\" name=\"postcode\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-country\">Country *<\/label>\n\t\t\t\t\t\t\t<select id=\"ept-ua-country\" name=\"country\" required>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"\">\u2014 Seleziona \u2014<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AF\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AX\">\u00c5land Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AL\">Albania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DZ\">Algeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AS\">American Samoa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AD\">Andorra<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AO\">Angola<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AI\">Anguilla<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AQ\">Antarctica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AG\">Antigua and Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AR\">Argentina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AM\">Armenia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AW\">Aruba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AU\">Australia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AT\">Austria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"AZ\">Azerbaijan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BS\">Bahamas<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BH\">Bahrain<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BD\">Bangladesh<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BB\">Barbados<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BY\">Belarus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PW\">Belau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BE\">Belgium<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BZ\">Belize<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BJ\">Benin<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BM\">Bermuda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BT\">Bhutan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BO\">Bolivia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BA\">Bosnia and Herzegovina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BW\">Botswana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BV\">Bouvet Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BR\">Brazil<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IO\">British Indian Ocean Territory<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BN\">Brunei<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BG\">Bulgaria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BF\">Burkina Faso<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BI\">Burundi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KH\">Cambodia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CM\">Cameroon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CA\">Canada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CV\">Cape Verde<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KY\">Cayman Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CF\">Central African Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"TD\">Chad<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CL\">Chile<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CN\">China<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CX\">Christmas Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CC\">Cocos (Keeling) Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CO\">Colombia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KM\">Comoros<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CG\">Congo (Brazzaville)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CD\">Congo (Kinshasa)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CK\">Cook Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CR\">Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HR\">Croatia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CU\">Cuba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CW\">Cura&ccedil;ao<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CY\">Cyprus<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CZ\">Czech Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DK\">Denmark<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DJ\">Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DM\">Dominica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DO\">Dominican Republic<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"EC\">Ecuador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"EG\">Egypt<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"SV\">El Salvador<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GQ\">Equatorial Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ER\">Eritrea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"EE\">Estonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"SZ\">Eswatini<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ET\">Ethiopia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FK\">Falkland Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FO\">Faroe Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FJ\">Fiji<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FI\">Finland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FR\">France<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GF\">French Guiana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PF\">French Polynesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"TF\">French Southern Territories<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GA\">Gabon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GM\">Gambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GE\">Georgia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"DE\">Germany<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GH\">Ghana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GI\">Gibraltar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GR\">Greece<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GL\">Greenland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GD\">Grenada<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GP\">Guadeloupe<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GU\">Guam<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GT\">Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GG\">Guernsey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GN\">Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GW\">Guinea-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"GY\">Guyana<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HT\">Haiti<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HM\">Heard Island and McDonald Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HN\">Honduras<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HK\">Hong Kong<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"HU\">Hungary<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IS\">Iceland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IN\">India<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ID\">Indonesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IR\">Iran<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IQ\">Iraq<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IE\">Ireland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IM\">Isle of Man<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IL\">Israel<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"IT\">Italy<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"CI\">Ivory Coast<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"JM\">Jamaica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"JP\">Japan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"JE\">Jersey<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"JO\">Jordan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KZ\">Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KE\">Kenya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KI\">Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KW\">Kuwait<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KG\">Kyrgyzstan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LA\">Laos<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LV\">Latvia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LB\">Lebanon<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LS\">Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LR\">Liberia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LY\">Libya<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LI\">Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LT\">Lithuania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LU\">Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MO\">Macao<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MG\">Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MW\">Malawi<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MY\">Malaysia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MV\">Maldives<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ML\">Mali<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MT\">Malta<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MH\">Marshall Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MQ\">Martinique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MR\">Mauritania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MU\">Mauritius<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"YT\">Mayotte<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MX\">Mexico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"FM\">Micronesia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MD\">Moldova<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MC\">Monaco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MN\">Mongolia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ME\">Montenegro<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MS\">Montserrat<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MA\">Morocco<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MZ\">Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MM\">Myanmar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NA\">Namibia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NR\">Nauru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NP\">Nepal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NL\">Netherlands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NC\">New Caledonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NZ\">New Zealand<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NI\">Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NE\">Niger<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NG\">Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NU\">Niue<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NF\">Norfolk Island<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KP\">North Korea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MK\">North Macedonia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MP\">Northern Mariana Islands<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"NO\">Norway<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"OM\">Oman<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PK\">Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PS\">Palestinian Territory<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PA\">Panama<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PG\">Papua New Guinea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PY\">Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PE\">Peru<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PH\">Philippines<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PN\">Pitcairn<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PL\">Poland<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PT\">Portugal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PR\">Puerto Rico<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"QA\">Qatar<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"RE\">Reunion<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"RO\">Romania<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"RU\">Russia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"RW\">Rwanda<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"BL\">Saint Barth&eacute;lemy<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"SH\">Saint Helena<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"KN\">Saint Kitts and Nevis<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"LC\">Saint Lucia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"SX\">Saint Martin (Dutch part)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"MF\">Saint Martin (French part)<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"PM\">Saint Pierre and 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value=\"ZM\">Zambia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"ZW\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-phone\">Phone *<\/label>\n\t\t\t\t\t\t\t<input type=\"tel\" id=\"ept-ua-phone\" name=\"phone\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-email\">E-mail address *<\/label>\n\t\t\t\t\t\t\t<input type=\"email\" id=\"ept-ua-email\" name=\"email\"\n\t\t\t\t\trequired\t\t\t\t\t>\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-password\">Password *<\/label>\n\t\t\t\t\t\t\t<input type=\"password\" id=\"ept-ua-password\" name=\"password\"\n\t\t\t\t\trequired\t\t\t\t\tminlength=\"8\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ept-ua-reg-group\">\n\t\t\t<label for=\"ept-ua-ambassador_ref\">Ambassador ref. code<\/label>\n\t\t\t\t\t\t\t<input type=\"text\" 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