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form_profile.html
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<!DOCTYPE html>
<html lang="en">
<!-- begin::Head -->
<head>
<meta charset="utf-8" />
<title>Keen | Form User</title>
<meta name="description" content="Blank page example">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<!--begin::Fonts -->
<script src="https://ajax.googleapis.com/ajax/libs/webfont/1.6.16/webfont.js"></script>
<script>
WebFont.load({
google: {
"families": ["Poppins:300,400,500,600,700"]
},
active: function () {
sessionStorage.fonts = true;
}
});
</script>
<!--end::Fonts -->
<!--begin::Page Vendors Styles(used by this page) -->
<link href="assets/vendors/custom/fullcalendar/fullcalendar.bundle.css" rel="stylesheet" type="text/css" />
<!--end::Page Vendors Styles -->
<!--begin:: Global Mandatory Vendors -->
<link href="assets/vendors/general/perfect-scrollbar/css/perfect-scrollbar.css" rel="stylesheet" type="text/css" />
<!--end:: Global Mandatory Vendors -->
<!--begin:: Global Optional Vendors -->
<link href="assets/vendors/general/tether/dist/css/tether.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/bootstrap-datepicker/dist/css/bootstrap-datepicker3.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/bootstrap-datetime-picker/css/bootstrap-datetimepicker.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/bootstrap-timepicker/css/bootstrap-timepicker.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/bootstrap-daterangepicker/daterangepicker.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/bootstrap-touchspin/dist/jquery.bootstrap-touchspin.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/bootstrap-select/dist/css/bootstrap-select.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/nouislider/distribute/nouislider.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/owl.carousel/dist/assets/owl.carousel.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/owl.carousel/dist/assets/owl.theme.default.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/dropzone/dist/dropzone.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/summernote/dist/summernote.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/bootstrap-markdown/css/bootstrap-markdown.min.css" rel="stylesheet"
type="text/css" />
<link href="assets/vendors/general/animate.css/animate.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/toastr/build/toastr.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/morris.js/morris.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/sweetalert2/dist/sweetalert2.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/socicon/css/socicon.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/custom/vendors/line-awesome/css/line-awesome.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/custom/vendors/flaticon/flaticon.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/custom/vendors/flaticon2/flaticon.css" rel="stylesheet" type="text/css" />
<link href="assets/vendors/general/@fortawesome/fontawesome-free/css/all.min.css" rel="stylesheet"
type="text/css" />
<!--end:: Global Optional Vendors -->
<!--begin::Global Theme Styles(used by all pages) -->
<link href="assets/css/style.bundle.css" rel="stylesheet" type="text/css" />
<link href="assets/css/style.css" rel="stylesheet" type="text/css" />
<!--end::Global Theme Styles -->
<!--begin::Layout Skins(used by all pages) -->
<link href="assets/css/skins/header/base/light.css" rel="stylesheet" type="text/css" />
<link href="assets/css/skins/header/menu/light.css" rel="stylesheet" type="text/css" />
<link href="assets/css/skins/brand/navy.css" rel="stylesheet" type="text/css" />
<link href="assets/css/skins/aside/navy.css" rel="stylesheet" type="text/css" />
<!--end::Layout Skins -->
<link rel="shortcut icon" href="assets/media/logos/favicon.ico" />
</head>
<!-- end::Head -->
<!-- begin::Body -->
<body
class="kt-quick-panel--left kt-demo-panel--right kt-offcanvas-panel--right kt-header--fixed kt-header-mobile--fixed kt-subheader--enabled kt-subheader--transparent kt-aside--enabled kt-aside--fixed kt-page--loading">
<!-- begin:: Header Mobile -->
<div id="kt_header_mobile" class="kt-header-mobile kt-header-mobile--fixed ">
<div class="kt-header-mobile__logo">
<a href="demo1/index.html">
<img alt="Logo" src="assets/media/logos/logo-dashboard.png" />
</a>
</div>
<div class="kt-header-mobile__toolbar">
<button class="kt-header-mobile__toolbar-toggler kt-header-mobile__toolbar-toggler--left"
id="kt_aside_mobile_toggler"><span></span></button>
<button class="kt-header-mobile__toolbar-topbar-toggler" id="kt_header_mobile_topbar_toggler"><i
class="flaticon-more"></i></button>
</div>
</div>
<!-- end:: Header Mobile -->
<!-- begin:: Root -->
<div class="kt-grid kt-grid--hor kt-grid--root">
<!-- begin:: Page -->
<div class="kt-grid__item kt-grid__item--fluid kt-grid kt-grid--ver kt-page">
<!-- begin:: Aside -->
<button class="kt-aside-close " id="kt_aside_close_btn"><i class="la la-close"></i></button>
<div class="kt-aside kt-aside--fixed kt-grid__item kt-grid kt-grid--desktop kt-grid--hor-desktop"
id="kt_aside">
<!-- begin::Aside Brand -->
<div class="kt-aside__brand kt-grid__item " id="kt_aside_brand">
<div class="kt-aside__brand-logo">
<a href="demo1/index.html">
<img alt="Logo" src="assets/media/logos/logo-dashboard.png" />
</a>
</div>
<div class="kt-aside__brand-tools">
<button class="kt-aside__brand-aside-toggler kt-aside__brand-aside-toggler--left"
id="kt_aside_toggler"><span></span></button>
</div>
</div>
<!-- end:: Aside Brand -->
<!-- begin:: Aside Menu -->
<div class="kt-aside-menu-wrapper kt-grid__item kt-grid__item--fluid" id="kt_aside_menu_wrapper">
<div id="kt_aside_menu" class="kt-aside-menu " data-ktmenu-vertical="1" data-ktmenu-scroll="1"
data-ktmenu-dropdown-timeout="500">
<ul class="kt-menu__nav ">
<li class="kt-menu__item " aria-haspopup="true">
<a target="_blank" href="#" class="kt-menu__link "><i class="kt-menu__link-icon flaticon-home-2
"></i><span class="kt-menu__link-text">Dashboard</span></a>
</li>
<li class="kt-menu__item " aria-haspopup="true">
<a target="_blank" href="#" class="kt-menu__link "><i class="kt-menu__link-icon flaticon-clipboard
"></i><span class="kt-menu__link-text">Quizes</span></a>
</li>
<li class="kt-menu__item " aria-haspopup="true">
<a target="_blank" href="#" class="kt-menu__link "><i class="kt-menu__link-icon flaticon-comment
"></i><span class="kt-menu__link-text">Communication</span></a>
</li>
<li class="kt-menu__item " aria-haspopup="true">
<a target="_blank" href="#" class="kt-menu__link ">
<i class="kt-menu__link-icon flaticon-users"></i><span
class="kt-menu__link-text">Students</span></a>
</li>
</ul>
</div>
</div>
<!-- end:: Aside Menu -->
</div>
<!-- end:: Aside -->
<!-- begin:: Wrapper -->
<div class="kt-grid__item kt-grid__item--fluid kt-grid kt-grid--hor kt-wrapper" id="kt_wrapper">
<!-- begin:: Header -->
<div id="kt_header" class="kt-header kt-grid__item kt-header--fixed ">
<!-- begin:: Header Menu -->
<button class="kt-header-menu-wrapper-close" id="kt_header_menu_mobile_close_btn"><i
class="la la-close"></i></button>
<div class="kt-header-menu-wrapper" id="kt_header_menu_wrapper">
<div id="kt_header_menu" class="kt-header-menu kt-header-menu-mobile kt-header-menu--layout- ">
</div>
</div>
<!-- end:: Header Menu -->
<!-- begin:: Header Topbar -->
<div class="kt-header__topbar">
<!--begin: Notifications -->
<div class="kt-header__topbar-item dropdown">
<div class="kt-header__topbar-wrapper" data-toggle="dropdown" data-offset="30px, 0px"
aria-expanded="true">
<span class="kt-header__topbar-icon">
<i class="flaticon2-bell-alarm-symbol"></i>
<span
class="kt-badge kt-badge--dot kt-badge--notify kt-badge--sm kt-badge--brand"></span>
</span>
</div>
<div
class="dropdown-menu dropdown-menu-fit dropdown-menu-right dropdown-menu-anim dropdown-menu-top-unround dropdown-menu-lg">
<form>
<div class="kt-head kt-head-background">
<h3 class="kt-head__title">User Notifications</h3>
<div class="kt-head__sub"><span class="kt-head__desc">23 new
notifications</span></div>
</div>
<div class="kt-notification kt-margin-t-30 kt-margin-b-20 kt-scroll"
data-scroll="true" data-height="270" data-mobile-height="220">
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-line-chart kt-font-success"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New order has been received
</div>
<div class="kt-notification__item-time">
2 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-box-1 kt-font-brand"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New customer is registered
</div>
<div class="kt-notification__item-time">
3 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-chart2 kt-font-danger"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
Application has been approved
</div>
<div class="kt-notification__item-time">
3 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-image-file kt-font-warning"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New file has been uploaded
</div>
<div class="kt-notification__item-time">
5 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-bar-chart kt-font-info"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New user feedback received
</div>
<div class="kt-notification__item-time">
8 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-pie-chart-2 kt-font-success"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
System reboot has been successfully completed
</div>
<div class="kt-notification__item-time">
12 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-favourite kt-font-focus"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New order has been placed
</div>
<div class="kt-notification__item-time">
15 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item kt-notification__item--read">
<div class="kt-notification__item-icon">
<i class="flaticon2-safe kt-font-primary"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
Company meeting canceled
</div>
<div class="kt-notification__item-time">
19 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-psd kt-font-success"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New report has been received
</div>
<div class="kt-notification__item-time">
23 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon-download-1 kt-font-danger"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
Finance report has been generated
</div>
<div class="kt-notification__item-time">
25 hrs ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon-security kt-font-warning"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New customer comment recieved
</div>
<div class="kt-notification__item-time">
2 days ago
</div>
</div>
</a>
<a href="#" class="kt-notification__item">
<div class="kt-notification__item-icon">
<i class="flaticon2-pie-chart kt-font-focus"></i>
</div>
<div class="kt-notification__item-details">
<div class="kt-notification__item-title">
New customer is registered
</div>
<div class="kt-notification__item-time">
3 days ago
</div>
</div>
</a>
</div>
</form>
</div>
</div>
<!--end: Notifications -->
<!--begin:: Languages -->
<div class="kt-header__topbar-item kt-header__topbar-item--langs">
<div class="kt-header__topbar-wrapper" data-toggle="dropdown" data-offset="10px,0px">
<span class="kt-header__topbar-icon">
<img class="" src="assets/media/flags/020-flag.svg" alt="" />
</span>
</div>
<div
class="dropdown-menu dropdown-menu-fit dropdown-menu-right dropdown-menu-anim dropdown-menu-top-unround">
<ul class="kt-nav kt-margin-t-10 kt-margin-b-10">
<li class="kt-nav__item kt-nav__item--active">
<a href="#" class="kt-nav__link">
<span class="kt-nav__link-icon"><img src="assets/media/flags/020-flag.svg"
alt="" /></span>
<span class="kt-nav__link-text">English</span>
</a>
</li>
<li class="kt-nav__item">
<a href="#" class="kt-nav__link">
<span class="kt-nav__link-icon"><img src="assets/media/flags/016-spain.svg"
alt="" /></span>
<span class="kt-nav__link-text">Spanish</span>
</a>
</li>
<li class="kt-nav__item">
<a href="#" class="kt-nav__link">
<span class="kt-nav__link-icon"><img
src="assets/media/flags/017-germany.svg" alt="" /></span>
<span class="kt-nav__link-text">German</span>
</a>
</li>
</ul>
</div>
</div>
<!--end:: Languages -->
<!--begin: User Bar -->
<div class="kt-header__topbar-item kt-header__topbar-item--user">
<div class="kt-header__topbar-wrapper" data-toggle="dropdown" data-offset="0px, 0px">
<div class="kt-header__topbar-user">
<span class="kt-header__topbar-welcome kt-hidden-mobile">Hi,</span>
<span class="kt-header__topbar-username kt-hidden-mobile">Jorge</span>
<img alt="Pic" src="assets/media/users/300_15.jpg" />
<!--use below badge element instead the user avatar to display username's first letter(remove kt-hidden class to display it) -->
<span
class="kt-badge kt-badge--username kt-badge--lg kt-badge--brand kt-hidden kt-badge--bold">J</span>
</div>
</div>
<div
class="dropdown-menu dropdown-menu-fit dropdown-menu-right dropdown-menu-anim dropdown-menu-top-unround dropdown-menu-sm">
<div
class="kt-user-card kt-margin-b-40 kt-margin-b-30-tablet-and-mobile kt-head-background">
<div class="kt-user-card__wrapper">
<div class="kt-user-card__pic">
<img alt="Pic" src="assets/media/users/300_15.jpg" />
</div>
<div class="kt-user-card__details">
<div class="kt-user-card__name">Jorge Martins</div>
<div class="kt-user-card__position">EAD, Camoniano</div>
</div>
</div>
</div>
<ul class="kt-nav kt-margin-b-10">
<li class="kt-nav__item">
<a href="demo1/custom/user/profile-v1.html" class="kt-nav__link">
<span class="kt-nav__link-icon"><i class="flaticon2-calendar-3"></i></span>
<span class="kt-nav__link-text">My Profile</span>
</a>
</li>
<li class="kt-nav__item">
<a href="demo1/custom/user/profile-v1.html" class="kt-nav__link">
<span class="kt-nav__link-icon"><i class="flaticon2-browser-2"></i></span>
<span class="kt-nav__link-text">My Tasks</span>
</a>
</li>
<li class="kt-nav__item">
<a href="demo1/custom/user/profile-v1.html" class="kt-nav__link">
<span class="kt-nav__link-icon"><i class="flaticon2-mail"></i></span>
<span class="kt-nav__link-text">Messages</span>
</a>
</li>
<li class="kt-nav__item">
<a href="demo1/custom/user/profile-v1.html" class="kt-nav__link">
<span class="kt-nav__link-icon"><i class="flaticon2-gear"></i></span>
<span class="kt-nav__link-text">Settings</span>
</a>
</li>
<li class="kt-nav__item kt-nav__item--custom kt-margin-t-15">
<a href="demo1/custom/user/login-v1.html" target="_blank"
class="btn btn-label-brand btn-upper btn-sm btn-bold">Sign Out</a>
</li>
</ul>
</div>
</div>
<!--end: User Bar -->
</div>
<!-- end:: Header Topbar -->
</div>
<!-- end:: Header -->
<div class="kt-grid__item kt-grid__item--fluid kt-grid kt-grid--hor">
<!-- begin:: Subheader -->
<div class="kt-subheader kt-grid__item" id="kt_subheader">
<div class="kt-subheader__main">
<h3 class="kt-subheader__title">Add User</h3>
<span class="kt-subheader__separator kt-hidden"></span>
<div class="kt-subheader__breadcrumbs">
<a href="#" class="kt-subheader__breadcrumbs-home"><i class="flaticon2-shelter"></i></a>
<span class="kt-subheader__breadcrumbs-separator"></span>
<a href="" class="kt-subheader__breadcrumbs-link">
Features </a>
<span class="kt-subheader__breadcrumbs-separator"></span>
<a href="" class="kt-subheader__breadcrumbs-link">
Misc </a>
<span class="kt-subheader__breadcrumbs-separator"></span>
<a href="" class="kt-subheader__breadcrumbs-link">
Blank Page </a>
<!-- <span class="kt-subheader__breadcrumbs-link kt-subheader__breadcrumbs-link--active">Active link</span> -->
</div>
</div>
</div>
<!-- end:: Subheader -->
<!-- begin:: Content -->
<div class="kt-content kt-grid__item kt-grid__item--fluid" id="kt_content">
<div class="row">
<div class="col-lg-12">
<!--begin::Portlet-->
<div class="kt-portlet">
<div class="kt-portlet__body">
<form class="kt-form" id="kt_form">
<div class="row">
<div class="col-xl-2"></div>
<div class="col-xl-12">
<div class="kt-section kt-section--first">
<div class="kt-section__body">
<h3 class="kt-section__title kt-section__title-lg">
Student Info
</h3>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-12 col-xl-12 kt-padding-10-tablet-and-mobile kt-align-center">
<div class="kt-avatar kt-avatar--outline kt-avatar--primary kt-avatar--circle"
id="kt_profile_avatar_4">
<div
class="kt-avatar__holder kt-avatar-profile">
</div>
<label class="kt-avatar__upload"
data-toggle="kt-tooltip"
title="Change avatar">
<i class="fa fa-camera"></i>
<input type='file' name="profile_avatar"
accept=".png, .jpg, .jpeg" />
</label>
<span class="kt-avatar__cancel"
data-toggle="kt-tooltip"
title="Cancel avatar">
<i class="fa fa-times"></i>
</span>
</div>
</div>
</div>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">First Name</label>
<input class="form-control" type="text"
value="Jack">
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">Last Name</label>
<input class="form-control" type="text" value="Joe"
placeholder="Enter yout last name" required>
</div>
</div>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-4 col-xl-4 kt-padding-10-tablet-and-mobile">
<label class="">Company Name</label>
<input class="form-control" type="text"
value="Camoniano">
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-4 col-xl-4 kt-padding-10-tablet-and-mobile">
<label class="">Contact Phone</label>
<input type="text" class="form-control"
value="+45678967456" placeholder="Phone">
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-4 col-xl-4 kt-padding-10-tablet-and-mobile">
<label class="">Email Address</label>
<input type="email" class="form-control"
value="[email protected]"
placeholder="Email">
</div>
</div>
</div>
</div>
<div
class="kt-separator kt-separator--border-dashed kt-separator--space-lg">
</div>
<div class="kt-section">
<div class="kt-section__body">
<h3 class="kt-section__title kt-section__title-lg">
Address Details
</h3>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">Country</label>
<select class="form-control">
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia, Plurinational State
of</option>
<option value="BQ">Bonaire, Sint Eustatius and
Saba</option>
<option value="BA">Bosnia and Herzegovina
</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean
Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic
</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands
</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic
Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)
</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories
</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald
Islands</option>
<option value="VA">Holy See (Vatican City State)
</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of
</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's
Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic
Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the former
Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States
of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands
</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory,
Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and
Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis
</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)
</option>
<option value="PM">Saint Pierre and Miquelon
</option>
<option value="VC">Saint Vincent and the
Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe
</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)
</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South
Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen
</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan, Province of China
</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of
</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands
</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US" selected>United States
</option>
<option value="UM">United States Minor Outlying
Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela, Bolivarian
Republic of</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British
</option>
<option value="VI">Virgin Islands, U.S.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">Zip Code</label>
<input class="form-control" type="text"
value="780456">
</div>
</div>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">Address Line
1</label>
<input class="form-control" type="text"
value="District 6 1352 W. Olive Ave">
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">Address Line
2</label>
<input class="form-control" type="text"
value="Fresno 559-488-4020">
</div>
</div>
<div class="form-group row">
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">City</label>
<input class="form-control" type="text"
value="Polo Alto">
</div>
<div class="col-12 col-sm-12 col-md-12 col-lg-6 col-xl-6 kt-padding-10-tablet-and-mobile">
<label class="">State /
Province</label>
<input class="form-control" type="text"
value="Los Angeles">
</div>
</div>
</div>
</div>
</div>
<div class="col-xl-2"></div>
</div>
<div class="kt-portlet__foot kt-align-right">
<div class="kt-form__actions">
<div class="row">
<div class="col-12">
<button type="reset" class="btn btn-light">Cancel</button>
<button type="submit" class="btn btn-success">Save</button>
</div>
</div>
</div>
</div>
</form>
</div>
</div>
<!--end::Portlet-->
</div>
</div>
<!-- end:: Content -->
</div>
<!-- begin:: Footer -->
<div class="kt-footer kt-grid__item kt-grid kt-grid--desktop kt-grid--ver-desktop">
<div class="kt-footer__copyright">
2019 © <a href="#" target="_blank" class="kt-link">Camoniano</a>
</div>
<div class="kt-footer__menu"> <a href="#" target="_blank"
class="kt-footer__menu-link kt-link">About</a> <a href="#" target="_blank"
class="kt-footer__menu-link kt-link">Contact</a> <a href="#" target="_blank"
class="kt-footer__menu-link kt-link">Flag An Error</a> </div>
</div>
<!-- end:: Footer -->
</div>
<!-- end:: Wrapper -->
</div>
<!-- end:: Page -->
</div>
<!-- end:: Root -->
<!-- begin:: Scrolltop -->
<div id="kt_scrolltop" class="kt-scrolltop">
<i class="la la-arrow-up"></i>
</div>