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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.
    
</div>
<br />
<form class="b-form w-full form-block" method="post"  id="form_contact" name="form_contact" action="">
 <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">Alege produs</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="listaProduse" name="listaProduse" onchange="validareForm()">
                   <option value="">Alege produs...</option>
                                          <option value="6E9B35D963C643F088B943D7FC949DAA">Școala de vară de ultrasonografie clinica 2025 ONLINE - PRET: 400.00 Lei</option>
                                          <option value="030DD1EE68F64153B07A131BF211CB6C">Abordarea multidisciplinara a nodulilor tiroidieni: de la diagnostic la tratament - PRET: 200.00 Lei</option>
                                          <option value="C9B50519AEFD4D8398F2D2C82767BFFC">Voucher general Eduson - PRET: 450.00 Lei</option>
                                          <option value="3F769370B145498387AB7A91EC720877">Voucher abonament multilunar Eduson - PRET: 1050.00 Lei</option>
                                          <option value="DB6DF5E9A60642B88996356519405687">Voucher Abonament Eduson Premium - PRET: 300.00 Lei</option>
                                          <option value="534B383597AE45B99A7DF7DD5307789A">CARTE ULTRASONOGRAFIA CLINICA A ABDOMENULUI – O ABORDARE COMPLEXA, CENTRATA PE EXPLORAREA ARMONICA CU CONTRAST - PRET: 380.00 Lei</option>
                                          <option value="107D5D02423C49EFAC9E5BC9910D1D5C">SonoAnatomie abdominala. SonoQuizz-uri. SonoSkills. Cazuri particulare - PRET: 300.00 Lei</option>
                                          <option value="D5153988190644EBB9125E59C2E377CE">Cum fac eu? Rolul experientei in practica medicala - PRET: 150.00 Lei</option>
                                          <option value="E2288A2530804BB79ED94FC67ADC56FC">SonoAnatomia abdomenului - Sonoskills Sonoquizz - PRET: 300.00 Lei</option>
                                          <option value="E84E6F4A7F64490C86C56877B6DF688D">Workshop SonoAnatomie. Abdomen. Tehnici de examinare. Aplicatii clinice – Partea a 2-a - PRET: 300.00 Lei</option>
                                          <option value="C45EF4A816264FBA8DCA475F1356FF5D">Anestezia regionala cu ghidaj ecografic – ghid complet - PRET: 250.00 Lei</option>
                                          <option value="904C716231244B1FA799D67A6A6540DC">Ultrasonografie arteriala. Nivelul de baza. - PRET: 250.00 Lei</option>
                                          <option value="87CC1BFCBF4B4AD1B2FB08186C78FEC0">Utilizarea ecografiei pentru diagnosticul, tratamentul si monitorizarea pacientului cu boli inflamatorii si degenerative articulare. - PRET: 250.00 Lei</option>
                                          <option value="D635EC997D4A4F7BA7D3A53C47D5E8BF">US clinica in cabinetele medicilor de familie: Tehnica de examinare, aspectul normal si principalele modificari ecografice - PRET: 250.00 Lei</option>
                                          <option value="D45537F8D2D6460092A7AD517FEF2A3E">Artroza - boala cu care traim toata viata. De la concept la solutii terapeutice - PRET: 200.00 Lei</option>
                                          <option value="8C41558B63DB4EEC991E17667CD20A6D">SonoAnatomia abdomenului - Tehnici de examinare si aplicatii clinice - PRET: 300.00 Lei</option>
                                          <option value="CB01657B682446B9A7ABA2FA53A7C74C">Screening US si orientare diagnostica POCUS in cabinetul medicului de familie - PRET: 250.00 Lei</option>
                                          <option value="8E79067E03964433985CF6577D2E1D9F">Abordarea provocarilor rezultate din problemele infertilitatii - PRET: 250.00 Lei</option>
                                          <option value="5BF92B4B8A9C4AB2B28ACCC369F53D0E">Patologia cardio-vasculara in sarcina - PRET: 300.00 Lei</option>
                                          <option value="27BBC43F5BDE4E028FB82621FFE2DDDD">Diabetul zaharat - o abordare practica - PRET: 250.00 Lei</option>
                                          <option value="081F212DE1D942CC9C9D0F8FB100CB9C">Conferinta internationala Ultrasonografia in urgente si stari critice - PRET: 250.00 Lei</option>
                                          <option value="BDEE82427FE944B496228A8C0DFBE858">Ecografia Transvaginala in practica Ginecologica si Obstetricala - PRET: 250.00 Lei</option>
                                          <option value="A98A590EBFBB4DE5A7687075745E4DB9">Ecografia structurilor musculoscheletale - PRET: 300.00 Lei</option>
                                          <option value="E645792C39C4412180DB3008238A0BA4">Ecografia fetala - PRET: 250.00 Lei</option>
                                          <option value="4430B02BFED8448DB7659AEA0DD83DCA">Ultrasonografie pediatrica - PRET: 250.00 Lei</option>
                                          <option value="BBC4C374FD7043CC8FFECDE95346FC2F">Ecografia Tiroidiana pentru toti - PRET: 300.00 Lei</option>
                                          <option value="011C10AA3D61C1613209903F4DF58C54">Ultrasonografia venelor membrelor inferioare. Nivelul de baza - PRET: 250.00 Lei</option>
                                  </select>
               <div id="produsBtErr" style="color: #cc0000; display:none; font-size: 10px;">
                   Alege produs.
              </div>
            </div>
     <!-- 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-1/3 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">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-1/3 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">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 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">CNP</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="cnp" id="cnp" placeholder="" type="text" value="" onblur="validareForm()"/>
                 <div id="cnpErr" style="color: #cc0000; display:none; font-size: 10px;">
                     Introdu CNP.
                </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 </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="RO">Romania</option>
                                          <option value="AX">Aaland</option>
                                          <option value="AF">Afganistan</option>
                                          <option value="AL">Albania</option>
                                          <option value="DZ">Algeria</option>
                                          <option value="AD">Andora</option>
                                          <option value="AO">Angola</option>
                                          <option value="AI">Anguila</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">Azerbaigian</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">Belgia</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</option>
                                          <option value="BQ">Bonaire</option>
                                          <option value="BA">Bosnia siHerzegovina</option>
                                          <option value="BW">Botswana</option>
                                          <option value="BV">Bouvet Island</option>
                                          <option value="BR">Brazilia</option>
                                          <option value="IO">British Indian Ocean Territory</option>
                                          <option value="VG">British Virgin Islands</option>
                                          <option value="BN">Brunei</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">Camerun</option>
                                          <option value="CA">Canada</option>
                                          <option value="CV">Cape Verde</option>
                                          <option value="KY">Cayman Islands</option>
                                          <option value="CZ">Cehia</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="CY">Cipru</option>
                                          <option value="CI">Coasta de Fildes</option>
                                          <option value="CC">Cocos [Keeling] Islands</option>
                                          <option value="CO">Columbia</option>
                                          <option value="KM">Comoros</option>
                                          <option value="CK">Cook Islands</option>
                                          <option value="CR">Costa Rica</option>
                                          <option value="HR">Croatia</option>
                                          <option value="CU">Cuba</option>
                                          <option value="CW">Curacao</option>
                                          <option value="DK">Danemarca</option>
                                          <option value="CD">Democratic Republic of the Congo</option>
                                          <option value="DJ">Djibouti</option>
                                          <option value="DM">Dominica</option>
                                          <option value="TL">East Timor</option>
                                          <option value="EC">Ecuador</option>
                                          <option value="EG">Egipt</option>
                                          <option value="SV">El Salvador</option>
                                          <option value="CH">Elvetia</option>
                                          <option value="AE">Emiratele Arabe Unite</option>
                                          <option value="GQ">Equatorial Guinea</option>
                                          <option value="ER">Eritrea</option>
                                          <option value="EE">Estonia</option>
                                          <option value="ET">Etiopia</option>
                                          <option value="FK">Falkland Islands</option>
                                          <option value="FJ">Fiji</option>
                                          <option value="FI">Finlanda</option>
                                          <option value="FR">Franta</option>
                                          <option value="GF">French Guiana</option>
                                          <option value="PF">French Polynesia</option>
                                          <option value="GA">Gabon</option>
                                          <option value="GM">Gambia</option>
                                          <option value="GH">Gana</option>
                                          <option value="GE">Georgia</option>
                                          <option value="DE">Germania</option>
                                          <option value="GI">Gibraltar</option>
                                          <option value="GR">Grecia</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="HN">Honduras</option>
                                          <option value="HK">Hong Kong</option>
                                          <option value="IN">India</option>
                                          <option value="ID">Indonesia</option>
                                          <option value="FO">Insulele Feroe</option>
                                          <option value="IQ">Irac</option>
                                          <option value="IR">Iran</option>
                                          <option value="IE">Irlanda</option>
                                          <option value="IS">Islanda</option>
                                          <option value="IM">Isle of Man</option>
                                          <option value="IL">Israel</option>
                                          <option value="IT">Italia</option>
                                          <option value="JM">Jamaica</option>
                                          <option value="JP">Japonia</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="XK">Kosovo</option>
                                          <option value="KW">Kuwait</option>
                                          <option value="KG">Kyrgyzstan</option>
                                          <option value="LA">Laos</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</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="GB">Marea Britanie</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</option>
                                          <option value="MD">Moldova</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 [Burma]</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="KP">North Korea</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">Palestine</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 Islands</option>
                                          <option value="PL">Poland</option>
                                          <option value="PT">Portugal</option>
                                          <option value="PR">Puerto Rico</option>
                                          <option value="QA">Qatar</option>
                                          <option value="CG">Republica Congo</option>
                                          <option value="DO">Republica Dominicana</option>
                                          <option value="RE">Reunion</option>
                                          <option value="RU">Rusia</option>
                                          <option value="RW">Rwanda</option>
                                          <option value="BL">Saint BarthÃ©lemy</option>
                                          <option value="SH">Saint Helena</option>
                                          <option value="KN">Saint Kitts and Nevis</option>
                                          <option value="LC">Saint Lucia</option>
                                          <option value="MF">Saint Martin</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="AS">Samoa Americana</option>
                                          <option value="SM">San Marino</option>
                                          <option value="SA">Saudi Arabia</option>
                                          <option value="ST">SÃ£o TomÃ© and PrÃ­ncipe</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</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="KR">South Korea</option>
                                          <option value="SS">South Sudan</option>
                                          <option value="ES">Spania</option>
                                          <option value="LK">Sri Lanka</option>
                                          <option value="US">Statele Unite ale Americii</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="SY">Syria</option>
                                          <option value="TW">Taiwan</option>
                                          <option value="TJ">Tajikistan</option>
                                          <option value="TZ">Tanzania</option>
                                          <option value="TF">Teritoriile Franceze de Sud</option>
                                          <option value="TH">Thailand</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">Turcia</option>
                                          <option value="TM">Turkmenistan</option>
                                          <option value="TC">Turks and Caicos Islands</option>
                                          <option value="TV">Tuvalu</option>
                                          <option value="UM">U.S. Minor Outlying Islands</option>
                                          <option value="VI">U.S. Virgin Islands</option>
                                          <option value="UG">Uganda</option>
                                          <option value="UA">Ukraine</option>
                                          <option value="HU">Ungaria</option>
                                          <option value="UY">Uruguay</option>
                                          <option value="UZ">Uzbekistan</option>
                                          <option value="VU">Vanuatu</option>
                                          <option value="VA">Vatican City</option>
                                          <option value="VE">Venezuela</option>
                                          <option value="VN">Vietnam</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 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="platabt" type="submit" class="b-button rounded" name="submitplatapt" style="background-color:#c0c0c0; padding:20px 20px;" disabled>Plateste</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="">
                  <input type="hidden" id="id_webinar" name="id_webinar" value="">
                  <input type="hidden" id="nume_produs" name="nume_produs" value="">
              </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('listaProduse').value.trim() == ""){
          err += 1;
          document.getElementById('produsBtErr').style.display = 'block';
     }else{
           document.getElementById('produsBtErr').style.display = 'none';
     }

     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){
		 document.getElementById('platabt').disabled = false;
               document.getElementById('platabt').style.backgroundColor = "#09b1bb";
               document.getElementById('platabt').style.color = "#ffffff";
         
     }else{
           
               document.getElementById('platabt').disabled = true;
               document.getElementById('platabt').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>
