   
      <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 #state_new {
                width: 57%;
                margin-left: 2px !important;
            }

            .form_mainbody #city, .form_mainbody #mcity {
                width: 52.5% !important;
                margin-left: 131px !important;
            }
            .form_mainbody #country_new {
                width: 52.5% !important;
              margin-left: 139px !important;

            }
            .form_mainbody .second_div .birthdate {
                margin-left: 33px !important;
                width: 44% !important;
             }
             .form_mainbody .second_div .birthtime {
                margin-left: 30px !important;
                width: 44% !important;
             }
             .form_mainbody #state_new {
               width: 52.5% !important;
              margin-left: 41px !important;
             }
             ._foundation_chart .second_div .lab{
                 margin-left:5px !important;
             }
             ._foundation_chart .second_div .city_div,._foundation_chart .second_div .country_div{
                    padding-left: 3px;
                }
        .form_mainbody .second_div .u_time {
           margin-left: 6px !important;
           width: 34% !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">Criar Mapa Individual</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">Tipo de Gráfico


</label>
                        <select name="pet-type" id="pet-type" expandto="50" class="country_list" tabindex="5">
                            
                            <option value="p"  >Pessoa</option>
                            <option value="c"  disabled title='Upgrade your account to Pro enable this chart.'>Gato</option>
                            <option value="d" disabled title='Upgrade your account to Pro enable this chart.' >Cão</option>
                            <option value="h" disabled title='Upgrade your account to Pro enable this chart.'>Cavalo</option>
                            <option value="r" disabled title='Upgrade your account to Pro enable this chart.'>Coelho</option>
                        </select>
                    </div>
                </div>
                
                <div class="first_div">
                    <input type='text' id='f_name' class="req requiredfield" name='f_name' value='' placeholder="Primeiro nome" 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="Último nome" 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;">Data de nascimento</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">
                                    Insira sua data de nascimento. Insira usando o formato: Ano (AAAA), Mês (MM), Dia (DD). por exemplo. 24 de abril de 1970 entrada como 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;">Hora de nascimento</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">
                                    
Insira a hora local de nascimento no formato de 24 horas. Por exemplo. 1:05:00 às 13:05:00


                                </span>
                            </a>
                        </div>
                    </div>
                </div>
                <div class="second_div">
                    <div class="second-inner-section">
                        <div class="country_div" >   
                                
                            <lable class="lab">País</lable>
                            <select name="country" id="country_new" expandto="50" class="country_list requiredfield" tabindex="5">
                                <option value="">Select Country</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">
                                    Selecione o país de nascimento                                </span>
                            </a>
                        </div>
                        <div class="city_div" style="padding-bottom: 10px;">
                            <lable class="lab">Cidade</lable>
                            <input type="text" id="city_new" class="requiredfield"  name="city" placeholder="Enter City/Town" 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">
                                    Por favor, insira uma cidade ou vila. Ex. Nova Iorque. Você pode usar seu próprio idioma para Cidade ou Vila. Ex. Moscovo ou Moskva ou qualquer derivado conhecido. Outro exemplo: Munique ou München.                                </span>
                            </a>                            
                        </div> 

                        <div class="city_div">
                            <lable id="state_label" class="lab">Estado/Região</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">
                                    Este campo é calculado automaticamente. Se precisar de um estado diferente, por favor, digite-o. Você deve usar a língua inglesa para o estado, por exemplo, New Mexico ou Samara, não Campa. Sua entrada será validada. Será exibido em inglês quando validado.                                    
                                </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">Hora de nascimento 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">
                                    Este é um campo calculado automaticamente. Representa a hora local de nascimento convertida para o "Tempo Universal Coordenado" (UTC).                                </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="Ok" name="_submit_foundation_chart_hybrid"/>
                    <a href="https://www.geneticmatrix.com/pt-pt/casa-do-usuario/"><input type="button" id="found_cancel" class="found_cancel" value="Cancelar" /></a>
                </div>
            </div>          
                        <input type="hidden" name="client_id" value="0">
            <input type="hidden" name="paid" value="0">
                            
        </form>
    </div>
    
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