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<title>TESOL Course INDIA</title>

</head>

<body>
<!-- HEADER --> 
<header>
<?php include_once("include/header.php"); ?>
</header>
<!-- HEADER END --> 

<!--========================================================
                    BODY START
=========================================================-->
<div class="main-conetnt"> 

<!--Special Course Part Start-->
<div class="container-fluid">
	<div class="container">
    	<div class="special_course_wrap">
        	<h2>Apply</h2>
            <div class="heading_border">&nbsp;</div>
            <div class="col-lg-8 col-sm-12">
               <div class="caption" style="padding:20px;">

                <h5 class="he1" style="color:#000;font-size:25px;">ACT - TESOL Application India tesolcourseindia.com<br></h5>

                  <form name="form1" id="form1" method="POST">

          

                 <div class="form-group">

                <input type="text" name="txtname" id="txtname" placeholder="Full Name" class="form-control" required>

                <span class="fnameErr error" style="color: red;"></span>

            	</div>

                  <div class="form-group">

                <input type="text" name="location" id="location" placeholder="Country, state and city" class="form-control" required>

                <span class="placeErr error" style="color: red;"></span>

              </div>
        

              <div class="form-group">

                <input type="email" name="email" id="email" placeholder="Email Address" class="form-control" required>

                <span class="emailErr error" style="color: red;"></span>

              </div>

              <div class="form-group">

                <input type="text" name="contact" id="contact" placeholder="Phone" class="form-control" required>

                <span class="phoneErr error" style="color: red;"></span>

              </div>

             
            <div class="form-group">                
                <select name="cmbGender" id="cmbGender" class="form-control" required>
                <option value="male">Male</option>
                <option value="female">Female</option>
                </select>
                <span class="phoneErr error" style="color: red;"></span>

              </div>

              <div class="form-group"> <!-- Subject field -->

		<label class="control-label " for="subject">Date of Birth  <span class="asteriskField" style="color:#F00">*</span> </label>

		<input class="form-control" id="dob" name="dob" type="date" required/>

	</div>
    
    <div class="form-group"> <!-- Subject field -->

		<label class="control-label " for="subject">Educational Qualification  <span class="asteriskField" style="color:#F00">*</span> </label>

		
<select class="form-control" name="qualification" id="qualification" required>

            <option value="">Select</option>
           
						<option value="10+2">
				10+2
			</option>
						<option value="Bachelors Degree">
				Bachelors Degree
			</option>
						<option value="Post Graduate Diploma">
				Post Graduate Diploma
			</option>
						<option value="Master Degree">
				Master Degree
			</option>
						<option value="Others">
				Others
			</option>
        </select>
	</div>
    <div class="form-group"> <!-- Subject field -->

		<label class="control-label " for="subject">Select your mode of study  <span class="asteriskField" style="color:#F00">*</span> </label>

		
<select class="form-control" name="mode" id="mode" required onchange="showDiv('hidden_div', this)">

            <option value="">Select</option>
           
						<option value="online">
				Online TEFL Program
			</option>
						<option value="inclass">
				In Class TEFL Program 
			</option>
						
        </select>
	</div>
    
    <div class="form-group" id="hidden_div"> <!-- Message field -->

		<label class="control-label " for="message">Please select your Course</label>

		<select class="form-control" name="cmbCourse" id="cmbCourse" >

            <option value="">Select Course</option>

						<option value="120 Hour International Certificate in TESOL/TEFL Program">
				120 Hour International Certificate in TESOL/TEFL Program
			</option>
						<option value="220 Hour International Diploma in TESOL/TEFL Program">
				220 Hour International Diploma in TESOL/TEFL Program
			</option>
						<option value="280 Hour International Advanced Diploma in TESOL/TEFL Program">
				280 Hour International Advanced Diploma in TESOL/TEFL Program
			</option>
						<option value="400 Hour International PG Diploma in TESOL/TEFL Program">
				400 Hour International PG Diploma in TESOL/TEFL Program
			</option>
						<option value="Bachelors in TEFL">
				Bachelors in TEFL
			</option>
						<option value="Masters in TEFL">
				Masters in TEFL
			</option>
						
            					
</select>

	</div>
    
     <div class="form-group" id="hidden_div1"> <!-- Message field -->

		<label class="control-label " for="message">TESOL Course Location</label>

		<select class="form-control" name="tr_location" id="tr_location" >

            <option value="">Select Course Location</option>

						<option value="Goa">
				Goa
			</option>
            <option value="Kolkata">
				Kolkata
			</option>
            <option value="Chennai">
				Chennai
			</option>
            <option value="Bangalore">
				Bangalore
			</option>
            <option value="Kerala">
				Kerala
			</option>
			<option value="Mumbai">
				Mumbai
			</option>
			<option value="New Delhi">
				New Delhi
			</option>
			<option value="Pune">
				Pune
			</option>
			<option value="Hyderabad">
				Hyderabad
			</option>
			<option value="Bangkok">
				Bangkok
			</option>
			<option value="Chandigarh">
				Chandigarh
			</option>
			<option value="Ahmedabad">
				Ahmedabad
			</option>
						
            					
</select>

	</div>
    
    

             <div class="form-group">

               <textarea placeholder="Additional Comments" name="comment" id="comment" class="form-control" required></textarea>

               <span class="msgErr error" style="color: red;"></span>

              </div>

              <div class="form-group">

                <span class="sucess" style="color: green;"></span>

                <span class="clearfix"></span>

                

                 <button type="submit" class="btn" name="submit" id="submit" onClick="SaveData()">SUBMIT <i class="fa fa-paper-plane"></i></button>

                 <input type="hidden" name="txtAction1" id="txtAction1">

              </div>

              

            </form>

               

               <span class="bg"></span>

              </div>
            
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Fill out my <a href="https://appliations.wufoo.com/forms/sx3bi2x09r94cg">online form</a>.
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            </div>
            
            <div class="clearfix"></div>
        </div>
    </div>
</div>
<!--Special Course Part End-->


<div class="clearfix"></div>
    
</div>
<style>
#hidden_div {
    display: none;
}
#hidden_div1 {
    display: none;
}

</style>
<script language="javascript">

	function SaveData()

	{

	    form1.txtAction1.value = "save_data";

	    form1.submit();

	}
	
function showDiv(divId, element)
{
    document.getElementById("hidden_div").style.display = element.value == 'online' ? 'block' : 'none';
	document.getElementById("hidden_div").style.display = element.value == 'inclass' ? 'none' : 'block';
	document.getElementById("hidden_div1").style.display = element.value == 'online' ? 'none' : 'block';
	document.getElementById("hidden_div1").style.display = element.value == 'inclass' ? 'block' : 'none';
}

</script>


<!--========================================================
                    FOOTER START
=========================================================-->
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</footer>
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