<div class="contactFormSection">
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               <div class="col-md-6">[text* first-name placeholder "First Name" ] </div>
			   <div class="col-md-6">[text* last-name placeholder "Last Name" ]</div>
			   <div class="col-md-6">[email* your-email placeholder "Your Email" ] </div>
			   <div class="col-md-6">[tel your-phone placeholder "Phone" ] </div>
			   <div class="col-md-6">[text* your-company placeholder "Company" ] </div>
			   <div class="col-md-6">[select* your-country  first_as_label "Select your Country" "United States" "Canada" "Afghanistan" "Albania" "Algeria" "American Samoa" "Andorra" "Anguilla" "Angola" "Antigua and Barbuda" "Argentina" "Armenia" "Aruba" "Australia" "Austria" "Azerbaijan" "Bahamas" "Bahrain" "Bangladesh" "Barbados" "Belarus" "Belgium" "Belize" "Benin" "Bermuda" "Bhutan" "Bolivia" "Bosnia and Herzegovina" "Botswana" "Bouvet Island" "Brazil" "Brunei Darussalam" "Bulgaria" "Burkina Faso" "Burundi" "Cambodia" "Cameroon" "Cape Verde" "Cayman Islands" "Central African Republic" "Chad" "Chile" "China" "Colombia" "Comoros" "Congo, Republic of the" "Congo, the Democratic Republic of the" "Cook Islands" "Costa Rica" "Côte d'Ivoire" "Croatia" "Cuba" "Cyprus" "Czech Republic" "Denmark" "Djibouti" "Dominica" "Dominican Republic" "Ecuador" "Egypt" "El Salvador" "Equatorial Guinea" "Eritrea" "Estonia" "Ethiopia" "Falkland Islands (Malvinas)" "Faroe Islands" "Fiji" "Finland" "France" "French Guiana" "French Polynesia" "Gabon" "Gambia" "Georgia" "Germany" "Ghana" "Gibraltar" "Greece" "Greenland" "Grenada" "Guadeloupe" "Guam" "Guatemala" "Guernsey" "Guinea" "Guinea-Bissau" "Guyana" "Haiti" "Holy See (Vatican City State)" "Honduras" "Hong Kong" "Hungary" "Iceland" "India" "Indonesia" "Iran" "Iraq" "Ireland" "Isle of Man" "Israel" "Italy" "Jamaica" "Japan" "Jersey" "Jordan" "Kazakhstan" "Kenya" "Kiribati" "Korea, North" "Korea, South" "Kuwait" "Kyrgyzstan" "Laos" "Latvia" "Lebanon" "Lesotho" "Liberia" "ibya" "Liechtenstein" "Lithuania" "Luxembourg" "Macao" "Macedonia" "Madagascar" "Malawi" "Malaysia" "Maldives" "Mali" "Malta" "Marshall Islands" "Mauritania" "Mauritius" "Martinique" "Mayotte" "Mexico" "Micronesia" "Moldova" "Monaco" "Mongolia" "Montenegro" "Montserrat" "Morocco" "Mozambique" "Myanmar" "Namibia" "Nauru" "Nepal" "Netherlands" "Netherlands Antilles" "New Caledonia" "New Zealand" "Nicaragua" "Niger" "Nigeria" "Niue" "Norfolk Island" "Northern Mariana Islands" "Norway" "Oman" "Pakistan" "Panama" "Palau" "Papua New Guinea" "Paraguay" "Peru" "Philippines" "Pitcairn" "Poland" "Portugal" "Puerto Rico" "Qatar" "Réunion" "Romania" "Russian Federation" "Rwanda" "Saint Helena" "Saint Kitts and Nevis" "Saint Lucia" "Saint Pierre and Miquelon" "Saint Vincent and the Grenadines" "Samoa" "San Marino" "Sao Tome and Principe" "Saudi Arabia" "Senegal" "Serbia" "Seychelles" "Sierra Leone" "Singapore" "Slovakia" "Slovenia" "Solomon Islands" "Somalia" "South Africa" "Spain" "Sri Lanka" "Sudan" "Suriname" "Svalbard and Jan Mayen" "Swaziland" "Sweden" "Switzerland" "Syria" "Taiwan" "Tajikistan" "Tanzania" "Thailand" "Togo" "Tokelau" "Tonga" "Trinidad and Tobago" "Tunisia" "Turkey" "Turkmenistan" "Uganda" "Ukraine" "United Arab Emirates" "United Kingdom" "Uruguay" "Uzbekistan" "Vanuatu" "Venezuela" "Vietnam" "Virgin Islands, British" "Virgin Islands, U.S." "Wallis and Futuna" "Western Sahara" "Yemen" "Zambia" "Zimbabwe"]</div>

<div class="col-md-6">
[select* your-job-role first_as_label "Job Role" "C-level" "Consultant" "Coordinator" "Director" "Manager" "Specialist/Analyst"]</div>

<div class="col-md-6">[select* your-area-of-interest first_as_label "Area of Interest" "Quality Auditing and Certification" "Health and Human Services Auditing and Certification" "Environmental certification" "Health and Safety Certification" "Aerospace Certification" "Automotive Certification" "Information Security Certification" "Medical Device Certification" "Forestry Certification" "Advisory Services – Business Improvement" "Product testing or product certification" "Farm Audits" "Farm Inspection Services" "Aquaculture Services" "Fishery Services" "Aquaculture Supply Chain" "Aquaculture Advisory" "Food Safety" "GFSI Certification" "Supplier Audits" "Supply Chain Audits (site specific)" "Supplier/Site Data Management - Food Safety" "Advisory Services – Food Safety" "Retail Store Audits" "Restaurant Inspections and Services" "Retail Supply Chain Audits" "Supplier/Site Data Management - Retail" "Training Services"]</div>

<div class="col-md-6">[select* your-profession-type first_as_label "Profession Type " "Auditing" "Business Analyst" "Business Excellence Manager" "Commercial" "Compliance or Regulatory" "Engineering" "EH&amp;S" "Food Safety" "IT and Security" "Logistics" "Business Management" "Operations" "Policy" "Procurement" "Project Management" "Quality" "Risk" "Quality, Environment Health and Safety" "Other"]</div>
<div class="col-md-6">[select* your-industry first_as_label "Industry" "Aerospace" "Agriculture" "Animal Feed and Pet Foods" "Aquaculture" "Automotive" "Construction of buildings" "Defence" "Disability &amp; Human Services" "Education" "Finance" "Food Packaging Manufacturing" "Food Service" "Forestry" "Government Administration" "Healthcare" "Legal Services" "Manufacturing - Food &amp; Beverages" "Manufacturing General" "Medical Devices" "Mining and Quarrying" "Professional Services" "Quick Service Restaurant / Dining" "Rail" "Telecommunications, Information &amp; Communication" "Transport &amp; Storage - Food &amp; Beverage" "Utilities" "Wholesale &amp; Retail Trade"]</div>
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					[textarea your-message]
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