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     <h1></h1><div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row" style="font-size: 40px;">
	Completeaza datele din formularul de mai jos pentru a participa gratuit.
    
</div>
<br />
<form class="b-form w-full form-block" method="post"  id="form_contact" name="form_contact" action="">
     <!-- rand 1 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Nume</label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="nume" id="nume" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="prenumeErr" style="color: #cc0000; display:none; font-size: 10px;">
                    Introdu nume.
               </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Prenume</label>
                 <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="prenume" id="prenume" placeholder="" type="text" value="" onblur="validareForm()"/>
                 <div id="numeErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Introdu prenume.
                </div>
            </div>
     </div>
     <!-- rand 2 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Telefon</label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="telefon" id="telefon" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="telefonErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu numar de telefon.
              </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Email</label>
                 <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="email" id="email" placeholder="" type="text" value="" onblur="validareForm()"/>
                <div id="emailErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Email invalid.
                </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/3 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">CUIM/NRU </label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="cuim" id="cuim" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="cuimErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu CUIM.
              </div>
            </div>
     </div>
     <!-- rand 3 -->

     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Tara</label>
               <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="tara" name="tara" onchange="validareForm()">
                   <option value="">Alege tara...</option>
                                          <option value="Romania">Romania</option>
                                          <option value="Aaland">Aaland</option>
                                          <option value="Afganistan">Afganistan</option>
                                          <option value="Albania">Albania</option>
                                          <option value="Algeria">Algeria</option>
                                          <option value="Andora">Andora</option>
                                          <option value="Angola">Angola</option>
                                          <option value="Anguila">Anguila</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="Azerbaigian">Azerbaigian</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="Belgia">Belgia</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="Bonaire">Bonaire</option>
                                          <option value="Bosnia siHerzegovina">Bosnia siHerzegovina</option>
                                          <option value="Botswana">Botswana</option>
                                          <option value="Bouvet Island">Bouvet Island</option>
                                          <option value="Brazilia">Brazilia</option>
                                          <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
                                          <option value="British Virgin Islands">British Virgin Islands</option>
                                          <option value="Brunei">Brunei</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="Camerun">Camerun</option>
                                          <option value="Canada">Canada</option>
                                          <option value="Cape Verde">Cape Verde</option>
                                          <option value="Cayman Islands">Cayman Islands</option>
                                          <option value="Cehia">Cehia</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="Cipru">Cipru</option>
                                          <option value="Coasta de Fildes">Coasta de Fildes</option>
                                          <option value="Cocos [Keeling] Islands">Cocos [Keeling] Islands</option>
                                          <option value="Columbia">Columbia</option>
                                          <option value="Comoros">Comoros</option>
                                          <option value="Cook Islands">Cook Islands</option>
                                          <option value="Costa Rica">Costa Rica</option>
                                          <option value="Croatia">Croatia</option>
                                          <option value="Cuba">Cuba</option>
                                          <option value="Curacao">Curacao</option>
                                          <option value="Danemarca">Danemarca</option>
                                          <option value="Democratic Republic of the Congo">Democratic Republic of the Congo</option>
                                          <option value="Djibouti">Djibouti</option>
                                          <option value="Dominica">Dominica</option>
                                          <option value="East Timor">East Timor</option>
                                          <option value="Ecuador">Ecuador</option>
                                          <option value="Egipt">Egipt</option>
                                          <option value="El Salvador">El Salvador</option>
                                          <option value="Elvetia">Elvetia</option>
                                          <option value="Emiratele Arabe Unite">Emiratele Arabe Unite</option>
                                          <option value="Equatorial Guinea">Equatorial Guinea</option>
                                          <option value="Eritrea">Eritrea</option>
                                          <option value="Estonia">Estonia</option>
                                          <option value="Etiopia">Etiopia</option>
                                          <option value="Falkland Islands">Falkland Islands</option>
                                          <option value="Fiji">Fiji</option>
                                          <option value="Finlanda">Finlanda</option>
                                          <option value="Franta">Franta</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="Gana">Gana</option>
                                          <option value="Georgia">Georgia</option>
                                          <option value="Germania">Germania</option>
                                          <option value="Gibraltar">Gibraltar</option>
                                          <option value="Grecia">Grecia</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="Guernsey">Guernsey</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="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
                                          <option value="Honduras">Honduras</option>
                                          <option value="Hong Kong">Hong Kong</option>
                                          <option value="India">India</option>
                                          <option value="Indonesia">Indonesia</option>
                                          <option value="Insulele Feroe">Insulele Feroe</option>
                                          <option value="Irac">Irac</option>
                                          <option value="Iran">Iran</option>
                                          <option value="Irlanda">Irlanda</option>
                                          <option value="Islanda">Islanda</option>
                                          <option value="Isle of Man">Isle of Man</option>
                                          <option value="Israel">Israel</option>
                                          <option value="Italia">Italia</option>
                                          <option value="Jamaica">Jamaica</option>
                                          <option value="Japonia">Japonia</option>
                                          <option value="Jersey">Jersey</option>
                                          <option value="Jordan">Jordan</option>
                                          <option value="Kazakhstan">Kazakhstan</option>
                                          <option value="Kenya">Kenya</option>
                                          <option value="Kiribati">Kiribati</option>
                                          <option value="Kosovo">Kosovo</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="Libya">Libya</option>
                                          <option value="Liechtenstein">Liechtenstein</option>
                                          <option value="Lithuania">Lithuania</option>
                                          <option value="Luxembourg">Luxembourg</option>
                                          <option value="Macao">Macao</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="Marea Britanie">Marea Britanie</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="Montenegro">Montenegro</option>
                                          <option value="Montserrat">Montserrat</option>
                                          <option value="Morocco">Morocco</option>
                                          <option value="Mozambique">Mozambique</option>
                                          <option value="Myanmar [Burma]">Myanmar [Burma]</option>
                                          <option value="Namibia">Namibia</option>
                                          <option value="Nauru">Nauru</option>
                                          <option value="Nepal">Nepal</option>
                                          <option value="Netherlands">Netherlands</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="North Korea">North Korea</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="Palestine">Palestine</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 Islands">Pitcairn Islands</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="Republica Congo">Republica Congo</option>
                                          <option value="Republica Dominicana">Republica Dominicana</option>
                                          <option value="Reunion">Reunion</option>
                                          <option value="Rusia">Rusia</option>
                                          <option value="Rwanda">Rwanda</option>
                                          <option value="Saint BarthÃ©lemy">Saint BarthÃ©lemy</option>
                                          <option value="Saint Helena">Saint Helena</option>
                                          <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
                                          <option value="Saint Lucia">Saint Lucia</option>
                                          <option value="Saint Martin">Saint Martin</option>
                                          <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
                                          <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
                                          <option value="Samoa">Samoa</option>
                                          <option value="Samoa Americana">Samoa Americana</option>
                                          <option value="San Marino">San Marino</option>
                                          <option value="Saudi Arabia">Saudi Arabia</option>
                                          <option value="SÃ£o TomÃ© and PrÃ­ncipe">SÃ£o TomÃ© and PrÃ­ncipe</option>
                                          <option value="Senegal">Senegal</option>
                                          <option value="Serbia">Serbia</option>
                                          <option value="Seychelles">Seychelles</option>
                                          <option value="Sierra Leone">Sierra Leone</option>
                                          <option value="Singapore">Singapore</option>
                                          <option value="Sint Maarten">Sint Maarten</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 and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
                                          <option value="South Korea">South Korea</option>
                                          <option value="South Sudan">South Sudan</option>
                                          <option value="Spania">Spania</option>
                                          <option value="Sri Lanka">Sri Lanka</option>
                                          <option value="Statele Unite ale Americii">Statele Unite ale Americii</option>
                                          <option value="Sudan">Sudan</option>
                                          <option value="Suriname">Suriname</option>
                                          <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
                                          <option value="Swaziland">Swaziland</option>
                                          <option value="Sweden">Sweden</option>
                                          <option value="Syria">Syria</option>
                                          <option value="Taiwan">Taiwan</option>
                                          <option value="Tajikistan">Tajikistan</option>
                                          <option value="Tanzania">Tanzania</option>
                                          <option value="Teritoriile Franceze de Sud">Teritoriile Franceze de Sud</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="Turcia">Turcia</option>
                                          <option value="Turkmenistan">Turkmenistan</option>
                                          <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
                                          <option value="Tuvalu">Tuvalu</option>
                                          <option value="U.S. Minor Outlying Islands">U.S. Minor Outlying Islands</option>
                                          <option value="U.S. Virgin Islands">U.S. Virgin Islands</option>
                                          <option value="Uganda">Uganda</option>
                                          <option value="Ukraine">Ukraine</option>
                                          <option value="Ungaria">Ungaria</option>
                                          <option value="Uruguay">Uruguay</option>
                                          <option value="Uzbekistan">Uzbekistan</option>
                                          <option value="Vanuatu">Vanuatu</option>
                                          <option value="Vatican City">Vatican City</option>
                                          <option value="Venezuela">Venezuela</option>
                                          <option value="Vietnam">Vietnam</option>
                                          <option value="Wallis and Futuna">Wallis and Futuna</option>
                                          <option value="Western Sahara">Western Sahara</option>
                                          <option value="Yemen">Yemen</option>
                                          <option value="Zambia">Zambia</option>
                                          <option value="Zimbabwe">Zimbabwe</option>
                                  </select>
               <div id="taraErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Alege tara.
              </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Judet</label>
                <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="judet" name="judet">
                    <option value="">-</option>
                                            <option value="Alba">Alba</option>
                                            <option value="Arad">Arad</option>
                                            <option value="Arges">Arges</option>
                                            <option value="Bacau">Bacau</option>
                                            <option value="Bihor">Bihor</option>
                                            <option value="Bistrita-Nasaud">Bistrita-Nasaud</option>
                                            <option value="Botosani">Botosani</option>
                                            <option value="Braila">Braila</option>
                                            <option value="Brasov">Brasov</option>
                                            <option value="Bucuresti">Bucuresti</option>
                                            <option value="Buzau">Buzau</option>
                                            <option value="Calarasi">Calarasi</option>
                                            <option value="Caras-Severin">Caras-Severin</option>
                                            <option value="Cluj">Cluj</option>
                                            <option value="Constanta">Constanta</option>
                                            <option value="Covasna">Covasna</option>
                                            <option value="Dambovita">Dambovita</option>
                                            <option value="Dolj">Dolj</option>
                                            <option value="Galati">Galati</option>
                                            <option value="Giurgiu">Giurgiu</option>
                                            <option value="Gorj">Gorj</option>
                                            <option value="Harghita">Harghita</option>
                                            <option value="Hunedoara">Hunedoara</option>
                                            <option value="Ialomita">Ialomita</option>
                                            <option value="Iasi">Iasi</option>
                                            <option value="Ilfov">Ilfov</option>
                                            <option value="Maramures">Maramures</option>
                                            <option value="Mehedinti">Mehedinti</option>
                                            <option value="Mures">Mures</option>
                                            <option value="Neamt">Neamt</option>
                                            <option value="Olt">Olt</option>
                                            <option value="Prahova">Prahova</option>
                                            <option value="Salaj">Salaj</option>
                                            <option value="Satu-Mare">Satu-Mare</option>
                                            <option value="Sibiu">Sibiu</option>
                                            <option value="Suceava">Suceava</option>
                                            <option value="Teleorman">Teleorman</option>
                                            <option value="Timis">Timis</option>
                                            <option value="Tulcea">Tulcea</option>
                                            <option value="Valcea">Valcea</option>
                                            <option value="Vaslui">Vaslui</option>
                                            <option value="Vrancea">Vrancea</option>
                                    </select>
                <div id="judetErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Alege judet.
               </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Localitate</label>
                 <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="oras" id="oras" placeholder="" type="text" value="" onblur="validareForm()"/>
                <div id="cityErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Introdu localitate.
                </div>
            </div>
     </div>

     <!--Rand 4-->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
               <label class="mb-2 text-sm text-gray-600 flex">Strada</label>
              <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="strada" id="strada" placeholder="" type="text" value="" onblur="validareForm()"/>
              <div id="stradaErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu strada.
              </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Numar</label>
               <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="numar" id="numar" placeholder="" type="text" value="" onblur="validareForm()"/>
               <div id="numarErr" style="color: #cc0000; display:none; font-size: 10px;">
                    Introdu numar.
               </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/3 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Cod postal</label>
              <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="codpostal" id="codpostal" placeholder="" type="text" value="" onblur="validareForm()"/>
              <div id="codpostalErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Introdu cod postal.
              </div>
            </div>

     </div>
         <!-- rand 5 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Specialitate medicala</label>
                 <!-- <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="spec_med" id="spec_med" placeholder="" type="text" value="" onblur="validareForm()"/> -->
                
                 <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="spec_med" name="spec_med">
                                            <option value="administrativ">administrativ</option>
                                            <option value="alergologie si imunologie clinica">alergologie si imunologie clinica</option>
                                            <option value="anatomie patologica">anatomie patologica</option>
                                            <option value="anestezie si terapie intensiva">anestezie si terapie intensiva</option>
                                            <option value="balneologie">balneologie</option>
                                            <option value="boli infectioase">boli infectioase</option>
                                            <option value="cardiologie">cardiologie</option>
                                            <option value="chirurgie cardiovasculara">chirurgie cardiovasculara</option>
                                            <option value="chirurgie generala">chirurgie generala</option>
                                            <option value="chirurgie oro-maxilo-faciala">chirurgie oro-maxilo-faciala</option>
                                            <option value="chirurgie pediatrica">chirurgie pediatrica</option>
                                            <option value="chirurgie plastica si reparatorie">chirurgie plastica si reparatorie</option>
                                            <option value="chirurgie toracica">chirurgie toracica</option>
                                            <option value="chirurgie vasculara">chirurgie vasculara</option>
                                            <option value="dermatovenerologie">dermatovenerologie</option>
                                            <option value="diabet zaharat nutritie si boli metabolice">diabet zaharat nutritie si boli metabolice</option>
                                            <option value="endocrinologie">endocrinologie</option>
                                            <option value="epidemiologie">epidemiologie</option>
                                            <option value="fiziokinetoterapie">fiziokinetoterapie</option>
                                            <option value="fizioterapie">fizioterapie</option>
                                            <option value="gastroenterologie">gastroenterologie</option>
                                            <option value="genetica medicala">genetica medicala</option>
                                            <option value="geriatrie si gerontologie">geriatrie si gerontologie</option>
                                            <option value="hematologie">hematologie</option>
                                            <option value="igiena">igiena</option>
                                            <option value="interne">interne</option>
                                            <option value="kinetoterapie">kinetoterapie</option>
                                            <option value="medicina de familie">medicina de familie</option>
                                            <option value="medicina de laborator">medicina de laborator</option>
                                            <option value="medicina de urgenta">medicina de urgenta</option>
                                            <option value="medicina generala">medicina generala</option>
                                            <option value="medicina legala">medicina legala</option>
                                            <option value="medicina muncii">medicina muncii</option>
                                            <option value="medicina nucleara">medicina nucleara</option>
                                            <option value="medicina sportiva">medicina sportiva</option>
                                            <option value="microbiologie">microbiologie</option>
                                            <option value="nefrologie">nefrologie</option>
                                            <option value="neonatologie">neonatologie</option>
                                            <option value="neurochirurgie">neurochirurgie</option>
                                            <option value="neurologie">neurologie</option>
                                            <option value="obstetrica-ginecologie">obstetrica-ginecologie</option>
                                            <option value="oftalmologie">oftalmologie</option>
                                            <option value="oncologie medicala">oncologie medicala</option>
                                            <option value="ORL">ORL</option>
                                            <option value="ortopedie pediatrica">ortopedie pediatrica</option>
                                            <option value="ortopedie si traumatologie">ortopedie si traumatologie</option>
                                            <option value="otorinolaringologie">otorinolaringologie</option>
                                            <option value="pediatrie">pediatrie</option>
                                            <option value="pneumoftiziologie">pneumoftiziologie</option>
                                            <option value="pneumologie">pneumologie</option>
                                            <option value="psihiatrie">psihiatrie</option>
                                            <option value="radiologie si imagistica medicala">radiologie si imagistica medicala</option>
                                            <option value="radioterapie">radioterapie</option>
                                            <option value="recuperare, medicina fizica si balneologie">recuperare, medicina fizica si balneologie</option>
                                            <option value="reseller">reseller</option>
                                            <option value="reumatologie">reumatologie</option>
                                            <option value="senologie">senologie</option>
                                            <option value="urologie">urologie</option>
                                            <option value="veterinar">veterinar</option>
                                    </select>
                <div id="spec_medErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Alege specialitate medicala.
                </div>
            </div>
            <div class="w-full md:max-w-auto md:w-1/2 lg:w-1/2 px-2 mx-auto mb-6 md:mx-0 border-box">
                 <label class="mb-2 text-sm text-gray-600 flex">Specialitate profesionala</label>
                 <select class="b-select form-select focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" id="grad_profesional" name="grad_profesional">
                                            <option value="altul">altul</option>
                                            <option value="primar">primar</option>
                                            <option value="rezident">rezident</option>
                                            <option value="specialist">specialist</option>
                                    </select>
                <div id="grad_profesionalErr" style="color: #cc0000; display:none; font-size: 10px;">
                     introdu grad profesional.
                </div>
            </div>

     </div>
     <!-- rand 6 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
          <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box">
                    <label class="mb-2 text-sm text-gray-600 flex">Loc de munca</label>
                    <input class="b-input form-input focus:border-primary rounded dark:bg-gray-800 dark:border-gray-700 dark:text-white bg-white w-full" name="loc_munca" id="loc_munca" placeholder="" type="text" value="" onblur="validareForm()"/>
                    <div id="loc_muncaErr" style="color: #cc0000; display:none; font-size: 10px;">
                         Introdu loc de munca.
                    </div>
           </div>
     </div>
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row text-center">
          <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box">
               <input type="checkbox" id="accept" name="accept" value="0" class="form-checkbox" onclick="validareForm()">
               <label for="accept">Sunt de acord ca datele mele personale sa fie procesate conform <a style="color:#0000CC" href="https://www.edusontv.net/pages/politica-de-confidentialitate-1" target="_blank">Politicii de confidentialitate</a></label>
               <div id="acceptErr" style="color: #cc0000; display:none; font-size: 10px;">
                    Bifeaza pentru a continua.
               </div>
          </div>
     </div>
     <!-- rand 6 -->
     <div class="container mx-auto mt-8 -mb-6 flex flex-col flex-wrap md:flex-row">
      <div class="w-full md:max-w-auto px-2 mx-auto mb-6 md:mx-0 border-box text-center">
              <div>
                                 <button id="trimite" type="submit" class="b-button rounded" name="submitOp" style="background-color:#c0c0c0; padding:20px 20px;">Plateste&nbsp;150.00&nbsp;RON cu Ordin de Plata</button>
               &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                  <button id="plateste" type="submit" class="b-button rounded" name="submitStripe" style="background-color:#c0c0c0; padding:20px 20px;" disabled>Plateste&nbsp;150.00&nbsp;RON cu card bancar</button>
                                    <input type="hidden" id="titlu" name="titlu" value="">
                  <input type="hidden" id="cui" name="cui" value="">
                  <input type="hidden" id="cnp" name="cnp" value="">
                  <input type="hidden" id="tip" name="tip" value="CURSANT">
                  <input type="hidden" id="nr_reg_com" name="nr_reg_com" value="">
                  <input type="hidden" id="id_cursant" name="id_cursant" value="">
                  <input type="hidden" id="user_eduson" name="user_eduson" value="uscreen3">
                  <input type="hidden" id="linkstripe" name="linkstripe" value="https://buy.stripe.com/6oE9C3bo72n8eoEg0t">
                  <input type="hidden" id="id_webinar" name="id_webinar" value="B000D004288B4FCBBB41200D25A2B868">
                  <input type="hidden" id="nume_produs" name="nume_produs" value="Cum fac eu? Rolul experientei in practica medicala">
              </div>
         </div>


</div>

</form>

<script>
     // function redirect(){
     //      console.log(document.getElementById('linkstripe').value);
     //      var linkredirect = document.getElementById('linkstripe').value;
     //      window.location.replace(linkredirect);

     // }
function validareForm(){
     var err = 0;
     if (validareMail() == false) {
          err += 1;
     }

     if (document.getElementById('nume').value.trim() == ""){
          err += 1;
          document.getElementById('numeErr').style.display = 'block';
     }else{
          document.getElementById('numeErr').style.display = 'none';
     }

     if (document.getElementById('prenume').value.trim() == ""){
          err += 1;
          document.getElementById('prenumeErr').style.display = 'block';
     }else{
          document.getElementById('prenumeErr').style.display = 'none';
     }


     if (document.getElementById('telefon').value.trim() == ""){
          err += 1;
          document.getElementById('telefonErr').style.display = 'block';
     }else{
          document.getElementById('telefonErr').style.display = 'none';
     }

     // if (document.getElementById('tara').value.trim() == ""){
     //      err += 1;
     //      document.getElementById('taraErr').style.display = 'block';
     // }else{
     //      document.getElementById('taraErr').style.display = 'none';
     // }

     if (document.getElementById('cuim').value.trim() == ""){
          err += 1;
          document.getElementById('cuimErr').style.display = 'block';
     }else{
          document.getElementById('cuimErr').style.display = 'none';
     }

     if (document.getElementById('spec_med').value.trim() == "" ){
          err += 1;
          document.getElementById('spec_medErr').style.display = 'block';
     }else{
          document.getElementById('spec_medErr').style.display = 'none';
     }

     if (document.getElementById('grad_profesional').value.trim() == ""){
          err += 1;
          document.getElementById('grad_profesionalErr').style.display = 'block';
     }else{
          document.getElementById('grad_profesionalErr').style.display = 'none';
     }


     if (document.getElementById('grad_profesional').value.trim() == ""){
          err += 1;
          document.getElementById('grad_profesionalErr').style.display = 'block';
     }else{
          document.getElementById('grad_profesionalErr').style.display = 'none';
     }

     if (document.getElementById('loc_munca').value.trim() == ""){
          err += 1;
          document.getElementById('loc_muncaErr').style.display = 'block';
     }else{
          document.getElementById('loc_muncaErr').style.display = 'none';
     }

     if (!document.getElementById('accept').checked){
          err += 1;
          document.getElementById('acceptErr').style.display = 'block';
     }else{
          document.getElementById('acceptErr').style.display = 'none';
     }
     //console.log(err);
     if (err == 0){
         //console.log(document.getElementById('linkstripe').value)
          if (document.getElementById('linkstripe').value!="") {
               document.getElementById('trimite').disabled = false;
               document.getElementById('trimite').style.backgroundColor = "#09b1bb";
               document.getElementById('trimite').style.color = "#ffffff";

               document.getElementById('plateste').disabled = false;
               document.getElementById('plateste').style.backgroundColor = "#3386FF";
               document.getElementById('plateste').style.color = "#ffffff";
          }else{
               document.getElementById('register').disabled = false;
               document.getElementById('register').style.backgroundColor = "#3386FF";
               document.getElementById('register').style.color = "#ffffff";       
          }

     }else{
           if (document.getElementById('linkstripe').value!="") {

               document.getElementById('trimite').disabled = true;
               document.getElementById('trimite').style.backgroundColor = "#c0c0c0;";

               document.getElementById('plateste').disabled = true;
               document.getElementById('plateste').style.backgroundColor = "#c0c0c0";
            }else{
               document.getElementById('register').disabled = true;
               document.getElementById('register').style.backgroundColor = "#c0c0c0";
          }
     }
}

function validareMail()
{
var email=document.getElementById('email').value;
var mailformat = /^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/;
     if(email.match(mailformat))
       {
         console.log("Valid email address!");
         document.getElementById('emailErr').style.display = 'none';
         return true;
       }
     else
       {
         console.log("Invalid email address!");
         document.getElementById('emailErr').style.display = 'block';
         return false;
  }
}
</script>
