   
      <style>
        ._foundation_chart .second_div .lab {
            line-height: 1.8 !important;
        }
        .five_div .ftc_checkbox {
            margin-left: 15px;
        }
        .five_div .country_new_div {
            width: 80%;
            float: right;
        }
        .second-inner-section label.lab {
            margin-left: 7px;
            float: left;
            font-size: 25px;
            font-weight: bold;
            margin-top: 10px;
        }
        .second-inner-section #pet-type {
            font-size: 20px;
            /* font-weight: bold; */
            height: 35px;
            width: 53%;
            border: 2px solid #9B9B9B;
            padding: 0 0 0 10px;
            background: #e0dcdc;
            float: left;
            margin-left: 62px;
            margin-top: 4px;
        }
        span.u_time {
            padding: 22px;
            font-size: 20px;
        }
        .pac-container:after {
            /* Disclaimer: not needed to show 'powered by Google' if also a Google Map is shown */
            background-image: none !important;
            height: 0px;
        }
        .pac-item-query + span
        {
            display: none
        }
        .pac-icon {
            width: 0;
            background-image: none;
        }

        .form_mainbody #city_new, .form_mainbody #mcity {
            width: 55% !important;
            margin-left: 71px !important;
        }
        .form_mainbody #country_new {
            width: 54.8% !important;
            margin-left: 67px;
            padding-left: 12px;
            
        }
        .form_mainbody .second_div .birthdate {
            margin-left: 67px;
            width: 53%;
        }

        /*.form_mainbody .second_div .birthdate {
            margin-left: 90px;
            width: 47%;
            }*/
        .form_mainbody .second_div .birthtime {
            margin-left: 64px;
            width: 53%;
        }
        /*        input#birthtime {
                    margin-left: 14px;
                    width: 47%;
                    }*/
        .form_mainbody .second_div .u_time {
            margin-left: 6px;
            width: 53%;
        }        

        .form_mainbody #state_new {
            width: 55%;
            margin-left: 37px;
        }
        .chart_help_tooltip .vtop{
            margin-top:7px !important;

        }
        input + a .vtop {
            margin-top: 8px !important;
        }
        #state_new::-webkit-input-placeholder {
            color: #DD3A32
        }
        .u_time::-webkit-input-placeholder {
            color: #DD3A32
        }

           option:disabled { opacity: 0.5; }
    </style>
             
        
    
             <style> 
            .form_mainbody .second_div .birthdate {
                margin-left: 31px; !important
             }
            .form_mainbody #city_new, .form_mainbody #mcity {
                margin-left: 28px !important;
            }
            .form_mainbody #country_new{
                margin-left: 20px !important;
            }
        </style>
        
      
      
       <div id="FoundationChartForm" class="_foundation_chart form_mainbody">
        <div id="form_header" class="form_top foundation_chart">
            <img class="header_img" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/fou_chart.png"/>
            <div class="charttitle">Créer un graphique de base

</div>
            <img class="header_img" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/fou_chart.png"/>
        </div>
        <form id="new_main_form" class="main_form" method="post" >
            <div class="form-contain">
                <div class="second-div">
                    <div class="second-inner-section" style="margin-bottom:12px">
                        <label class="lab">Type de graphique

</label>
                        <select name="pet-type" id="pet-type" expandto="50" class="country_list" tabindex="5">
                            
                            <option value="p"  >Person</option>
                            <option value="c"  disabled title='Upgrade your account to Pro enable this chart.'>Chat</option>
                            <option value="d" disabled title='Upgrade your account to Pro enable this chart.' >Chien</option>
                            <option value="h" disabled title='Upgrade your account to Pro enable this chart.'>Cheval</option>
                            <option value="r" disabled title='Upgrade your account to Pro enable this chart.'>Lapin</option>
                        </select>
                    </div>
                </div>
                
                <div class="first_div">
                    <input type='text' id='f_name' class="req requiredfield" name='f_name' value='' placeholder="Prénom" tabindex="1"/>                    
                </div>
                <div class="first_div" id="l_name_div">
                    <input type='text' id='l_name' class="req requiredfield" name='l_name' value='' placeholder="Nom" tabindex="2"/>                    
                </div>


                <div class="second_div">
                    <div class="second-inner-section">
                        <div class="bdate">
                            <!--<img src="" style="width: 25px;height: 25px;margin-top: 9px;" class="vtop"/>-->
                            <lable class="lab" style="margin-left:21px;">Date de naissance</lable>
                            <input type="text" id="birthdate" class="birthdate reg requiredfield" name="birthdate_new"  placeholder="YYYY-MM-DD" tabindex="3"/>
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Please input your date of birth. Input using the format: Year (YYYY) , Month (MM), Day (DD). eg. 24th April 1970 input as 1970-04-24                                </span>
                            </a>
                        </div>
                        <div class="btime" >   
                            <!--<img src="" style="width: 25px;height: 25px;margin-top: 9px;" class="vtop"/>-->
                            <lable class="lab" style="margin-left:21px;">Heure de naissance</lable>    
                            <input type="text" id="birthtime" class="birthtime reg requiredfield" name="birthtime" placeholder="HH:MM or HH:MM:SS" maxlength="8" tabindex="4" style=""/>
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Please input the local time of birth in a 24 Hour format. Eg. 1:05:00 pm as 13:05:00                                </span>
                            </a>
                        </div>
                    </div>
                </div>
                <div class="second_div">
                    <div class="second-inner-section">
                        <div class="country_div" >   
                                
                            <lable class="lab">Pays</lable>
                            <select name="country" id="country_new" expandto="50" class="country_list requiredfield" tabindex="5">
                                <option value="">Sélectionner le pays</option>
                                                                
                                    <option value=" North Korea" data-code="KP"> North Korea </option>
                                                                
                                    <option value=" South Korea" data-code="KR"> South Korea </option>
                                                                
                                    <option value="Afghanistan" data-code="AF">Afghanistan </option>
                                                                
                                    <option value="Aland Islands" data-code="AX">Aland Islands </option>
                                                                
                                    <option value="Albania" data-code="AL">Albania </option>
                                                                
                                    <option value="Algeria" data-code="DZ">Algeria </option>
                                                                
                                    <option value="Andorra" data-code="AD">Andorra </option>
                                                                
                                    <option value="Angola" data-code="AO">Angola </option>
                                                                
                                    <option value="Anguilla" data-code="AI">Anguilla </option>
                                                                
                                    <option value="Antigua and Barbuda" data-code="AG">Antigua and Barbuda </option>
                                                                
                                    <option value="Argentina" data-code="AR">Argentina </option>
                                                                
                                    <option value="Armenia" data-code="AM">Armenia </option>
                                                                
                                    <option value="Aruba" data-code="AW">Aruba </option>
                                                                
                                    <option value="Australia" data-code="AU">Australia </option>
                                                                
                                    <option value="Austria" data-code="AT">Austria </option>
                                                                
                                    <option value="Azerbaijan" data-code="AZ">Azerbaijan </option>
                                                                
                                    <option value="Bahamas" data-code="BS">Bahamas </option>
                                                                
                                    <option value="Bahrain" data-code="BH">Bahrain </option>
                                                                
                                    <option value="Bangladesh" data-code="BD">Bangladesh </option>
                                                                
                                    <option value="Barbados" data-code="BB">Barbados </option>
                                                                
                                    <option value="Belarus" data-code="BY">Belarus </option>
                                                                
                                    <option value="Belgium" data-code="BE">Belgium </option>
                                                                
                                    <option value="Belize" data-code="BZ">Belize </option>
                                                                
                                    <option value="Benin" data-code="BJ">Benin </option>
                                                                
                                    <option value="Bermuda" data-code="BM">Bermuda </option>
                                                                
                                    <option value="Bhutan" data-code="BT">Bhutan </option>
                                                                
                                    <option value="Bolivia" data-code="BO">Bolivia </option>
                                                                
                                    <option value="Bosnia and Herzegovina" data-code="BA">Bosnia and Herzegovina </option>
                                                                
                                    <option value="Botswana" data-code="BW">Botswana </option>
                                                                
                                    <option value="Brazil" data-code="BR">Brazil </option>
                                                                
                                    <option value="Brunei" data-code="BN">Brunei </option>
                                                                
                                    <option value="Bulgaria" data-code="BG">Bulgaria </option>
                                                                
                                    <option value="Burkina Faso" data-code="BF">Burkina Faso </option>
                                                                
                                    <option value="Burundi" data-code="BI">Burundi </option>
                                                                
                                    <option value="Cambodia" data-code="KH">Cambodia </option>
                                                                
                                    <option value="Cameroon" data-code="CM">Cameroon </option>
                                                                
                                    <option value="Canada" data-code="CA">Canada </option>
                                                                
                                    <option value="Cape Verde" data-code="CV">Cape Verde </option>
                                                                
                                    <option value="Cayman Islands" data-code="KY">Cayman Islands </option>
                                                                
                                    <option value="Central African Republic" data-code="CF">Central African Republic </option>
                                                                
                                    <option value="Chad" data-code="TD">Chad </option>
                                                                
                                    <option value="Chile" data-code="CL">Chile </option>
                                                                
                                    <option value="China" data-code="CN">China </option>
                                                                
                                    <option value="Colombia" data-code="CO">Colombia </option>
                                                                
                                    <option value="Comoros" data-code="KM">Comoros </option>
                                                                
                                    <option value="Congo" data-code="CG">Congo </option>
                                                                
                                    <option value="Congo Demoractic Republic" data-code="CD">Congo Demoractic Republic </option>
                                                                
                                    <option value="Cook Islands" data-code="CK">Cook Islands </option>
                                                                
                                    <option value="Costa Rica" data-code="CR">Costa Rica </option>
                                                                
                                    <option value="Croatia" data-code="HR">Croatia </option>
                                                                
                                    <option value="Cuba" data-code="CU">Cuba </option>
                                                                
                                    <option value="Curaçao" data-code="CW">Curaçao </option>
                                                                
                                    <option value="Cyprus" data-code="CY">Cyprus </option>
                                                                
                                    <option value="Czech Republic" data-code="CZ">Czech Republic </option>
                                                                
                                    <option value="Denmark" data-code="DK">Denmark </option>
                                                                
                                    <option value="Djibouti" data-code="DJ">Djibouti </option>
                                                                
                                    <option value="Dominica" data-code="DM">Dominica </option>
                                                                
                                    <option value="Dominican Republic" data-code="DO">Dominican Republic </option>
                                                                
                                    <option value="Ecuador" data-code="EC">Ecuador </option>
                                                                
                                    <option value="Egypt" data-code="EG">Egypt </option>
                                                                
                                    <option value="El Salvador" data-code="SV">El Salvador </option>
                                                                
                                    <option value="Equatorial Guinea" data-code="GQ">Equatorial Guinea </option>
                                                                
                                    <option value="Eritrea" data-code="ER">Eritrea </option>
                                                                
                                    <option value="Estonia" data-code="EE">Estonia </option>
                                                                
                                    <option value="Ethiopia" data-code="ET">Ethiopia </option>
                                                                
                                    <option value="Falkland Islands" data-code="FK">Falkland Islands </option>
                                                                
                                    <option value="Faroe Islands" data-code="FO">Faroe Islands </option>
                                                                
                                    <option value="Fiji" data-code="FJ">Fiji </option>
                                                                
                                    <option value="Finland" data-code="FI">Finland </option>
                                                                
                                    <option value="France" data-code="FR">France </option>
                                                                
                                    <option value="French Guiana" data-code="GF">French Guiana </option>
                                                                
                                    <option value="French Polynesia" data-code="PF">French Polynesia </option>
                                                                
                                    <option value="Gabon" data-code="GA">Gabon </option>
                                                                
                                    <option value="Gambia" data-code="GM">Gambia </option>
                                                                
                                    <option value="Georgia" data-code="GE">Georgia </option>
                                                                
                                    <option value="Germany" data-code="DE">Germany </option>
                                                                
                                    <option value="Ghana" data-code="GH">Ghana </option>
                                                                
                                    <option value="Gibraltar" data-code="GI">Gibraltar </option>
                                                                
                                    <option value="Greece" data-code="GR">Greece </option>
                                                                
                                    <option value="Greenland" data-code="GL">Greenland </option>
                                                                
                                    <option value="Grenada" data-code="GD">Grenada </option>
                                                                
                                    <option value="Guadeloupe" data-code="GP">Guadeloupe </option>
                                                                
                                    <option value="Guam" data-code="GU">Guam </option>
                                                                
                                    <option value="Guatemala" data-code="GT">Guatemala </option>
                                                                
                                    <option value="Guernsey" data-code="GG">Guernsey </option>
                                                                
                                    <option value="Guinea" data-code="GN">Guinea </option>
                                                                
                                    <option value="Guinea-Bissau" data-code="GW">Guinea-Bissau </option>
                                                                
                                    <option value="Guyana" data-code="GY">Guyana </option>
                                                                
                                    <option value="Haiti" data-code="HT">Haiti </option>
                                                                
                                    <option value="Honduras" data-code="HN">Honduras </option>
                                                                
                                    <option value="Hong Kong" data-code="HK">Hong Kong </option>
                                                                
                                    <option value="Hungary" data-code="HU">Hungary </option>
                                                                
                                    <option value="Iceland" data-code="IS">Iceland </option>
                                                                
                                    <option value="India" data-code="IN">India </option>
                                                                
                                    <option value="Indonesia" data-code="ID">Indonesia </option>
                                                                
                                    <option value="Iran" data-code="IR">Iran </option>
                                                                
                                    <option value="Iraq" data-code="IQ">Iraq </option>
                                                                
                                    <option value="Ireland" data-code="IE">Ireland </option>
                                                                
                                    <option value="Isle of Man" data-code="IM">Isle of Man </option>
                                                                
                                    <option value="Israel" data-code="IL">Israel </option>
                                                                
                                    <option value="Italy" data-code="IT">Italy </option>
                                                                
                                    <option value="Ivory Coast" data-code="CI">Ivory Coast </option>
                                                                
                                    <option value="Jamaica" data-code="JM">Jamaica </option>
                                                                
                                    <option value="Japan" data-code="JP">Japan </option>
                                                                
                                    <option value="Jersey" data-code="JE">Jersey </option>
                                                                
                                    <option value="Jordan" data-code="JO">Jordan </option>
                                                                
                                    <option value="Kazakhstan" data-code="KZ">Kazakhstan </option>
                                                                
                                    <option value="Kenya" data-code="KE">Kenya </option>
                                                                
                                    <option value="Kiribati" data-code="KI">Kiribati </option>
                                                                
                                    <option value="Kosovo" data-code="XK">Kosovo </option>
                                                                
                                    <option value="Kuwait" data-code="KW">Kuwait </option>
                                                                
                                    <option value="Kyrgyzstan" data-code="KG">Kyrgyzstan </option>
                                                                
                                    <option value="Laos" data-code="LA">Laos </option>
                                                                
                                    <option value="Latvia" data-code="LV">Latvia </option>
                                                                
                                    <option value="Lebanon" data-code="LB">Lebanon </option>
                                                                
                                    <option value="Lesotho" data-code="LS">Lesotho </option>
                                                                
                                    <option value="Liberia" data-code="LR">Liberia </option>
                                                                
                                    <option value="Libya" data-code="LY">Libya </option>
                                                                
                                    <option value="Liechtenstein" data-code="LI">Liechtenstein </option>
                                                                
                                    <option value="Lithuania" data-code="LT">Lithuania </option>
                                                                
                                    <option value="Luxembourg" data-code="LU">Luxembourg </option>
                                                                
                                    <option value="Macau" data-code="MO">Macau </option>
                                                                
                                    <option value="Macedonia" data-code="MK">Macedonia </option>
                                                                
                                    <option value="Madagascar" data-code="MG">Madagascar </option>
                                                                
                                    <option value="Malawi" data-code="MW">Malawi </option>
                                                                
                                    <option value="Malaysia" data-code="MY">Malaysia </option>
                                                                
                                    <option value="Maldives" data-code="MV">Maldives </option>
                                                                
                                    <option value="Mali" data-code="ML">Mali </option>
                                                                
                                    <option value="Malta" data-code="MT">Malta </option>
                                                                
                                    <option value="Marshall Islands" data-code="MH">Marshall Islands </option>
                                                                
                                    <option value="Martinique" data-code="MQ">Martinique </option>
                                                                
                                    <option value="Mauritania" data-code="MR">Mauritania </option>
                                                                
                                    <option value="Mauritius" data-code="MU">Mauritius </option>
                                                                
                                    <option value="Mayotte" data-code="YT">Mayotte </option>
                                                                
                                    <option value="Mexico" data-code="MX">Mexico </option>
                                                                
                                    <option value="Micronesia" data-code="FM">Micronesia </option>
                                                                
                                    <option value="Moldova" data-code="MD">Moldova </option>
                                                                
                                    <option value="Monaco" data-code="MC">Monaco </option>
                                                                
                                    <option value="Mongolia" data-code="MN">Mongolia </option>
                                                                
                                    <option value="Montenegro" data-code="ME">Montenegro </option>
                                                                
                                    <option value="Montserrat" data-code="MS">Montserrat </option>
                                                                
                                    <option value="Morocco" data-code="MA">Morocco </option>
                                                                
                                    <option value="Mozambique" data-code="MZ">Mozambique </option>
                                                                
                                    <option value="Myanmar" data-code="MM">Myanmar </option>
                                                                
                                    <option value="Namibia" data-code="NA">Namibia </option>
                                                                
                                    <option value="Nauru" data-code="NR">Nauru </option>
                                                                
                                    <option value="Nepal" data-code="NP">Nepal </option>
                                                                
                                    <option value="Netherlands" data-code="NL">Netherlands </option>
                                                                
                                    <option value="New Caledonia" data-code="NC">New Caledonia </option>
                                                                
                                    <option value="New Zealand" data-code="NZ">New Zealand </option>
                                                                
                                    <option value="Nicaragua" data-code="NI">Nicaragua </option>
                                                                
                                    <option value="Niger" data-code="NE">Niger </option>
                                                                
                                    <option value="Nigeria" data-code="NG">Nigeria </option>
                                                                
                                    <option value="Niue" data-code="NU">Niue </option>
                                                                
                                    <option value="Norfolk Island" data-code="NF">Norfolk Island </option>
                                                                
                                    <option value="Northern Mariana Islands" data-code="MP">Northern Mariana Islands </option>
                                                                
                                    <option value="Norway" data-code="NO">Norway </option>
                                                                
                                    <option value="Oman" data-code="OM">Oman </option>
                                                                
                                    <option value="Pakistan" data-code="PK">Pakistan </option>
                                                                
                                    <option value="Palau" data-code="PW">Palau </option>
                                                                
                                    <option value="Palestine" data-code="PS">Palestine </option>
                                                                
                                    <option value="Panama" data-code="PA">Panama </option>
                                                                
                                    <option value="Papua New Guinea" data-code="PG">Papua New Guinea </option>
                                                                
                                    <option value="Paraguay" data-code="PY">Paraguay </option>
                                                                
                                    <option value="Peru" data-code="PE">Peru </option>
                                                                
                                    <option value="Philippines" data-code="PH">Philippines </option>
                                                                
                                    <option value="Poland" data-code="PL">Poland </option>
                                                                
                                    <option value="Portugal" data-code="PT">Portugal </option>
                                                                
                                    <option value="Puerto Rico" data-code="PR">Puerto Rico </option>
                                                                
                                    <option value="Qatar" data-code="QA">Qatar </option>
                                                                
                                    <option value="Reunion" data-code="RE">Reunion </option>
                                                                
                                    <option value="Romania" data-code="RO">Romania </option>
                                                                
                                    <option value="Russia" data-code="RU">Russia </option>
                                                                
                                    <option value="Rwanda" data-code="RW">Rwanda </option>
                                                                
                                    <option value="Saint Helena" data-code="SH">Saint Helena </option>
                                                                
                                    <option value="Saint Kitts-Nevis" data-code="KN">Saint Kitts-Nevis </option>
                                                                
                                    <option value="Saint Lucia" data-code="LC">Saint Lucia </option>
                                                                
                                    <option value="Saint Martin" data-code="MF">Saint Martin </option>
                                                                
                                    <option value="Saint Pierre and Miquelon" data-code="PM">Saint Pierre and Miquelon </option>
                                                                
                                    <option value="Saint Vincent and Grenadines" data-code="VC">Saint Vincent and Grenadines </option>
                                                                
                                    <option value="Samoa" data-code="WS">Samoa </option>
                                                                
                                    <option value="Samoa, American" data-code="AS">Samoa, American </option>
                                                                
                                    <option value="San Marino" data-code="SM">San Marino </option>
                                                                
                                    <option value="Sao Tome and Principe" data-code="ST">Sao Tome and Principe </option>
                                                                
                                    <option value="Saudi Arabia" data-code="SA">Saudi Arabia </option>
                                                                
                                    <option value="Senegal" data-code="SN">Senegal </option>
                                                                
                                    <option value="Serbia" data-code="RS">Serbia </option>
                                                                
                                    <option value="Seychelles" data-code="SC">Seychelles </option>
                                                                
                                    <option value="Sierra Leone" data-code="SL">Sierra Leone </option>
                                                                
                                    <option value="Singapore" data-code="SG">Singapore </option>
                                                                
                                    <option value="Slovakia" data-code="SK">Slovakia </option>
                                                                
                                    <option value="Slovenia" data-code="SI">Slovenia </option>
                                                                
                                    <option value="Solomon Islands" data-code="SB">Solomon Islands </option>
                                                                
                                    <option value="Somalia" data-code="SO">Somalia </option>
                                                                
                                    <option value="South Africa" data-code="ZA">South Africa </option>
                                                                
                                    <option value="Spain" data-code="ES">Spain </option>
                                                                
                                    <option value="Sri Lanka" data-code="LK">Sri Lanka </option>
                                                                
                                    <option value="Sudan" data-code="SD">Sudan </option>
                                                                
                                    <option value="Suriname" data-code="SR">Suriname </option>
                                                                
                                    <option value="Swaziland" data-code="SZ">Swaziland </option>
                                                                
                                    <option value="Sweden" data-code="SE">Sweden </option>
                                                                
                                    <option value="Switzerland" data-code="CH">Switzerland </option>
                                                                
                                    <option value="Syria" data-code="SY">Syria </option>
                                                                
                                    <option value="Taiwan" data-code="TW">Taiwan </option>
                                                                
                                    <option value="Tajikistan" data-code="TJ">Tajikistan </option>
                                                                
                                    <option value="Tanzania" data-code="TZ">Tanzania </option>
                                                                
                                    <option value="Thailand" data-code="TH">Thailand </option>
                                                                
                                    <option value="Timor-Leste" data-code="TL">Timor-Leste </option>
                                                                
                                    <option value="Togo" data-code="TG">Togo </option>
                                                                
                                    <option value="Tokelau Islands" data-code="TK">Tokelau Islands </option>
                                                                
                                    <option value="Tonga" data-code="TO">Tonga </option>
                                                                
                                    <option value="Trinidad and Tobago" data-code="TT">Trinidad and Tobago </option>
                                                                
                                    <option value="Tunisia" data-code="TN">Tunisia </option>
                                                                
                                    <option value="Turkey" data-code="TR">Turkey </option>
                                                                
                                    <option value="Turkmenistan" data-code="TM">Turkmenistan </option>
                                                                
                                    <option value="Turks and Caicos" data-code="TC">Turks and Caicos </option>
                                                                
                                    <option value="Tuvalu" data-code="TV">Tuvalu </option>
                                                                
                                    <option value="Uganda" data-code="UG">Uganda </option>
                                                                
                                    <option value="Ukraine" data-code="UA">Ukraine </option>
                                                                
                                    <option value="United Arab Emirates" data-code="AE">United Arab Emirates </option>
                                                                
                                    <option value="United Kingdom" data-code="GB">United Kingdom </option>
                                                                
                                    <option value="United States" data-code="US">United States </option>
                                                                
                                    <option value="Uruguay" data-code="UY">Uruguay </option>
                                                                
                                    <option value="Uzbekistan" data-code="UZ">Uzbekistan </option>
                                                                
                                    <option value="Vanuatu" data-code="VU">Vanuatu </option>
                                                                
                                    <option value="Venezuela" data-code="VE">Venezuela </option>
                                                                
                                    <option value="Vietnam" data-code="VN">Vietnam </option>
                                                                
                                    <option value="Virgin Islands, British" data-code="VG">Virgin Islands, British </option>
                                                                
                                    <option value="Virgin Islands, U.S." data-code="VI">Virgin Islands, U.S. </option>
                                                                
                                    <option value="Wallis and Futuna" data-code="WF">Wallis and Futuna </option>
                                                                
                                    <option value="Yemen" data-code="YE">Yemen </option>
                                                                
                                    <option value="Zambia" data-code="ZM">Zambia </option>
                                                                
                                    <option value="Zimbabwe" data-code="ZW">Zimbabwe </option>
                                 
                            </select>
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Please select the country of birth                                </span>
                            </a>
                        </div>
                        <div class="city_div" style="padding-bottom: 10px;">
                            <lable class="lab">Ville / Municipalité</lable>
                            <input type="text" id="city_new" class="requiredfield"  name="city" placeholder="Entrez la ville " tabindex="6" />
                            <input type="hidden" name="selected_city">
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Veuillez saisir une ville ou un village. Par exemple, New York. Vous pouvez utiliser votre propre langue pour Ville ou Village. Par exemple, Moscou ou Moskva ou tout dérivé connu. Un autre exemple : Munich ou München.                                </span>
                            </a>                            
                        </div> 

                        <div class="city_div">
                            <lable id="state_label" class="lab">État / Région</lable>
                            <input type="text" id="state_new" class="requiredfield"  name="state" disabled="disable" placeholder="" tabindex="7"/>
                            <input type="hidden" name="selected_city"> 
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Ce champ est calculé automatiquement. Si vous avez besoin d’un état différent, veuillez le saisir. Vous devez utiliser la langue anglaise pour l’état, par exemple New Mexico ou Samara et non Campa. Votre saisie sera ensuite validée. Elle s’affichera en anglais une fois validée.                                    
                                </span>
                            </a>
                        </div>
                        <div class="btime" id="utc_time">
                            <img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/clock.png" style="width:25px;height: 25px;margin-top:9px"class="vtop"/>
                            <lable class="lab">Heure de naissance UTC</lable>
                            <input type="text" class="u_time birthtime reg " style="" disabled="disabled">
                            <a class="chart_help_tooltip" href="#"><img src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/question2.png" class="vtop"/>
                                <span>
                                    <img alt="" src="https://www.geneticmatrix.com/wp-content/plugins/ChartCreationForm/images/callout.gif" class="callout_arrow">
                                    Il s'agit d'un champ calculé automatiquement. Il représente l'heure de naissance locale convertie en "Temps Universel Coordonné".                                </span>
                            </a>
                            <input type="hidden" id="lat" name="lat" value="0">
                            <input type="hidden" id="log" name="log" value="0">
                            <input type="hidden" id="utctype" name="utctype">
                            <input type="hidden" id="utcerror" class="birthtime reg requiredfield" name="utcerror" value="1" maxlength="5" tabindex="4"/>
                            <input type="hidden" id="state_code_short" name="state_code_short" value="" maxlength="5" tabindex="4"/>
                            <input type="hidden" id="dobUTC" class="birthtime reg" name="dobUTC"  tabindex="4"/>
                        </div> 
                    </div>
                <div class="five_div">
                    <div class="five-inner-section" id="dst-section" style="display:none">
                        <div class="ftc_checkbox">
                            <input type="checkbox" value="1" id="ftc_checkbox"  name="dst"/>
                            <label for="ftc_checkbox"></label>
                        </div>
                        <label style="font-size: 17px;margin-left: 13px;">Select to calculate chart With  DST (Day Light Savings Time).</label>
                    </div>
                </div>    
                </div>
                <div id="form_button">
                    <input type="submit" id="found_ok" class="found_ok" value="O.K." name="_submit_foundation_chart_hybrid"/>
                    <a href="https://www.geneticmatrix.com/fr/user-home/"><input type="button" id="found_cancel" class="found_cancel" value="Annuler" /></a>
                </div>
            </div>          
                        <input type="hidden" name="client_id" value="0">
            <input type="hidden" name="paid" value="0">
                            
        </form>
    </div>
    
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